Multimodal MR Imaging (Diffusion, Perfusion, and Spectroscopy): Is It Possible to Distinguish Oligodendroglial Tumor Grade and 1p/19q Codeletion in the Pretherapeutic Diagnosis?

S. Fellah; D. Caudal; A.M. De Paula; P. Dory-Lautrec; D. Figarella-Branger; O. Chinot; P. Metellus; P.J. Cozzone; S. Confort-Gouny; B. Ghattas; V. Callot; N. Girard

doi:10.3174/ajnr.A3352

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Fig 1.
Confounding examples of grade II and grade III oligodendrogliomas and oligoastrocytomas by cMRI.
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Fig 2.
Boxplots show significant differences in rCBV, rCBF, rK2, and ADC between grade II and grade III oligodendroglial tumors: (A) rCBV, (B) rCBF, and (C) rK2 are significantly higher in grade III compared with grade II tumors, whereas (D) ADC is significantly increased in grade II tumors.
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Fig 3.
Boxplots show that grade II tumors with 1p/19q codeletion have significantly higher rCBV and rCBF than tumors with intact 1p/19q. No significant difference could be observed between genotypes in grade III oligodendroglial tumors.

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Table 1:

Histopathologic and cMRI features of the tumors

	Grade II Oligoastrocytomas (n = 14)	Grade II Oligodendrogliomas (n = 10)	All Grade II (n = 24)	Grade III Oligoastrocytomas (n = 14)	Grade III Oligodendrogliomas (n = 12)	All Grade III (n = 26)	Total (n = 50)
Contrast enhancement
Absent	8	7	15 (62.5%)	2	1	3 (11.5%)	18 (36%)
Blurry	6	2	8 (33.3%)	6	5	11 (42.4%)	19 (38%)
Nodular	0	1	1 (4.2%)	4	1	5 (19.2%)	6 (12%)
Ringlike	0	0	0 (0%)	2	5	7 (26.9%)	7 (14%)
Location
Frontal	3	3	6 (25%)	6	6	12 (46.2%)	18 (36%)
Temporal	1	2	3 (12.5%)	3	3	6 (23.1%)	9 (18%)
Insular	2	4	6 (25%)	3	2	5 (19.2%)	11 (22%)
Temporoinsular	7	1	8 (33.3%)	1	1	2 (7.7%)	10 (20%)
Parietal	1	0	1 (4.2%)	0	0	0 (0%)	1 (2%)
Thalamic	0	0	0 (0%)	1	0	1 (3.8%)	1 (2%)
Tumor borders
Sharp	6	3	9 (37.5%)	5	4	9 (34.6%)	18 (36%)
Indistinct	8	7	15 (62.5%)	9	8	17 (65.4%)	32 (64%)
Edema
Yes	9	8	17 (70.9%)	9	7	16 (61.5%)	33 (66%)
No	5	2	7 (29.1%)	5	5	10 (38.5%)	17 (34%)
Necrosis
Yes	8	4	12 (50%)	6	9	15 (57.7%)	27 (54%)
No	6	6	12 (50%)	8	3	11 (42.3%)	23 (46%)
Hemorrhage
Yes	0	0	0 (0%)	1	4	5 (19.2%)	5 (10%)
No	14	10	24 (100%)	13	8	21 (80.8%)	45 (90%)
1p/19q loss
Yes	4	9	13 (54.2%)	0	6	6 (23.1%)	19 (38%)
No	10	1	11 (45.8%)	14	6	20 (76.9%)	31 (62%)

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Table 2:

DWI, PWI, and MRS measurements in grade II and grade III oligodendroglial tumors and genotypes according to grade

Parameter	Grade			Grade and Deletions
Parameter	II (n = 24)	III (n = 26)	P value	Grade II with 1p/19q Loss (n = 13)	Grade II with Intact 1p/19q (n = 11)	Grade III with 1p/19q Loss (n = 6)	Grade III with Intact 1p/19q (n = 20)
ADC (10^–3 mm²/s)	1238.50 ± 208.42	995.19 ± 266.97	.0008	1181.9 ± 201.32	1305.4 ± 205.38	1059.16 ± 127.21^{^b}	976 ± 296.38^{^a,^b}
rADC	1.66 ± 0.29	1.3 ± 0.29	< .0001	1.57 ± 0.22	1.77 ± 0.33	1.49 ± 0.15	1.24 ± 0.3^{^a,^b}
rCBV	1.57 ± 0.82	3.89 ± 1.97	< .0001	2.09 ± 0.73	0.95 ± 0.33^{^a}	4.43 ± 2.38^{^a,^b}	3.72 ± 1.86^{^a,^b}
rCBF	1.65 ± 0.97	4.12 ± 2.15	< .0001	2.21 ± 0.92	0.98 ± 0.48^{^a}	4.87 ± 3.36^{^a,^b}	3.89 ± 1.69^{^a,^b}
rK2	5.18 ± 7.26	13.64 ± 9.86	< .0001	6.5 ± 8.14	3.57 ± 6.05	12.65 ± 12.59^{^b}	13.93 ± 9.27^{^a,^b}
NAA/H₂O^{^c}	3.19 ± 1.52	2.39 ± 0.71	.023	3.20 ± 1.13	3.18 ± 1.96	2.53 ± 0.62	2.34 ± 0.75^{^a}
Cr/H₂O^{^c}	3.24 ± 1.37	2.84 ± 1.13	.472	3.03 ± 0.94	3.5 ± 1.77	2.8 ± 0.86	2.86 ± 1.22
Cho/H₂O^{^c}	3.87 ± 1.18	4.81 ± 2.65	.26	3.74 ± 0.82	4.03 ± 1.53	4.75 ± 1.28	4.83 ± 2.97
mIns/H₂O^{^c}	2.27 ± 2.16	1.77 ± 1.19	.669	2.09 ± 1.6	2.49 ± 2.76	1.5 ± 0.53	1.84 ± 1.33
Glx/H₂O^{^c}	8.54 ± 2.96	7.94 ± 2.82	.69	8.92 ± 2.74	2.08 ± 3.27	7.83 ± 1.63	7.97 ± 3.12
Lipids/H₂O^{^c}	14.25 ± 16.07	15.88 ± 28.40	.969	19.13 ± 20.76	8.48 ± 3.02	11.76 ± 5.89	17.11 ± 32.32
NAA/Cr^{^c}	1.02 ± 0.38	0.99 ± 0.61	.145	1.11 ± 0.40	0.91 ± 0.34	0.98 ± 0.35	0.99 ± 0.67^{^a}
Cho/Cr^{^c}	1.33 ± 0.55	1.80 ± 1.00	.034	1.42 ± 0.69	1.22 ± 0.33	2.14 ± 1.81	1.7 ± 0.64^{^b}
NAA/Cho^{^c}	0.86 ± 0.41	0.64 ± 0.40	.02	0.91 ± 0.48	0.8 ± 0.34	0.59 ± 0.27^{^a}	0.66 ± 0.43
mIns/Cr^{^c}	0.67 ± 0.41	0.58 ± 0.31	.846	0.72 ± 0.5	0.61 ± 0.28	0.56 ± 0.14	0.59 ± 0.35

Note:—mIns indicates myo-inositol; rADC, relative apparent diffusion coefficient; rCBV, relative cerebral blood volume; rCBF, relative cerebral blood flow; rK2, relative permeability index.
↵a Significantly different from grade II with 1p/19q loss (P < .05).
↵b Significantly different from grade II with intact 1p/19q (P < .05).
↵c Short TE.

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Table 3:

Sensitivity, specificity, PPV, NPV, and misclassification error rate in the differentiation of tumor grades and genotypes

Sensitivity/Specificity, PPV/NPV	cMRI^{^a}	Multimodal MRI^{^b,^c}
Grade^{^b}
II	73/65%, 67/72%	84/82%, 82/84%
III	65/73%, 72/67%	82/84%, 84/82%
Misclassification error rate	31%	17%
Genotype^{^c}
1p/19q Loss	23/70%, 33/59%	29/79%, 46/64%
1p/19q Intact	70/23%, 59/33%	79/29%, 64/46%
Misclassification error rate	48%	40%

Note:—CE indicates contrast enhancement; NPV, negative predictive value; PPV, positive predictive value.
The 6 most important predictors arising from the random forest analyses are:
↵a CE+Location+Necrosis+Hemorrhage+Edema+Tumor borders
↵b rCBF+rCBV+CE+ADC+Hemorrhage+ NAA/Cho at short TE
↵c Location+ADC+rCBF+Cho/H2O+ NAA/Cr+lipids/H₂O at short TE.