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Research ArticleAdult Brain

Combining Diffusion Tensor Metrics and DSC Perfusion Imaging: Can It Improve the Diagnostic Accuracy in Differentiating Tumefactive Demyelination from High-Grade Glioma?

S.B. Hiremath, A. Muraleedharan, S. Kumar, C. Nagesh, C. Kesavadas, M. Abraham, T.R. Kapilamoorthy and B. Thomas
American Journal of Neuroradiology April 2017, 38 (4) 685-690; DOI: https://doi.org/10.3174/ajnr.A5089
S.B. Hiremath
aFrom the Departments of Imaging Sciences and Interventional Radiology (S.B.H., A.M., S.K., C.N., C.K., T.R.K., B.T.)
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  • ORCID record for S.B. Hiremath
A. Muraleedharan
aFrom the Departments of Imaging Sciences and Interventional Radiology (S.B.H., A.M., S.K., C.N., C.K., T.R.K., B.T.)
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S. Kumar
aFrom the Departments of Imaging Sciences and Interventional Radiology (S.B.H., A.M., S.K., C.N., C.K., T.R.K., B.T.)
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C. Nagesh
aFrom the Departments of Imaging Sciences and Interventional Radiology (S.B.H., A.M., S.K., C.N., C.K., T.R.K., B.T.)
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C. Kesavadas
aFrom the Departments of Imaging Sciences and Interventional Radiology (S.B.H., A.M., S.K., C.N., C.K., T.R.K., B.T.)
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M. Abraham
bNeurosurgery (M.A.), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
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T.R. Kapilamoorthy
aFrom the Departments of Imaging Sciences and Interventional Radiology (S.B.H., A.M., S.K., C.N., C.K., T.R.K., B.T.)
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B. Thomas
aFrom the Departments of Imaging Sciences and Interventional Radiology (S.B.H., A.M., S.K., C.N., C.K., T.R.K., B.T.)
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    Fig 1.

    The boxplots for DTI metrics with statistical significance: p (A), q (B), L (C), and ADC (D) values of the enhancing areas and normal-appearing white matter in TDL and HGG, respectively.

  • Fig 2.
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    Fig 2.

    ROC curve for the diffusion tensor metrics: rCBV, combined ROC of DTI metrics and DSC perfusion, and combined ROC of enhancement pattern with DTI metrics and DSC perfusion.

Tables

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    Table 1:

    Analysis of conventional imaging sequences

    Conventional AnalysisHigh-Grade GliomaNot High-Grade Glioma
    Diagnosed positive176
    Diagnosed negative48
    • View popup
    Table 2:

    Summary of results, mean ± SD

    Enhancing AreasPerilesional HyperintensityNAWMPaPb95% CI
    ADCc
        TDLs0.83 ± 0.151.56 ± 0.110.76 ± 0.06.02d.810.74–0.92
        High-grade gliomas1.01 ± 0.251.54 ± 0.20.79 ± 0.060.90–1.13
    pc
        TDLs1.44 ± 0.262.7 ± 0.191.31 ± 0.10.02d.811.29–1.59
        High-grade gliomas1.76 ± 0.442.67 ± 0.341.37 ± 0.111.56–1.96
    qc
        TDLs0.25 ± 0.070.36 ± 0.050.55 ± 0.06.004d.550.21–0.30
        High-grade gliomas0.33 ± 0.070.38 ± 0.070.54 ± 0.070.30–0.37
    Lc
        TDLs1.46 ± 0.262.7 ± 0.181.43 ± 0.11.016d.831.31–1.62
        High-grade gliomas1.79 ± 0.432.7 ± 0.341.46 ± 0.091.60–1.99
    FA
        TDLs0.21 ± 0.060.44 ± 0.330.47 ± 0.07.341.0520.17–0.25
        High-grade gliomas0.23 ± 0.060.51 ± 0.090.45 ± 0.060.20–0.27
    rCBV
        TDLs2.11 ± 1.12–.003d1.47–2.76
        High-grade gliomas3.77 ± 1.65–3.02–4.52
    • ↵a Difference in the mean values of enhancing areas of TDLs and high-grade gliomas.

    • ↵b Difference in the mean values of perilesional hyperintensity of TDLs and high-grade gliomas.

    • ↵c Values of ADC, p, q, and L are in units of 10−3 mm2/s.

    • ↵d Significant.

    • View popup
    Table 3:

    ROC curve results on sensitivity and specificity to differentiate high-grade gliomas and TDLs

    ParameterSensitivity (%)Specificity (%)AUC
    ADC valuea52.492.90.738
    p valuea61.985.70.738
    q valuea71.492.90.823
    L valuea76.278.60.765
    rCBV52.492.90.796
    DTI + DSC perfusion (combined)71.492.90.901
    Heterogeneous enhancement pattern + combined85.792.90.966
    • ↵a Values of ADC, p, q, and L are in the units of 10−3 mm2/s.

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American Journal of Neuroradiology: 38 (4)
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S.B. Hiremath, A. Muraleedharan, S. Kumar, C. Nagesh, C. Kesavadas, M. Abraham, T.R. Kapilamoorthy, B. Thomas
Combining Diffusion Tensor Metrics and DSC Perfusion Imaging: Can It Improve the Diagnostic Accuracy in Differentiating Tumefactive Demyelination from High-Grade Glioma?
American Journal of Neuroradiology Apr 2017, 38 (4) 685-690; DOI: 10.3174/ajnr.A5089

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Combining Diffusion Tensor Metrics and DSC Perfusion Imaging: Can It Improve the Diagnostic Accuracy in Differentiating Tumefactive Demyelination from High-Grade Glioma?
S.B. Hiremath, A. Muraleedharan, S. Kumar, C. Nagesh, C. Kesavadas, M. Abraham, T.R. Kapilamoorthy, B. Thomas
American Journal of Neuroradiology Apr 2017, 38 (4) 685-690; DOI: 10.3174/ajnr.A5089
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