Histologic And Genetic Features Assessment Of Adult-type Diffse Gliomas With Quantitative Multi-model DWl Technologies

Part Ⅰ.The Value of Quantitative Multi-model DWI Technologies in Assessing the Histological Grade 2 and 3 Adult-type Diffuse GliomasPurpose: To evaluate the diagnostic performance of mean apparent propagation diffusion magnetic resonance imaging(MAP-MRI)in predicting grade 2 and 3 adult diffuse gliomas and compared it with diffusion tensor imaging(DTI)and diffusion kurtosis imaging(DKI).Materials and methods: In this prospective study,42 patients with pathologically diagnosed grade 2 or 3 adult diffuse gliomas between June 2018 and September 2021 were recruited and underwent conventional MRI and diffusion imaging scans prior to treatment.The mean and extreme diffusion parameters were measured for the solid portion of the tumor,with parameters including: mean square displacement(MSD),non-gaussianity(NG),q-space inverse variance(QIV),return to the origin probability(RTOP),mean diffusivity(MD),fractional anisotropy(FA),and mean kurtosis(MK).After Bonferroni correction,a comprehensive assessment of statistically significant diffusion parameters was performed,including the receiver operating characteristic(ROC)curve,the correct classification percentage(CCP),integrated discrimination improvement(IDI),net reclassification improvement(NRI),and k-fold cross-validation.Results: In grade 2 and 3 adult-type diffuse gliomas,the mean and minimum QIV were lower in the grade 3 group than in the grade 2 group(P’<0.01),while the mean and maximum MK,NG and RTOP were higher than in the grade 2 group(P’<0.05).No significant differences were observed in the MD,MSD and FA(P’>0.05).The area under curve(AUC)and CCP values for each diffusion parameter ranged from 0.812 to 0.973/0.719 to 0.906,respectively,with the mean QIV having both the highest AUC and CCP(0.973 and 0.906,respectively)and still showing a high diagnostic efficacy(AUC=0.944)after 5-fold cross-validation.In addition,mean and maximum NG were superior to mean and maximum MK(IDI=0.408,0.266;NRI >0),but stability is relatively low(AUC=0.267-0.444).Conclusion: MAP-MRI effectively predicts grade 2 and 3 adult-type diffuse gliomas and may be superior to DTI and DKI.Part Ⅱ.The Value of Quantitative Multi-model DWI Technologies in Assessing the Main Genetic Features of Adult-type Diffuse GliomasPurpose: To evaluate the diagnostic performance of mean apparent propagation diffusion magnetic resonance imaging(MAP-MRI)in predicting isocitrate dehydrogenase(IDH)1/2 mutations and synchronous deletion of the short arm of chromosome 1 and long arm of chromosome 19(1p/19 q combined deletion)in adult-type diffuse gliomas and compared it with diffusion tensor imaging(DTI)and diffusion kurtosis imaging(DKI).Materials and methods: In this prospective study,67 patients pathologically diagnosed with adult-type diffuse gliomas between June 2018 and September 2021 were recruited and underwent conventional MRI and diffusion imaging scans prior to treatment.The mean and extreme diffusion parameters were measured for the solid portion of the tumor,with parameters including: mean square displacement(MSD),non-gaussianity(NG),q-space inverse variance(QIV),return to the origin probability(RTOP),mean diffusivity(MD),fractional anisotropy(FA),and mean kurtosis(MK).After Bonferroni correction,a comprehensive assessment of statistically significant diffusion parameters was performed,including the receiver operating characteristic(ROC)curve,the correct classification percentage(CCP),integrated discrimination improvement(IDI),net reclassification improvement(NRI),and k-fold cross-validation.Results: The study included 67 patients(mean age,50 ± 12 years [standard deviation];35 men).We found that the mean diffusivity(MD),mean square displacement(MSD),q-space inverse variance(QIV),mean kurtosis(MK),and return to the origin probability(RTOP)of the IDH wild-type and IDH mutant groups were significantly different(P’<0.001)(AUC,0.806-0.978;CCP,0.563-0.909),with MAP-MRI showing higher IDI than DTI and DKI(0.094-0.435,respectively,with NRI>0).For identification 1p/19 q combined deletion,only minimum QIV was statistically different between groups(P’<0.05),and no significant difference were observed in the MD and MK(P’>0.05).Conclusion: MAP-MRI is useful to predict IDH 1/2 mutations and 1p/19 q combined deletions in adult-type diffuse gliomas,and its results may be superior to those of DTI and DKT.