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. 2018 Apr;137(2):313-319.
doi: 10.1007/s11060-017-2719-y. Epub 2018 Jan 30.

Normalization of ADC does not improve correlation with overall survival in patients with high-grade glioma (HGG)

Lei Qin  1   2 , Angie Li  3   4 , Jinrong Qu  3   5 , Katherine Reinshagen  2   3   6 , Xiang Li  3   5 , Su-Chun Cheng  7 , Annie Bryant  1   8 , Geoffrey S Young  9   10   11
Affiliations

Normalization of ADC does not improve correlation with overall survival in patients with high-grade glioma (HGG)

Lei Qin et al. J Neurooncol. 2018 Apr.

Abstract

Mixed reports leave uncertainty about whether normalization of apparent diffusion coefficient (ADC) to a within-subject white matter reference is necessary for assessment of tumor cellularity. We tested whether normalization improves the previously reported correlation of resection margin ADC with 15-month overall survival (OS) in HGG patients. Spin-echo echo-planar DWI was retrieved from 3 T MRI acquired between maximal resection and radiation in 37 adults with new-onset HGG (25 glioblastoma; 12 anaplastic astrocytoma). ADC maps were produced with the FSL DTIFIT tool (Oxford Centre for Functional MRI). 3 neuroradiologists manually selected regions of interest (ROI) in normal appearing white matter (NAWM) and in non-enhancing tumor (NT) < 2 cm from the margin of residual enhancing tumor or resection cavity. Normalized ADC (nADC) was computed as the ratio of absolute NT ADC to NAWM ADC. Reproducibility of nADC and absolute ADC among the readers' ROI was assessed using intra-class correlation coefficient (ICC) and within-subject coefficient of variation (wCV). Correlations of ADC and nADC with OS were compared using receiver operating characteristics (ROC) analysis. A p value 0.05 was considered statistically significant. Both mean ADC and nADC differed significantly between patients subgrouped by 15-month OS (p = 0.0014 and 0.0073 respectively). wCV and ICC among the readers were similar for absolute and normalized ADC. In ROC analysis of correlation with OS, nADC did not perform significantly better than absolute ADC. Normalization does not significantly improve the correlation of absolute ADC with OS in HGG, suggesting that normalization is not necessary for clinical or research ADC analysis in HGG patients.

Keywords: ADC normalization; Apparent diffusion coefficient (ADC); Diffusion weighted imaging (DWI); High-grade glioma (HGG).

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Conflict of interest statement

Compliance with ethical standards

Conflict of interest The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Representative ADC map (a) and post contrast T1 weighted (b) MRI. NAWM ROI is selected in the anterior right frontal lobe (hollow arrow) and NT ROI in the WM around the left fronto-parietal junction enhancing tumor (solid arrow)
Fig. 2
Fig. 2
a The ADCmean measured in tumor and NAWM by the three independent readers. b nADCmean of the same readers
Fig. 3
Fig. 3
Box and whisker plots of the ADCmean and nADCmean of patients subdivided by 15-month OS. t-test shows that both ADCmean and nADCmean differed significantly between the two survival groups. Left is absolute ADCmean; t-test between the two groups shows a p = 0.0014. Right is nADCmean; t-test has a p = 0.0073. On each box, the central mark is the median, the edges of the box are the 25th and 75th percentiles, the whiskers extend to cover ± 2.7σ of data, and the crosses “+” denote the outliers
See this image and copyright information in PMC

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