Simplified perfusion fraction from diffusion-weighted imaging in preoperative prediction of IDH1 mutation in WHO grade II-III gliomas: comparison with dynamic contrast-enhanced and intravoxel incoherent motion MRI

Abstract

Background Effect of isocitr ate dehydrogenase 1 (IDH1) mutation in neovascularization might be linked with tissue perfusion in gliomas. At present, the need of injection of contrast agent and the increasing scanning time limit the application of perfusion techniques. We used a simplified intravoxel incoherent motion (IVIM)-derived perfusion fraction (SPF) calculated from diffusion-weighted imaging (DWI) using only three b-values to quantitatively assess IDH1-linked tissue perfusion changes in WHO grade II-III gliomas (LGGs). Additionally, by comparing accuracy with dynamic contrast-enhanced (DCE) and full IVIM MRI, we tried to find the optimal imaging markers to predict IDH1 mutation status. Patients and methods Thirty patients were prospectively examined using DCE and multi-b-value DWI. All parameters were compared between the IDH1 mutant and wild-type LGGs using the Mann-Whitney U test, including the DCE MRI-derived Ktrans, ve and vp, the conventional apparen t diffusion coefficient (ADC0,1000), IVIM-de rived perfusion fraction (f), diffusion coefficient (D) and pseudo-diffusion coefficient (D*), SPF. We evaluated the diagnostic performance by receive r operating characteristic (ROC) analysis. Results Significant differences were detected between WHO grade II-III gliomas for all perfusion and diffusion parameters (P < 0.05). When compared to IDH1 mutant LGGs, IDH1 wild-type LGGs exhibited significantly higher perfusion metrics (P < 0.05) and lower diffusion metrics (P < 0.05). Among all parameters, SPF showed a higher diagnostic performance (area under the curve 0.861), with 94.4% sensitivity and 75% specificity. Conclusions DWI, DCE and IVIM MRI may noninvasively help discriminate IDH1 mutation statuses in LGGs. Specifically, simplified DWI-derived SPF showed a superior diagnostic performance.

Keywords: 2016 WHO CNS tumor classification; IDH1 mutation; diffusion-weighted MRI; dynamic contrast-enhanced MRI; glioma perfusion; intravoxel incoherent motion.

Figure 1

Flowchart of study design.

Figure 2

Images obtained in a 44-year-old man with astrocytoma (isocitrate dehydrogenase 1 [IDH1] mutant glioma). (A) Fluid-attenuated inversion recovery (FLAIR) image shows a heterogeneous hyperintense lesion in the right frontal lobe. (B) Apparent diffusion coefficient (ADC)_0,1000 map shows increased ADC value in the lesion. (C, D) Intravoxel incoherent motion (IVIM) perfusion fraction (f) and simplified perfusion fraction (SPF) maps show no increased values in the corresponding area of the hyperintense lesion as shown in (A). (E) On contrast-enhanced T1-weighted image, the lesion is non-enhancing. (F–H) Dynamic contrast-enhanced (DCE) MRI parametric maps of volume transfer constant (K^trans), extravascular extracellular volume fraction (v_e) and vascular plasma volume fraction (v_p) show no increased values in the lesion. Regions of interest are marked on parametric maps.

Figure 3

Images obtained in a 72-year-old woman with astrocytoma (isocitrate dehydrogenase 1 [IDH1] wildtype glioma). (A) FLAIR shows a heterogeneous hyperintense lesion in the right hemisphere. (B) Apparent diffusion coefficient (ADC)_0,1000 map shows a mixed pattern of high and intermediate ADC values in the lesion. (C, D) Intravoxel incoherent motion (IVIM) perfusion fraction (f) and simplified perfusion fraction (SPF) maps show markedly increased f and SPF values in the corresponding area of the contrast-enhanced lesion as shown in (E). (E) On contrast-enhanced T1-weighted image, the lesion is vividly enhanced. (F–H) Dynamic contrast-enhanced (DCE) MRI parametric maps of volume transfer constant (K^trans), extravascular extracellular volume fraction (v_e) and vascular plasma volume fraction (v_p) show obviously increased values in the corresponding area of the contrast-enhanced lesion. Regions of interest are marked on parametric maps.

Figure 4

Receiver operating characteristic (ROC) curves and corresponding area under the curve values for (A) diffusion-weighted imaging (DWI) parameters (simplified perfusion fraction [SPF], perfusion fraction [f], apparent diffusion coefficient [ADC]_0,1000) and (B) dynamic contrast-enhanced (DCE) MRI parameters (transfer constant [K^trans], extravascular extracellular volume fraction [v_e] and vascular plasma volume fraction [v_p]) in the differentiation of isocitrate dehydrogenase 1 (IDH1) mutant and wildtype gliomas. SPF showed the highest diagnostic performance with the area under the curve value of 0.86.