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Value of diffusion-weighted imaging combined with diffusion kurtosis imaging in the hierarchical diagnosis and prognosis assessment of glioma
WANG Shaokai  HAN Xiangjun  ZHU Jingyi  ZHAO Yu  LI Songbai 

Cite this article as: Wang SK, Han XJ, Zhu JY, et al. Value of diffusion-weighted imaging combined with diffusion kurtosis imaging in the hierarchical diagnosis and prognosis assessment of glioma[J]. Chin J Magn Reson Imaging, 2022, 13(9): 86-90, 99. DOI:10.12015/issn.1674-8034.2022.09.016.


[Abstract] Objective To investigate the value of diffusion-weighted imaging (DWI) combined with diffusion kurtosis imaging (DKI) in the hierarchical diagnosis and prognosis assessment of glioma.Materials and Methods A total of 82 cases with glioma who were admitted to our hospital from February 2017 to February 2019 were retrospectively analyzed, and all of them underwent DWI and DKI before surgery. The conventional MRI scan characteristics, DWI and DKI parameters, including apparent diffusion coefficient (ADC), mean kurtosis (MK), axial kurtosis (Ka), radial kurtosis (Kr), mean diffusivity (MD) and fractional anisotropy (FA) of patients with different grades of glioma were compared. The patients were followed up until October 2021. According to the prognosis, the patients were divided into the survival group and the death group, and the prognosis were analyzed by univariate analysis and multivariate logistic regression analysis. The receiver operating characteristic (ROC) curve of DWI and DKI parameters predicting prognosis were drawn.Results Among the 82 glioma patients, 38 were low-grade (5 cases of grade 1, 33 cases of grade 2), and 44 were high grade (21 cases of grade 3, 23 cases of grade 4). There was no significant difference in the number of lesions, signal, lesion area, edema and enhancement in different grades of gliomas (P＞0.05). With the increase of glioma grade, ADC and MD decreased, while MK, Ka, Kr increased (all P＜0.05); the glioma grade was significantly negatively correlated with ADC and MD, and significantly positively correlated with Ka and Kr (all P＜0.05). As of October 2021, 40 cases of the 82 glioma patients survived and 42 cases died. In the death group, the proportion of high-grade glioma, multiple lesions, obvious edema, and obvious enhancement, as well as MK, Ka, and Kr, were higher than those in the survival group, and ADC was lower than that in the survival group (P＜0.05). Multivariate logistic regression analysis showed that glioma grade, peritumoral edema, tumor enhancement, ADC, and MK were prognostic factors (P＜0.05). The area under the curve of MK for predicting the prognosis of glioma patients was 0.835 (95% CI: 0.690-0.961), and the sensitivity and specificity were 86.6% and 80.5% when 0.550 was used as the cut-off value; the area under the curve of ADC predicting the prognosis was 0.789 (95% CI: 0.633-0.945), the sensitivity and specificity were 82.9% and 76.8% when the cut-off value was 1.240; the area under the curve of MK combined with ADC for predicting prognosis was 0.903 (95% CI: 0.808-0.994), the sensitivity and specificity were 93.9% and 85.4%.Conclusions The DWI combined DKI can non-invasively evaluate the proliferation activity and water molecule diffusion information of glioma cells, and has a high evaluation value for the grading diagnosis and prognosis evaluation of glioma. The combination of MK and ADC can effectively predict the prognosis of glioma patients.
[Keywords] glioma；functional magnetic resonance imaging；diffusion-weighted imaging；diffusion kurtosis imaging；prognosis；predictive value

WANG Shaokai*   HAN Xiangjun   ZHU Jingyi   ZHAO Yu   LI Songbai  

Department of Radiology, the First Hospital of China Medical University, Shenyang 110001, China

*Wang SK, E-mail: wangshaokai678@163.com

Conflicts of interest   None.

ACKNOWLEDGMENTS National Natural Science Foundation of China Youth Science Fund (No. 81901846).
Received  2022-04-29
Accepted  2022-08-05
DOI: 10.12015/issn.1674-8034.2022.09.016
Cite this article as: Wang SK, Han XJ, Zhu JY, et al. Value of diffusion-weighted imaging combined with diffusion kurtosis imaging in the hierarchical diagnosis and prognosis assessment of glioma[J]. Chin J Magn Reson Imaging, 2022, 13(9): 86-90, 99. DOI:10.12015/issn.1674-8034.2022.09.016.

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