title: Imaging characteristics of oligodendrogliomas that predict grade.
abstract: OBJECTIVE
  Oligodendrogliomas are tumors that have variable WHO grades depending on anaplasia and astrocytic components and their treatment may differ accordingly. Our aim was to retrospectively evaluate imaging features of oligodendrogliomas that predict tumor grade.
  
  
  METHODS
  The imaging studies of 75 patients with oligodendrogliomas were retrospectively reviewed and compared with the histologic grade. The presence and degree of enhancement and calcification were evaluated subjectively. rCBV and ADC maps were measured. Logistic linear regression models were used to determine the relationship between imaging factors and tumor grade.
  
  
  RESULTS
  Thirty of 75 (40%) tumors enhanced, including 9 of 46 (19.6%) grade II and 21 of 29 (72.4%) grade III tumors (P < .001). Grade III tumors showed lower ADC values compared with grade II tumors (odds ratio of a tumor being grade III rather than grade II = 0.07; 95% CI, 0.02-0.25; P = .001). An optimal ADC cutoff of 925 10(-6) mm(2)/s was established, which yielded a specificity of 89.1%, sensitivity of 62.1%, and accuracy of 78.7%. There was no statistically significant association between tumor grade and the presence of calcification and perfusion values. Multivariable prediction rules were applied for ADC < 925 10(-6) mm(2)/s, the presence of enhancement, and the presence of calcification. If either ADC < 925 10(-6) mm(2)/s or enhancement was present, it yielded 93.1% sensitivity, 73.9% specificity, and 81.3% accuracy. The most accurate (82.2%) predictive rule was seen when either ADC < 925 10(-6) mm(2)/s or enhancement and calcification were present.
  
  
  CONCLUSIONS
  Models based on contrast enhancement, calcification, and ADC values can assist in predicting the grade of oligodendrogliomas and help direct biopsy sites, raise suspicion of sampling error, and predict prognosis.
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Services, The Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
authors.forename: L
authors.initials: L
authors.lastname: Khalid
authors.forename: M
authors.initials: M
authors.lastname: Carone
authors.forename: N
authors.initials: N
authors.lastname: Dumrongpisutikul
authors.forename: J
authors.initials: J
authors.lastname: Intrapiromkul
authors.forename: D
authors.initials: D
authors.lastname: Bonekamp
authors.forename: P B
authors.initials: PB
authors.lastname: Barker
authors.forename: D M
authors.initials: DM
authors.lastname: Yousem
mesh_terms: D000368:Aged; D001932:Brain Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009837:Oligodendroglioma / Q000473:pathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity