title: Diagnostic performance of regional DTI-derived tensor metrics in glioblastoma multiforme: simultaneous evaluation of p, q, L, Cl, Cp, Cs, RA, RD, AD, mean diffusivity and fractional anisotropy.
abstract: OBJECTIVE
  Almost a dozen diffusion tensor-imaging (DTI) variables have been used to evaluate brain tumours with scarce information about their diagnostic ability. We aimed to perform a comprehensive evaluation of tensor metrics reported in the last decade.
  
  
  METHODS
  Retrospective case control study performed in 14 patients with glioblastoma multiforme (GBM) and 28 controls. Conventional brain MR sequences and image postprocessing of DTI allowed the calculation of: MD, FA, p, q, L, Cl, Cp, Cs, RA, RD and AD, classified into five regions: normal appearance white matter (NAWM), immediate and distant oedema, enhancing rim and cystic cavity. ANOVA and AUROC analyses were performed.
  
  
  RESULTS
  ANOVA depicted a significant difference among all metrics (p < 0.05). RA had the highest performance in the NAWM and cystic cavity; immediate and distant zones of oedema were best diagnosed by RD and Cp respectively; q was the best biomarker of the enhancing rim zone; p < 0.001 for all metrics.
  
  
  CONCLUSIONS
  FA and MD, accepted biomarkers of brain injury, were surpassed by other metrics. RA, together with Cs, Cl and CP, might be the new leaders in the evaluation of brain tumours. DTI tensor metrics depict different clinical applicability at each tumour region.
authors.affiliation: Section of Research and Innovation in MRI, Magnetic Resonance Unit, Medica Sur Clinic & Foundation, Puente de Piedra # 150. Col. Toriello Guerra. Deleg. Tlalpan., 14050, Mexico City, Mexico.
authors.forename: David
authors.initials: D
authors.lastname: Cortez-Conradis
authors.forename: Rafael
authors.initials: R
authors.lastname: Favila
authors.forename: Keila
authors.initials: K
authors.lastname: Isaac-Olive
authors.forename: Manuel
authors.initials: M
authors.lastname: Martinez-Lopez
authors.forename: Camilo
authors.initials: C
authors.lastname: Rios
authors.forename: Ernesto
authors.initials: E
authors.lastname: Roldan-Valadez
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D016880:Anisotropy; D001932:Brain Neoplasms / Q000473:pathology*; D056324:Diffusion Tensor Imaging / Q000379:methods*; D005260:Female; D005909:Glioblastoma / Q000473:pathology*; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055815:Young Adult