title: Intravoxel incoherent motion diffusion-weighted imaging analysis of diffusion and microperfusion in grading gliomas and comparison with arterial spin labeling for evaluation of tumor perfusion.
abstract: To determine the utility of intravoxel incoherent motion (IVIM) imaging in grading gliomas and compare IVIM perfusion metrics with arterial spin labeling (ASL)-derived cerebral blood flow (CBF).
  
  
  
  Fifty-two patients with pathologically confirmed gliomas underwent IVIM and ASL imaging at 3.0T. IVIM perfusion-related diffusivity (D*), perfusion fraction (f), product of f and D*(f×D*), true diffusivity (D), and apparent diffusion coefficient (ADC) were obtained to distinguish glioma grades. The CBF derived from pseudocontinuous ASL within the solid tumor was compared and correlated with IVIM perfusion metrics for grading of gliomas. Values were also normalized to the contralateral normal-appearing white matter. Receiver-operating characteristic was performed to determine diagnostic efficiency. The reliability was estimated with intraclass coefficient, coefficient of variance, and Bland-Altman plots.
  
  
  
  IVIM perfusion metrics and CBF were significantly higher in the high-grade than the low-grade gliomas (P < 0.001), ADC and D were significantly lower in the high-grade than the low-grade gliomas (P < 0.001). f×D* differed significantly between grades II through IV (P < 0.05 for all). The other metrics showed significant difference between grade II and grade III (P < 0.05 for all). Area under the curve (AUC) was largest for f×D* in distinguishing high-grade from low-grade gliomas (AUC = 0.979, P < 0.001) and between grade II and grade III (AUC = 0.957, P < 0.001). f×D* improved diagnostic performance of CBF in grading gliomas and showed strong correlation with CBF (r = 0.696, P < 0.001).
  
  
  
  IVIM-derived metrics are promising biomarkers in preoperative grading gliomas. IVIM imaging may be an additive method to ASL and ADC for evaluating tumor perfusion and diffusion. J. Magn. Reson. Imaging 2016;44:620-632.
authors.affiliation: Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Nanxi
authors.initials: N
authors.lastname: Shen
authors.affiliation: Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Lingyun
authors.initials: L
authors.lastname: Zhao
authors.affiliation: Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Jingjing
authors.initials: J
authors.lastname: Jiang
authors.affiliation: Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Rifeng
authors.initials: R
authors.lastname: Jiang
authors.affiliation: Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Changliang
authors.initials: C
authors.lastname: Su
authors.affiliation: Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Shun
authors.initials: S
authors.lastname: Zhang
authors.affiliation: Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Xiangyu
authors.initials: X
authors.lastname: Tang
authors.affiliation: Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Wenzhen
authors.initials: W
authors.lastname: Zhu
mesh_terms: D000465:Algorithms; D001783:Blood Flow Velocity; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology*; D002560:Cerebrovascular Circulation; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D005910:Glioma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology*; D006801:Humans; D007089:Image Enhancement; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D008875:Middle Aged; D009038:Motion; D060787:Neoplasm Grading; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013113:Spin Labels
chemical_list: D013113:Spin Labels
keywords: arterial spin labeling (ASL); diffusion; gliomas; intravoxel incoherent motion (IVIM); perfusion