title: Diagnostic performance of texture analysis on MRI in grading cerebral gliomas.
abstract: OBJECTIVE
  Grading of cerebral gliomas is important both in treatment decision and assessment of prognosis. The purpose of this study was to determine the diagnostic accuracy of grading cerebral gliomas by assessing the tumor heterogeneity using MRI texture analysis (MRTA).
  
  
  METHODS
  95 patients with gliomas were included, 27 low grade gliomas (LGG) all grade II and 68 high grade gliomas (HGG) (grade III=34 and grade IV=34). Preoperative MRI examinations were performed using a 3T scanner and MRTA was done on preoperative contrast-enhanced three-dimensional isotropic spoiled gradient echo images in a representative ROI. The MRTA was assessed using a commercially available research software program (TexRAD) that applies a filtration-histogram technique for characterizing tumor heterogeneity. Filtration step selectively filters and extracts texture features at different anatomical scales varying from 2mm (fine features) to 6mm (coarse features), the statistical parameter standard deviation (SD) was obtained. Receiver operating characteristics (ROC) was performed to assess sensitivity and specificity for differentiating between the different grades and calculating a threshold value to quantify the heterogeneity.
  
  
  RESULTS
  LGG and HGG was best discriminated using SD at fine texture scale, with a sensitivity and specificity of 93% and 81% (AUC 0.910, p<0.0001). The diagnostic ability for MRTA to differentiate between the different sub-groups (grade II-IV) was slightly lower but still significant.
  
  
  CONCLUSIONS
  Measuring heterogeneity in gliomas to discriminate HGG from LGG and between different histological sub-types on already obtained images using MRTA can be a useful tool to augment the diagnostic accuracy in grading cerebral gliomas and potentially hasten treatment decision.
authors.affiliation: Oslo University Hospitals, Ullevål Sykehus, Department of Radiology and Nuclear Medicine, Oslo, Norway. Electronic address: kaskog@ous-hf.no.
authors.forename: Karoline
authors.initials: K
authors.lastname: Skogen
authors.affiliation: Oslo University Hospitals, Ullevål Sykehus, Department of Radiology and Nuclear Medicine, Oslo, Norway.
authors.forename: Anselm
authors.initials: A
authors.lastname: Schulz
authors.affiliation: Oslo University Hospitals, Ullevål Sykehus, Department of Radiology and Nuclear Medicine, Oslo, Norway.
authors.forename: Johann Baptist
authors.initials: JB
authors.lastname: Dormagen
authors.affiliation: University College London, Department of Nuclear Medicine, United Kingdom.
authors.forename: Balaji
authors.initials: B
authors.lastname: Ganeshan
authors.affiliation: Oslo University Hospitals, Ullevål Sykehus, Department of Neurosurgery, Oslo, Norway; University of Oslo, Department of Medicine, Oslo, Norway.
authors.forename: Eirik
authors.initials: E
authors.lastname: Helseth
authors.affiliation: Oslo University Hospitals, Rikshospitalet, Department of Radiology and Nuclear Medicine, Oslo, Norway.
authors.forename: Andrès
authors.initials: A
authors.lastname: Server
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001254:Astrocytoma / Q000175:diagnosis / Q000473:pathology; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000473:pathology; D003287:Contrast Media; D003657:Decision Making; D005909:Glioblastoma / Q000175:diagnosis / Q000473:pathology; D005910:Glioma / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007091:Image Processing, Computer-Assisted / Q000379:methods* / Q000706:statistics & numerical data; D021621:Imaging, Three-Dimensional / Q000379:methods / Q000706:statistics & numerical data; D008279:Magnetic Resonance Imaging / Q000379:methods* / Q000706:statistics & numerical data; D008875:Middle Aged; D060787:Neoplasm Grading; D009837:Oligodendroglioma / Q000175:diagnosis / Q000473:pathology; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D003287:Contrast Media
keywords: Glioma; Heterogeneity; MRI; Texture analysis