title: Automatic Analysis of Cellularity in Glioblastoma and Correlation with ADC Using Trajectory Analysis and Automatic Nuclei Counting.
abstract: OBJECTIVE
  Several studies have analyzed a correlation between the apparent diffusion coefficient (ADC) derived from diffusion-weighted MRI and the tumor cellularity of corresponding histopathological specimens in brain tumors with inconclusive findings. Here, we compared a large dataset of ADC and cellularity values of stereotactic biopsies of glioblastoma patients using a new postprocessing approach including trajectory analysis and automatic nuclei counting.
  
  
  METHODS
  Thirty-seven patients with newly diagnosed glioblastomas were enrolled in this study. ADC maps were acquired preoperatively at 3T and coregistered to the intraoperative MRI that contained the coordinates of the biopsy trajectory. 561 biopsy specimens were obtained; corresponding cellularity was calculated by semi-automatic nuclei counting and correlated to the respective preoperative ADC values along the stereotactic biopsy trajectory which included areas of T1-contrast-enhancement and necrosis.
  
  
  RESULTS
  There was a weak to moderate inverse correlation between ADC and cellularity in glioblastomas that varied depending on the approach towards statistical analysis: for mean values per patient, Spearman's ρ = -0.48 (p = 0.002), for all trajectory values in one joint analysis Spearman's ρ = -0.32 (p < 0.001). The inverse correlation was additionally verified by a linear mixed model.
  
  
  CONCLUSIONS
  Our data confirms a previously reported inverse correlation between ADC and tumor cellularity. However, the correlation in the current article is weaker than the pooled correlation of comparable previous studies. Hence, besides cell density, other factors, such as necrosis and edema might influence ADC values in glioblastomas.
authors.affiliation: Department of Neuroradiology, University of Heidelberg Medical Center, Heidelberg, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Eidel
authors.affiliation: Department of Neurosurgery, Division Stereotactic Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany.
authors.forename: Jan-Oliver
authors.initials: JO
authors.lastname: Neumann
authors.affiliation: Department of Neuroradiology, University of Heidelberg Medical Center, Heidelberg, Germany.
authors.forename: Sina
authors.initials: S
authors.lastname: Burth
authors.affiliation: Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany.
authors.forename: Pascal J
authors.initials: PJ
authors.lastname: Kieslich
authors.affiliation: Department of Neurosurgery, Division Stereotactic Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Jungk
authors.affiliation: Department of Neuropathology, University of Heidelberg Medical Center, Heidelberg, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Sahm
authors.affiliation: Department of Neuroradiology, University of Heidelberg Medical Center, Heidelberg, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Kickingereder
authors.affiliation: Department of Neurosurgery, Division Stereotactic Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany.
authors.forename: Karl
authors.initials: K
authors.lastname: Kiening
authors.affiliation: Department of Neurosurgery, Division Stereotactic Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Unterberg
authors.affiliation: Neurology Clinic, University of Heidelberg Medical Center, Heidelberg, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Wick
authors.affiliation: Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: Heinz-Peter
authors.initials: HP
authors.lastname: Schlemmer
authors.affiliation: Department of Neuroradiology, University of Heidelberg Medical Center, Heidelberg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Bendszus
authors.affiliation: Department of Neuroradiology, University of Heidelberg Medical Center, Heidelberg, Germany.|Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.|German Cancer Consortium (DKTK), Heidelberg, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Radbruch
mesh_terms: D001331:Automation; D001706:Biopsy; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D002467:Cell Nucleus / Q000473:pathology*; D005909:Glioblastoma / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D012189:Retrospective Studies