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Research ArticleAdult Brain
Open Access

Mean Diffusional Kurtosis in Patients with Glioma: Initial Results with a Fast Imaging Method in a Clinical Setting

A. Tietze, M.B. Hansen, L. Østergaard, S.N. Jespersen, R. Sangill, T.E. Lund, M. Geneser, M. Hjelm and B. Hansen
American Journal of Neuroradiology August 2015, 36 (8) 1472-1478; DOI: https://doi.org/10.3174/ajnr.A4311
A. Tietze
aFrom the Department of Neuroradiology (A.T., L.Ø., M.G., M.H.), Aarhus University Hospital, Aarhus, Denmark
bCenter of Functionally Integrative Neuroscience and MINDLab, Institute of Clinical Medicine (A.T., M.B.H., L.Ø., S.N.J., R.S., T.E.L., M.G., B.H.)
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M.B. Hansen
bCenter of Functionally Integrative Neuroscience and MINDLab, Institute of Clinical Medicine (A.T., M.B.H., L.Ø., S.N.J., R.S., T.E.L., M.G., B.H.)
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L. Østergaard
aFrom the Department of Neuroradiology (A.T., L.Ø., M.G., M.H.), Aarhus University Hospital, Aarhus, Denmark
bCenter of Functionally Integrative Neuroscience and MINDLab, Institute of Clinical Medicine (A.T., M.B.H., L.Ø., S.N.J., R.S., T.E.L., M.G., B.H.)
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S.N. Jespersen
bCenter of Functionally Integrative Neuroscience and MINDLab, Institute of Clinical Medicine (A.T., M.B.H., L.Ø., S.N.J., R.S., T.E.L., M.G., B.H.)
cDepartment of Physics and Astronomy (S.N.J.), Aarhus University, Aarhus, Denmark.
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R. Sangill
bCenter of Functionally Integrative Neuroscience and MINDLab, Institute of Clinical Medicine (A.T., M.B.H., L.Ø., S.N.J., R.S., T.E.L., M.G., B.H.)
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T.E. Lund
bCenter of Functionally Integrative Neuroscience and MINDLab, Institute of Clinical Medicine (A.T., M.B.H., L.Ø., S.N.J., R.S., T.E.L., M.G., B.H.)
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M. Geneser
aFrom the Department of Neuroradiology (A.T., L.Ø., M.G., M.H.), Aarhus University Hospital, Aarhus, Denmark
bCenter of Functionally Integrative Neuroscience and MINDLab, Institute of Clinical Medicine (A.T., M.B.H., L.Ø., S.N.J., R.S., T.E.L., M.G., B.H.)
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M. Hjelm
aFrom the Department of Neuroradiology (A.T., L.Ø., M.G., M.H.), Aarhus University Hospital, Aarhus, Denmark
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B. Hansen
bCenter of Functionally Integrative Neuroscience and MINDLab, Institute of Clinical Medicine (A.T., M.B.H., L.Ø., S.N.J., R.S., T.E.L., M.G., B.H.)
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    Fig 1.

    The tumor core was defined as the contrast-enhancing part on postcontrast T1-weighted images, and the FLAIR masks were defined as hyperintense regions on T2 FLAIR images (minus the tumor core and necrosis, if present). In cases of nonenhancing tumors, hyperintensity areas on T2 FLAIR images were defined as the tumor core (the tumor core and edema were identical regions). The NAWM was outlined in the centrum semiovale of the contralateral hemisphere (on ≥4 consecutive sections). The NAGM was defined in the contralateral thalamus (on ≥3 sections).

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    Fig 2.

    A, Contrast-enhanced T1-weighted and T2 FLAIR images of a grade II astrocytoma grade in the left hemisphere. The map of MK′ demonstrates low MK′, whereas the trace image and the MD map show high diffusivity (high signal changes on MD). B, Typical example of a glioblastoma, with contrast enhancement on postcontrast T1-weighted and complex signal changes on T2 FLAIR images. Increased MK′ is noted in most of the tumor. The trace image and MD show restricted diffusion, primarily in the periphery of the lesion.

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    Fig 3.

    Boxplots of average MK′ and normalized MK′ (in yellow) (A) and MD and normalized MD (in blue) (B) in the contrast-enhancing tumor core of all patients, grouped according to tumor types and grades, are shown. The horizontal lines in the boxes are the median values, the upper and lower box edges are the 25th and 75th percentiles, respectively, and the upper and lower whiskers represent the minimums and maximums, respectively. AC indicates grade III astrocytoma; ODG3, grade III oligodendroglioma; AC2, grade II astrocytoma; ODG2, grade II oligodendroglioma.

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    Table 1:

    Significance of mean MK′, nMK′, MD, and nMD values in different tumor gradesa

    Tumor TypeMK′nMK′MDnMD
    HGG/LGG.028b.058.383.511
    GBM/all<.001b.002b.006b.006b
    GBM/HGG.003b.011b.004b.004b
    AC3/all.135.135.063.033b
    AC3/HGG.011b.031b.024b.019b
    • Note:—AC3 indicates grade III astrocytoma.

    • ↵a Mean MK′, nMK′, MD, and nMD values in the tumor core were compared between different tumor grades, and the resulting P values are listed.

    • ↵b A P value of <.05 indicates a significant difference between groups.

    • View popup
    Table 2:

    Results of regression analysisa

    Tumor TypeMK′PnMK′PMDPnMDPMK′ + MDPbnMK′ + nMDPb
    HGG/LGG0.731.045c0.701.0560.595.5120.572.4560.754.032c0.746.041c
    .220.213
    GBM/all0.842.004c0.811.004c0.775.017c0.772.014c0.842.045c0.807.047c
    .796.835
    GBM/HGG0.886.027c0.838.022c0.876.018c0.876.019c0.895.1270.905.181
    .204.184
    AC3/all0.717.1460.717.1700.766.0520.800.0600.793.7440.779.885
    .165.155
    AC3/HGG0.871.039c0.824.0550.835.038c0.847.042c0.882.1270.871.301
    .328.265
    • Note:—AC3 indicates grade III astrocytoma.

    • ↵a The areas under the receiver operating characteristic curves as a measure for diagnostic accuracy are reported.

    • ↵b Two P values occur when two values (MK′ and MD) are tested at the same time.

    • ↵c The variable contributes significantly to the regression model if the corresponding P value is <.05.

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American Journal of Neuroradiology: 36 (8)
American Journal of Neuroradiology
Vol. 36, Issue 8
1 Aug 2015
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Cite this article
A. Tietze, M.B. Hansen, L. Østergaard, S.N. Jespersen, R. Sangill, T.E. Lund, M. Geneser, M. Hjelm, B. Hansen
Mean Diffusional Kurtosis in Patients with Glioma: Initial Results with a Fast Imaging Method in a Clinical Setting
American Journal of Neuroradiology Aug 2015, 36 (8) 1472-1478; DOI: 10.3174/ajnr.A4311

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Mean Diffusional Kurtosis in Patients with Glioma: Initial Results with a Fast Imaging Method in a Clinical Setting
A. Tietze, M.B. Hansen, L. Østergaard, S.N. Jespersen, R. Sangill, T.E. Lund, M. Geneser, M. Hjelm, B. Hansen
American Journal of Neuroradiology Aug 2015, 36 (8) 1472-1478; DOI: 10.3174/ajnr.A4311
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