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Research ArticlePediatric Neuroimaging

Multiparametric Analysis of Permeability and ADC Histogram Metrics for Classification of Pediatric Brain Tumors by Tumor Grade

S. Vajapeyam, D. Brown, P.R. Johnston, K.I. Ricci, M.W. Kieran, H.G.W. Lidov and T.Y. Poussaint
American Journal of Neuroradiology March 2018, 39 (3) 552-557; DOI: https://doi.org/10.3174/ajnr.A5502
S. Vajapeyam
aFrom the Departments of Radiology (S.V., D.B., P.R.J., T.Y.P.)
eHarvard Medical School (S.V., M.W.K., H.G.W.L., T.Y.P.), Boston, Massachusetts.
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D. Brown
aFrom the Departments of Radiology (S.V., D.B., P.R.J., T.Y.P.)
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P.R. Johnston
aFrom the Departments of Radiology (S.V., D.B., P.R.J., T.Y.P.)
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K.I. Ricci
cCancer Center (K.I.R.), Massachusetts General Hospital, Boston, Massachusetts
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M.W. Kieran
dDivision of Pediatric Oncology (M.W.K.), Dana-Farber Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
eHarvard Medical School (S.V., M.W.K., H.G.W.L., T.Y.P.), Boston, Massachusetts.
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H.G.W. Lidov
bPathology (H.G.W.L.), Boston Children's Hospital, Boston, Massachusetts
eHarvard Medical School (S.V., M.W.K., H.G.W.L., T.Y.P.), Boston, Massachusetts.
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T.Y. Poussaint
aFrom the Departments of Radiology (S.V., D.B., P.R.J., T.Y.P.)
eHarvard Medical School (S.V., M.W.K., H.G.W.L., T.Y.P.), Boston, Massachusetts.
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    Fig 1.

    A 6-year-old boy with a low-grade pilocytic astrocytoma. The upper row shows the T2-weighted image (A), T2-FLAIR image (B), postcontrast T1-weighted image (C), ADC map (D), and the ADC histogram of the FLAIR tumor volume (E), respectively. The lower row shows the Ktrans map (F), Kep map (G), ve map (H), vp map (I), and the ADC histogram of the enhancing tumor volume (J), respectively. The enhancing tumor volume was defined as the nodular enhancement of the solid component for pilocytic astrocytomas. Note the low Ktrans and Kep and the high ve values in this low-grade tumor. The mean ADC of the FLAIR tumor volume is 1821 × 10−6 mm2/s and 1808 × 10−6 mm2/s for the enhancing tumor volume.

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    Fig 2.

    A 5-year-old boy with parietal anaplastic ependymoma. The upper row shows the T2-weighted image (A), T2-FLAIR image (B), postcontrast T1-weighted image (C), ADC map (D), and the ADC histogram of the FLAIR tumor volume (E), respectively. The lower row shows the Ktrans map (F), Kep map (G), ve map (H), vp map (I), and the ADC histogram of the enhancing tumor volume (J), respectively. Note the high Ktrans and Kep and the lower ve values in this high-grade tumor. The histogram of the FLAIR tumor volume is bimodal. The mean ADC of the lower peak of the FLAIR tumor volume is 867 × 10−6 mm2/s and 1262 × 10−6 mm2/s for the enhancing tumor volume.

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    Fig 3.

    A, Scatterplot of ve versus FL_ADC_mean for all 41 cases analyzed. High-grade tumors are shown in red, and low-grade, in black. B, ROC curve for ve (AROC = 0.843). C, ROC curve for FL_ADC_mean (AROC = 0.870). D, ROC curve when ve and FL_ADC_mean are combined (AROC = 0.918). Note the improved accuracy shown for the multiparametric predictor, reflected in the increased AROC.

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    Table 1:

    Group comparisons: low- versus high-grade tumor

    VariableLow-Grade (Mean)High-Grade (Mean)Mean DiffMean SELower 95% CLUpper 95% CLP Value (T Test)χ2 (Wilcoxon)P Value (Wilcoxon)
    Ktrans (min−1)0.141.501.360.450.462.27.00416.72<.001
    Kep (min−1)1.188.857.671.993.6411.70<.00118.98<.001
    ve0.220.13−0.090.02−0.13−0.05<.00113.41<.001
    vp0.050.050.000.01−0.020.02.7640.23.630
    FL_ADC_mean (×10−6 mm2/s)14581022−43684.47−607−265<.00115.65<.001
    FL_ADC_SD (×10−6 mm2/s)336.8285.0−51.836.01−12521.06.158.56.454
    FL_ADC_skew0.451.240.800.260.271.32.0047.55.006
    FL_ADC_kurt1.281.970.700.73−0.792.18.3471.58.208
    PG_ADC_mean (×10−6 mm2/s)14721066−406100.7−610−203<.00111.70<.001
    PG_ADC_SD (×10−6 mm2/s)261.0308.447.4640.47−34.4129.3.2481.93.165
    PG_ADC_skew0.691.300.610.300.011.21.0472.26.133
    PG_ADC_kurt2.512.31−0.200.93−2.091.70.8350.34.560
    • Note:—Diff indicates difference; SE, standard error; CL, confidence limit; skew, skewness; kurt, kurtosis.

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    Table 2:

    Predictors of AROC

    PredictorAROCSE95% Lower CL95% Upper CLT ValueP Value
    Ktrans0.8830.0520.7810.9847.40<.001
    Kep0.9080.0470.8151.08.59<.001
    Ve0.8430.0660.7130.9725.19<.001
    FL_ADC_mean0.8700.0550.7620.9786.74<.001
    PG_ADC_mean0.8200.0660.6910.9494.86<.001
    Ve + FL_ADC_mean0.9180.0430.8341.09.81<.001
    • Note:—CL indicates confidence limit.

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American Journal of Neuroradiology: 39 (3)
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S. Vajapeyam, D. Brown, P.R. Johnston, K.I. Ricci, M.W. Kieran, H.G.W. Lidov, T.Y. Poussaint
Multiparametric Analysis of Permeability and ADC Histogram Metrics for Classification of Pediatric Brain Tumors by Tumor Grade
American Journal of Neuroradiology Mar 2018, 39 (3) 552-557; DOI: 10.3174/ajnr.A5502

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Multiparametric Analysis of Permeability and ADC Histogram Metrics for Classification of Pediatric Brain Tumors by Tumor Grade
S. Vajapeyam, D. Brown, P.R. Johnston, K.I. Ricci, M.W. Kieran, H.G.W. Lidov, T.Y. Poussaint
American Journal of Neuroradiology Mar 2018, 39 (3) 552-557; DOI: 10.3174/ajnr.A5502
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