Aram Tonoyan1, Ezequiel Farrher2, Ivan Maximov3, Farida Grinberg4,5, Elena Lyubimova6, Ludmila Fadeeva1, Eduard Pogosbekyan1, Nadim Joni Shah2,5, and Igor Pronin1
1Neuroimaging, Burdenko Neurosurgery Institute, Moscow, Russian Federation, 2Institute of Neuroscience and Medicine – 4, Medical Imaging Physics, Forschungszentrum Juelich GmbH, Juelich, Germany, 3Experimental physics III, TU Dortmund University, Dortmund, Germany, 4Institute of Neuroscience and Medicine – 4, Medical Imaging Physics, Forschungszentrum Juelich GmbH, Julich, Germany, 5Faculty of Medicine, Department of Neurology, RWTH Aachen University, JARA, Aachen, Germany, 6Radiology, Krasnodar Regional Hospital, Krasnodar, Russian Federation
Synopsis
MRI allows one to detect and visualize
the primary and metastatic tumours in the brain. However, conventional methods
suffer from a poor contrast. In turn, it leads to a problem in proper
diagnostics of the tumour origins. In the present work we demonstrated the
potential of kurtosis imaging technique in the tumour differentiation of
primary tumour and metastasis cancers.Introduction
Metastatic brain tumours and
brain glioblastomas are malignant by nature
and account an
absolute majority of all brain tumours in
adults. The metastasis
and glioblastomas present around 50% and 20% of all intracranial tumours,
respectively
1. A primary glioblastoma constitutes
90% of all glioblastomas, whereas less than 10% of the glioblastomas
are secondary. The secondary glioblastomas originate from WHO grade II and grade III gliomas
2.
The
primary glioblastoma is more
aggressive and has much worse
prognosis compared to secondary one1.
Conventional MRI allows us to differentiate the glioblastoma types. The
primary glioblastomas are characterised by a contrast
enhancement of whole solid tumour, tumour
necrosis, and peritumoral brain edema. The
secondary glioblastomas have large nonenhancing
solid tumour
regions regions without a contrast
enhancement and rarely undergo necrosis (see Fig.1)
Often it is difficult to differentiate the primary
glioblastomas from the brain metastasis using the conventional
MRI since both tumour types demonstrate similar
radiological features. In our work we assessed the
diagnostic efficacy of the diffusion kurtosis imaging in a differentiation of the brain metastasis and primary
glioblastomas.
Purpose
To assess the efficacy of diffusion kurtosis
imaging in a structural differentiation
of
the
brain metastasis and primary glioblastomas.
Methods
20 patients with the brain
metastasis (5 with a breast cancer, 6 with a lung
cancer, 5 with a colorectal cancer, and 4
with
melanomas) and 35 patients with primary glioblastomas underwent 3T
MR imaging and diffusion
weighted measurements (bvalues
=
0, 1000 and 2500 s/mm
2, 60
gradient directions, resolution = 3mm
3). Diffusion
scalar metrics such as mean
kurtosis (MK), axial kurtosis (AK), radial kurtosis (RK),
kurtosis anisotropy (KA), mean diffusivity (MD), axial diffusivity (AD), radial
diffusivity (RD), fractional anisotropy (FA), relative anisotropy (RA),
intracellular water fraction (ICWF), axial extracellular diffusivity (AECD),
radial extracellular diffusivity (RECD), tortuosity (Tort) were estimated
and later compared with
solid regions of metastasis and primary glioblastomas using a criterion
of significant level p<0.05 and a MannWhitney
test. A tumour
necrosis and peritumoral brain edema were excluded from the regions of
interest. All primary glioblastomas were newly diagnosed, without having
previous radiation or chemotherapy. All brain metastasis also were
newly diagnosed, without having brain previous radiation. The
diagnosis in all cases were
confirmed by a tumour
removal or stereotaxic biopsy performance in 1-2 weeks after MRI
screening.
Results
Values of MK, Tort, FA and RA did not show
the
significant difference between the brain
metastasis and primary glioblastomas. The AK,
RK, KA and ICWF were significantly higher (p<0,05) in the primary
glioblastomas comparing to
metastasis. The values of MD, AD,
RD, AECD and RECD were significantly higher in metastasis
comparing
to primary glioblastomas (see Fig. 2).
Discussion
An application of non-Gaussian diffusion models to
a division of different tumour types in the human brain is very challenging
problem. On the one hand, the microstructure organisation of tumour cells has a
significant difference in a water diffusion dynamics due to a cell
compartmentalization comparing to a normal white matter tissue with the ordered
axon bundles. On the other hand, we expect to see the difference in the tumour
cell organisation based on the tumour origin: primary or metastatic cancer what
can be seen by application of contrast enhancement technique. In a statistical
comparison of primary and metastasis tumours we found the higher values of AK, RK, KA, ICWF and
lower values of mean diffusivity MD, AD, RD, AECD and RECD in the primary
glioblastomas compared to the metastasis. These findings reflect a fact that a
water diffusion in the glioblastomas is more restricted. We hypothesized that
this effect might be connected to the higher cellularity of the glioblastomas
in contrast to the metastatic cancer tissue. In turn, this effect can be
detected and visualised by DKI metrics.
Conclusion
Diffusion kurtosis imaging and two compartment
model demonstrated a high potential
in the structural differentiation of
the
brain metastatic tumours and
primary glioblastomas. However, more detailed diffusion
model
3 accounting cellular
nature of the tumour should be taken in account in the future.
Acknowledgements
No acknowledgement found.References
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