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Simplified perfusion fraction from diffusion-weighted imaging in preoperative prediction of IDH1 mutation in WHO grade II–III gliomas: comparison with dynamic contrast-enhanced and intravoxel incoherent motion MRI

Xiaoqing Wang
Xiaoqing Wang
, 
Mengqiu Cao
Mengqiu Cao
, 
Hongjin Chen
Hongjin Chen
, 
Jianwei Ge
Jianwei Ge
, 
Shiteng Suo
Shiteng Suo
 and 
Yan Zhou
Yan Zhou
   | Jun 19, 2020
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Article Category: Research Article
Published Online: Jun 19, 2020
Page range: 301 - 310
Received: Mar 23, 2020
Accepted: May 13, 2020
DOI: https://doi.org/10.2478/raon-2020-0037
© 2020 Xiaoqing Wang, Mengqiu Cao, Hongjin Chen, Jianwei Ge, Shiteng Suo, Yan Zhou, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

Flowchart of study design.
Flowchart of study design.

Figure 2

Images obtained in a 44-year-old man with astrocytoma (isocitrate dehydrogenase 1 [IDH1] mutant glioma). (A) Fluid-attenuated inversion recovery (FLAIR) image shows a heterogeneous hyperintense lesion in the right frontal lobe. (B) Apparent diffusion coefficient (ADC)0,1000 map shows increased ADC value in the lesion. (C, D) Intravoxel incoherent motion (IVIM) perfusion fraction (f) and simplified perfusion fraction (SPF) maps show no increased values in the corresponding area of the hyperintense lesion as shown in (A). (E) On contrast-enhanced T1-weighted image, the lesion is non-enhancing. (F–H) Dynamic contrast-enhanced (DCE) MRI parametric maps of volume transfer constant (Ktrans), extravascular extracellular volume fraction (ve) and vascular plasma volume fraction (vp) show no increased values in the lesion. Regions of interest are marked on parametric maps.
Images obtained in a 44-year-old man with astrocytoma (isocitrate dehydrogenase 1 [IDH1] mutant glioma). (A) Fluid-attenuated inversion recovery (FLAIR) image shows a heterogeneous hyperintense lesion in the right frontal lobe. (B) Apparent diffusion coefficient (ADC)0,1000 map shows increased ADC value in the lesion. (C, D) Intravoxel incoherent motion (IVIM) perfusion fraction (f) and simplified perfusion fraction (SPF) maps show no increased values in the corresponding area of the hyperintense lesion as shown in (A). (E) On contrast-enhanced T1-weighted image, the lesion is non-enhancing. (F–H) Dynamic contrast-enhanced (DCE) MRI parametric maps of volume transfer constant (Ktrans), extravascular extracellular volume fraction (ve) and vascular plasma volume fraction (vp) show no increased values in the lesion. Regions of interest are marked on parametric maps.

Figure 3

Images obtained in a 72-year-old woman with astrocytoma (isocitrate dehydrogenase 1 [IDH1] wildtype glioma). (A) FLAIR shows a heterogeneous hyperintense lesion in the right hemisphere. (B) Apparent diffusion coefficient (ADC)0,1000 map shows a mixed pattern of high and intermediate ADC values in the lesion. (C, D) Intravoxel incoherent motion (IVIM) perfusion fraction (f) and simplified perfusion fraction (SPF) maps show markedly increased f and SPF values in the corresponding area of the contrast-enhanced lesion as shown in (E). (E) On contrast-enhanced T1-weighted image, the lesion is vividly enhanced. (F–H) Dynamic contrast-enhanced (DCE) MRI parametric maps of volume transfer constant (Ktrans), extravascular extracellular volume fraction (ve) and vascular plasma volume fraction (vp) show obviously increased values in the corresponding area of the contrast-enhanced lesion. Regions of interest are marked on parametric maps.
Images obtained in a 72-year-old woman with astrocytoma (isocitrate dehydrogenase 1 [IDH1] wildtype glioma). (A) FLAIR shows a heterogeneous hyperintense lesion in the right hemisphere. (B) Apparent diffusion coefficient (ADC)0,1000 map shows a mixed pattern of high and intermediate ADC values in the lesion. (C, D) Intravoxel incoherent motion (IVIM) perfusion fraction (f) and simplified perfusion fraction (SPF) maps show markedly increased f and SPF values in the corresponding area of the contrast-enhanced lesion as shown in (E). (E) On contrast-enhanced T1-weighted image, the lesion is vividly enhanced. (F–H) Dynamic contrast-enhanced (DCE) MRI parametric maps of volume transfer constant (Ktrans), extravascular extracellular volume fraction (ve) and vascular plasma volume fraction (vp) show obviously increased values in the corresponding area of the contrast-enhanced lesion. Regions of interest are marked on parametric maps.

Figure 4

Receiver operating characteristic (ROC) curves and corresponding area under the curve values for (A) diffusion-weighted imaging (DWI) parameters (simplified perfusion fraction [SPF], perfusion fraction [f], apparent diffusion coefficient [ADC]0,1000) and (B) dynamic contrast-enhanced (DCE) MRI parameters (transfer constant [Ktrans], extravascular extracellular volume fraction [ve] and vascular plasma volume fraction [vp]) in the differentiation of isocitrate dehydrogenase 1 (IDH1) mutant and wildtype gliomas. SPF showed the highest diagnostic performance with the area under the curve value of 0.86.
Receiver operating characteristic (ROC) curves and corresponding area under the curve values for (A) diffusion-weighted imaging (DWI) parameters (simplified perfusion fraction [SPF], perfusion fraction [f], apparent diffusion coefficient [ADC]0,1000) and (B) dynamic contrast-enhanced (DCE) MRI parameters (transfer constant [Ktrans], extravascular extracellular volume fraction [ve] and vascular plasma volume fraction [vp]) in the differentiation of isocitrate dehydrogenase 1 (IDH1) mutant and wildtype gliomas. SPF showed the highest diagnostic performance with the area under the curve value of 0.86.

Diagnostic performance of parameters for differentiation between isocitrate dehydrogenase 1 (IDH1) mutant and wild-type gliomas

ParameterAUC (95% CI)Sensitivity (%)Specificity (%)Cutoff value
Ktrans (min−1)0.773 (0.563–0.983)77.875.0> 0.062
ve0.760 (0.569–0.951)94.458.3> 0.119
vp0.680 (0.451–0.909)55.691.7> 0.029
ADC0,1000 (×10−3 mm2/s)0.718 (0.531–0.904)83.375.0≤ 1.002
SPF (%)0.861 (0.686–0.959)94.475.0> 14.500
D (×10−3 mm2/s)0.727 (0.541–0.913)72.283.3> 1.065
D* (×10−3 mm2/s)0.690 (0.493–0.886)44.491.4≤ 5.959
f (%)0.810 (0.658–0.963)72.283.3> 3.617

Parameters derived from dynamic contrast-enhanced (DCE) MRI and diffusion-weighted imaging (DWI) between WHO grade II and III gliomas

ParameterGrade IIGrade IIIP-value
Ktrans (min−1)0.067 ± 0.0480.116 ± 0.0640.013
ve0.071 ± 0.0570.401 ± 0.3440.018
vp0.036 ± 0.0200.051 ± 0.0180.035
ADC0,1000 (×10−3 mm2/s)1.093 ± 0.2030.904 ± 0.1840.028
SPF (%)10.78 ± 4.37816.391 ± 5.4710.012
D (×10−3 mm2/s)1.194 ± 0.2610.949 ± 0.1690.021
D* (×10−3 mm2/s)6.692 ± 1.5648.618 ± 2.2150.037
f (%)3.315 ± 1.5366.380 ± 3.4190.020

Parameters derived from dynamic contrast-enhanced (DCE) MRI and diffusion-weighted imaging (DWI) between isocitrate dehydrogenase 1 (IDH1) mutant and wild-type gliomas

ParameterIDH1 mutantIDH1 wild-typeP-value*
Ktrans (min−1)0.054 ± 0.0240.123 ± 0.0730.007
ve0.052 ± 0.0350.121 ± 0.0800.007
vp0.032 ± 0.0150.051 ± 0.0220.015
ADC0,1000 (×10−3 mm2/s)1.123 ± 0.1850.923 ± 0.1990.009
SPF (%)9.572 ± 3.43716.332 ± 4.925< 0.001
D (×10−3 mm2/s)1.108 ± 0.2450.959 ± 0.1460.047
D* (×10−3 mm2/s)6.546 ± 1.7578.196 ± 1.7940.020
f (%)3.080 ± 1.5815.712 ± 2.9240.005

Patient characteristics

CharacteristicIDH1 mutants (n = 18)IDH1 wild-type (n = 12)
Mean age (y)a42.8 (22–67)47.9 (19–78)
Sex distribution (M/F)b10/87/5
WHO grade
II157
III35
Histologic type
Astrocytoma125
Oligodendroglioma30
Oligoastrocytoma01
Anaplastic astrocytoma13
Anaplastic oligodendroglioma12
Anaplastic oligoastrocytoma11
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