Differentiation of low-grade and high-grade glioma using the combination of conventional magnetic resonance imaging and apparent diffusion coefficient value

BACKGROUND: The conventional magnetic resonance imaging (cMRI) and apparent diffusion coefficient (ADC) may have a role in predicting tumor grade for gliomas and may in turn assist in identifying tumor biopsy sites. In this study, we aimed to determine the added value of a joint approach of diffusion-weighted imaging (DWI) and cMRI to determine of low grade and high-grade glioma, compare to cMRI alone. METHODS: Data were collected from 56 glioma patients, who underwent examinations and received treatment at Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia, from the period of 2015-2018. Inclusion criteria was patients who underwent cMRI with a DWIADC sequence and patient that were diagnosed with glioma according to the histopathological results. Pathology reports of the imaging results were reviewed independently. A receiver operator curve (ROC) analysis assessed the predictive potential of cMRI and ADC values for low-grade and high-grade gliomas. RESULTS: Fifty-six subjects met the inclusion criteria. The combination of MRI and ADC values increased sensitivity (to 90%) and negative predictive value (to 92.9%), and also improved the negative likelihood ratio (to 0.14). However, the combination of MRI and ADC values had the highest area under the curve (78.6%) and sensitivity (78.6%), which was similar to the separated examination. CONCLUSION: The combination of ADC value and conventional MRI increases sensitivity in differentiating low-grade and high-grade glioma compared to separated examination.