Diffusion tensor imaging for preoperative evaluation of tumor grade in gliomas

The relationship between water diffusion parameters measured using diffusion tensor imaging (DTI) and histological malignancy of gliomas was investigated. DTI was performed using a 3.0 T MR scanner in 41 consecutive patients with histologically proven gliomas. Fractional anisotropy (FA) and mean diffusivity (MD) were calculated and compared with the WHO classification of the gliomas. The FA values of grade 1 gliomas (0.150 ± 0.017) were significantly lower than those of grade 3 (0.23 ± 0.033) or grade 4 gliomas (0.229 ± 0.033) ( P < 0.0001, respectively). The FA values of grade 2 gliomas (0.159 ± 0.018) were significantly lower than those of grade 3 or grade 4 gliomas ( P = 0.0002, P < 0.0001, respectively). The FA threshold between low grade and high grade gliomas was 0.188. The MD values of grade 1 gliomas (1619.1 ± 157.4 × 10 −6 mm 2/s) were significantly higher than those of grade 3 (1084.5 ± 218.9 × 10 −6 mm 2/s) ( P = 0.0036) or grade 4 gliomas (1098.0 ± 291.6 × 10 −6 mm 2/s) ( P = 0.0002). The MD values were not correlated with the other grades of glioma. FA values can distinguish between high grade and low grade gliomas. This is useful in deciding the surgical strategy or selecting the site of stereotactic biopsy.