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Diffusion Profiling via a Histogram Approach Distinguishes Low-grade from High-grade Meningiomas, Can Reflect the Respective Proliferative Potential and Progesterone Receptor Status

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Abstract

Purpose

Presurgical grading, estimation of growth kinetics, and other prognostic factors are becoming increasingly important for selecting the best therapeutic approach for meningioma patients. Diffusion-weighted imaging (DWI) provides microstructural information and reflects tumor biology. A novel DWI approach, histogram profiling of apparent diffusion coefficient (ADC) volumes, provides more distinct information than conventional DWI. Therefore, our study investigated whether ADC histogram profiling distinguishes low-grade from high-grade lesions and reflects Ki-67 expression and progesterone receptor status.

Procedures

Pretreatment ADC volumes of 37 meningioma patients (28 low-grade, 9 high-grade) were used for histogram profiling. WHO grade, Ki-67 expression, and progesterone receptor status were evaluated. Comparative and correlative statistics investigating the association between histogram profiling and neuropathology were performed.

Results

The entire ADC profile (p10, p25, p75, p90, mean, median) was significantly lower in high-grade versus low-grade meningiomas. The lower percentiles, mean, and modus showed significant correlations with Ki-67 expression. Skewness and entropy of the ADC volumes were significantly associated with progesterone receptor status and Ki-67 expression. ROC analysis revealed entropy to be the most accurate parameter distinguishing low-grade from high-grade meningiomas.

Conclusions

ADC histogram profiling provides a distinct set of parameters, which help differentiate low-grade versus high-grade meningiomas. Also, histogram metrics correlate significantly with histological surrogates of the respective proliferative potential. More specifically, entropy revealed to be the most promising imaging biomarker for presurgical grading. Both, entropy and skewness were significantly associated with progesterone receptor status and Ki-67 expression and therefore should be investigated further as predictors for prognostically relevant tumor biological features. Since absolute ADC values vary between MRI scanners of different vendors and field strengths, their use is more limited in the presurgical setting.

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Author information

Authors and Affiliations

  1. Clinic for Neuroradiology, Katharinenhospital Stuttgart, Stuttgart, Germany

    Georg Alexander Gihr, Diana Horvath-Rizea & Hans Henkes

  2. Eichamt Leipzig, Leipzig, Germany

    Nikita Garnov

  3. Department for Pathology, Katharinenhospital Stuttgart, Stuttgart, Germany

    Patricia Kohlhof-Meinecke

  4. Neurosurgical Clinic, Katharinenhospital Stuttgart, Stuttgart, Germany

    Oliver Ganslandt

  5. Clinic for Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany

    Hans Jonas Meyer & Alexey Surov

  6. Department for Neuroradiology, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany

    Karl-Titus Hoffmann & Stefan Schob

Authors
  1. Georg Alexander Gihr
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  2. Diana Horvath-Rizea
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  10. Stefan Schob
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Corresponding author

Correspondence to Stefan Schob.

Ethics declarations

The study was approved by the ethics committee of the medical council of Baden-Württemberg (Ethik-Kommission Landesärztekammer Baden-Württemberg, F-2017-047).

Conflict of Interest

The authors declare that they have no conflict of interest.

Funding Information

This study acknowledges funding via the Clinician-Scientist-Program of the medical faculty of the University Hospital Leipzig.

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Gihr, G.A., Horvath-Rizea, D., Garnov, N. et al. Diffusion Profiling via a Histogram Approach Distinguishes Low-grade from High-grade Meningiomas, Can Reflect the Respective Proliferative Potential and Progesterone Receptor Status. Mol Imaging Biol 20, 632–640 (2018). https://doi.org/10.1007/s11307-018-1166-2

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