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Diffusion-Tensor MR Imaging of Intracranial Neoplasia and Associated Peritumoral Edema: Introduction of the Tumor Infiltration Index¹

¹ From the Departments of Radiology (S.L., D.A., G.J., M.L. R.I.G.) and Pathology (D.Z.), New York University Medical Center, NY. Received April 30, 2003; revision requested July 11; final revision received November 11; accepted December 19. Supported by RSNA Research Resident Grant RR0201. Address correspondence to S.L., 564 First Ave, #19D, New York, NY 10016.

View larger version (15K): [in a new window]   Figure 1. Categorization schemata of intracranial neoplasms and peritumoral edema. GBMs = glioblastomas multiforme.

View larger version (29K): [in a new window]   Figure 2. Scatterplot of FA versus MD measured in peritumoral edema. A high correlation between these values (R = –0.88, P < .05) among the meningiomas and metastases is demonstrated; the linear regression fit for these tumors is represented by the formula y = –0.69x + 0.72, where y is the FA and x is the MD. The glioblastomas multiforme and low-grade gliomas tend to lie below this solid line, and the difference is measured by using the TII. The dotted lines represent the 95% CI bands.

View larger version (21K): [in a new window]   Figure 3. Scatterplot of FA versus MD measured in tumors. A weak correlation between these values (R = –0.42, P < .05) is demonstrated among the intracranial neoplasms.

View larger version (112K): [in a new window]   Figure 4. MR images and histogram data obtained in patient with meningioma. A, Transverse T2-weighted MR image (3,400/119) shows a meningioma in the left frontal lobe and the adjacent peritumoral edema. Two ROIs (outlined) delineate the tumor and the peritumoral signal intensity abnormality; the area between the two ROIs represents the peritumoral edema. A = anterior, R = right. B, A histogram is used to display the data depicted on the MD overlay map in C. From this histogram, the mean and SD of the intratumoral MD are calculated. C, Data from this MD overlay map indicate a mean MD of 0.513 x 10–3 mm2/sec in the tumor and of 0.747 x 10–3 mm2/sec in the peritumoral edema at histogram analysis. D, Data from this FA overlay map indicate a mean FA of 0.262 in the tumor and of 0.215 in the peritumoral edema at histogram analysis. The measured TII of this meningioma is –15.

View larger version (122K): [in a new window]   Figure 5. MR images and histogram data obtained in patient with metastatic renal cell carcinoma. A, Transverse contrast material-enhanced T1-weighted MR image (600/14) shows an enhancing mass (outlined) in the right parietal lobe. B, Transverse T2-weighted MR image (3,400/119) shows another ROI encompassing both the tumor and the surrounding signal intensity abnormality; the area between the two ROIs represents the peritumoral edema. In A and B, A = anterior, R = right. C, Data from this MD overlay map indicate a mean MD of 0.952 x 10–3 mm2/sec in the tumor and of 0.717 x 10–3 mm2/sec in the peritumoral edema at histogram analysis. D, Data from this FA overlay map indicate a mean FA of 0.161 in the tumor and of 0.203 in the peritumoral edema at histogram analysis. The measured TII of this solitary intraaxial metastatic brain tumor is 18.

View larger version (87K): [in a new window]   Figure 6. MR images and histogram data obtained in patient with glioblastoma multiforme. A, Transverse contrast-enhanced T1-weighted MR image (600/14) shows enhancing mass (outlined) in the left frontal lobe. B, Transverse T2-weighted MR image (3,400/119) shows another ROI encompassing both the tumor and the surrounding signal intensity abnormality; the area between the two ROIs represents the peritumoral edema. In A and B, A = anterior, R = right. C, Data from this MD overlay map indicate a mean MD of 0.759 x 10–3 mm2/sec in the tumor and of 0.496 x 10–3 mm2/sec in the peritumoral edema at histogram analysis. D, Data from this FA overlay map indicate a mean FA of 0.200 in the tumor and of 0.285 in the peritumoral edema at histogram analysis. The measured TII of this glioblastoma multiforme is 88.

View larger version (83K): [in a new window]   Figure 7. Images obtained in patient with oligodendroglioma. A, Transverse contrast-enhanced T1-weighted MR image (600/14) shows nonenhancing mass (outlined) in the left frontal lobe. B, Transverse T2-weighted MR image (3,400/119) shows another ROI encompassing both the tumor and the surrounding signal intensity abnormality; the area between the two ROIs represents the peritumoral edema. In A and B, A = anterior, R = right. C, Data from this MD overlay map indicate a mean MD of 0.746 x 10–3 mm2/sec in the tumor and of 0.632 x 10–3 mm2/sec in the peritumoral edema at histogram analysis. D, Data from this FA overlay map indicate a mean FA of 0.129 in the tumor and of 0.231 in the peritumoral edema at histogram analysis. The measured TII of this low-grade glioma is 48.

View larger version (20K): [in a new window]   Figure 8. Graph of TIIs in meningiomas and metastases, as compared with TIIs in gliomas. The mean TII of meningiomas and metastases is 0, with a 95% CI of between –15 and 15. The mean TII of gliomas is 64, with a 95% CI of between 38 and 90.