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Malignant Astrocytic Tumors: Clinical Importance of Apparent Diffusion Coefficient in Prediction of Grade and Prognosis¹

¹ From the Departments of Diagnostic Radiology (S.H., S.M., A.U., A.S., T.Y., S.T.), Neuroendovascular Therapy (X.Y.), and Neurosurgery (T.K.), Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi Aoba-ku, Sendai, Miyagi, 980-8574, Japan; and Department of Pathology, Tohoku University Hospital, Tohoku, Japan (M.W.). Received July 31, 2005; revision requested October 7; revision received November 15; accepted December 8; final version accepted February 3, 2006. Address correspondence to S.H. (e-mail: higano-s{at}rad.med.tohoku.ac.jp).

View larger version (13K): [in this window] [in a new window] [Download PPT slide]   Figure 1: Graph shows relationship between minimum ADC and Ki-67 LI. Significant negative correlation was noted between these parameters for astrocytic tumors as a whole. GBMs generally show higher Ki-67 LI and lower minimum ADC, whereas AAs show lower Ki-67 LI and higher minimum ADC.

View larger version (10K): [in this window] [in a new window] [Download PPT slide]   Figure 2: Graph shows relationship between minimum ADC and prognosis according to pathologic type. Minimum ADC values of AAs are higher than those of GBMs, although substantial overlap is noted. With the cutoff value of 0.90 x 10–3 mm2 · sec–1 for minimum ADC, most of the patients in the stable group have values above this threshold, and most of the patients in the progressive group have values below that level.

View larger version (126K): [in this window] [in a new window] [Download PPT slide]   Figure 3a: GBM in 56-year-old woman. Transverse (a) preoperative T2-weighted MR image (3600/96), (b) contrast-enhanced T1-weighted MR image (440/14), and (c) ADC map show irregularly shaped enhancing tumor (arrows in a) with perifocal edema in left mediofrontal lobe. Minimum ADC value was 0.72 x 10–3 mm2 · sec–1. (d) Postoperative contrast-enhanced transverse T1-weighted MR image (440/14) shows gross total removal of the tumor. (e) Contrast-enhanced transverse T1-weighted MR image (440/14) 9 months after surgery shows a patchy enhancing lesion (arrow). The lesion enlarged later, and gamma knife therapy was performed. With further progression of the disease, the patient died 1.5 years after initial treatment.

View larger version (120K): [in this window] [in a new window] [Download PPT slide]   Figure 3b: GBM in 56-year-old woman. Transverse (a) preoperative T2-weighted MR image (3600/96), (b) contrast-enhanced T1-weighted MR image (440/14), and (c) ADC map show irregularly shaped enhancing tumor (arrows in a) with perifocal edema in left mediofrontal lobe. Minimum ADC value was 0.72 x 10–3 mm2 · sec–1. (d) Postoperative contrast-enhanced transverse T1-weighted MR image (440/14) shows gross total removal of the tumor. (e) Contrast-enhanced transverse T1-weighted MR image (440/14) 9 months after surgery shows a patchy enhancing lesion (arrow). The lesion enlarged later, and gamma knife therapy was performed. With further progression of the disease, the patient died 1.5 years after initial treatment.

View larger version (100K): [in this window] [in a new window] [Download PPT slide]   Figure 3c: GBM in 56-year-old woman. Transverse (a) preoperative T2-weighted MR image (3600/96), (b) contrast-enhanced T1-weighted MR image (440/14), and (c) ADC map show irregularly shaped enhancing tumor (arrows in a) with perifocal edema in left mediofrontal lobe. Minimum ADC value was 0.72 x 10–3 mm2 · sec–1. (d) Postoperative contrast-enhanced transverse T1-weighted MR image (440/14) shows gross total removal of the tumor. (e) Contrast-enhanced transverse T1-weighted MR image (440/14) 9 months after surgery shows a patchy enhancing lesion (arrow). The lesion enlarged later, and gamma knife therapy was performed. With further progression of the disease, the patient died 1.5 years after initial treatment.

View larger version (115K): [in this window] [in a new window] [Download PPT slide]   Figure 3d: GBM in 56-year-old woman. Transverse (a) preoperative T2-weighted MR image (3600/96), (b) contrast-enhanced T1-weighted MR image (440/14), and (c) ADC map show irregularly shaped enhancing tumor (arrows in a) with perifocal edema in left mediofrontal lobe. Minimum ADC value was 0.72 x 10–3 mm2 · sec–1. (d) Postoperative contrast-enhanced transverse T1-weighted MR image (440/14) shows gross total removal of the tumor. (e) Contrast-enhanced transverse T1-weighted MR image (440/14) 9 months after surgery shows a patchy enhancing lesion (arrow). The lesion enlarged later, and gamma knife therapy was performed. With further progression of the disease, the patient died 1.5 years after initial treatment.

View larger version (124K): [in this window] [in a new window] [Download PPT slide]   Figure 3e: GBM in 56-year-old woman. Transverse (a) preoperative T2-weighted MR image (3600/96), (b) contrast-enhanced T1-weighted MR image (440/14), and (c) ADC map show irregularly shaped enhancing tumor (arrows in a) with perifocal edema in left mediofrontal lobe. Minimum ADC value was 0.72 x 10–3 mm2 · sec–1. (d) Postoperative contrast-enhanced transverse T1-weighted MR image (440/14) shows gross total removal of the tumor. (e) Contrast-enhanced transverse T1-weighted MR image (440/14) 9 months after surgery shows a patchy enhancing lesion (arrow). The lesion enlarged later, and gamma knife therapy was performed. With further progression of the disease, the patient died 1.5 years after initial treatment.

View larger version (137K): [in this window] [in a new window] [Download PPT slide]   Figure 4a: GBM in 43-year-old man. Transverse (a) preoperative T2-weighted MR image (3600/96), (b) contrast-enhanced T1-weighted MR image (440/14), and (c) ADC map show ill-defined tumor (arrows in a) in right insulo-opercular region. Irregular enhancing area is noted in center of tumor (arrow in b). Minimum ADC value was 1.07 x 10–3 mm2 · sec–1. (d) Postoperative contrast-enhanced transverse T1-weighted MR image (440/14) shows that most of the tumor, including all enhancing components, was removed. (e) Contrast-enhanced transverse T1-weighted MR image (440/14) 2 years after surgery shows no tumor recurrence.

View larger version (119K): [in this window] [in a new window] [Download PPT slide]   Figure 4b: GBM in 43-year-old man. Transverse (a) preoperative T2-weighted MR image (3600/96), (b) contrast-enhanced T1-weighted MR image (440/14), and (c) ADC map show ill-defined tumor (arrows in a) in right insulo-opercular region. Irregular enhancing area is noted in center of tumor (arrow in b). Minimum ADC value was 1.07 x 10–3 mm2 · sec–1. (d) Postoperative contrast-enhanced transverse T1-weighted MR image (440/14) shows that most of the tumor, including all enhancing components, was removed. (e) Contrast-enhanced transverse T1-weighted MR image (440/14) 2 years after surgery shows no tumor recurrence.

View larger version (104K): [in this window] [in a new window] [Download PPT slide]   Figure 4c: GBM in 43-year-old man. Transverse (a) preoperative T2-weighted MR image (3600/96), (b) contrast-enhanced T1-weighted MR image (440/14), and (c) ADC map show ill-defined tumor (arrows in a) in right insulo-opercular region. Irregular enhancing area is noted in center of tumor (arrow in b). Minimum ADC value was 1.07 x 10–3 mm2 · sec–1. (d) Postoperative contrast-enhanced transverse T1-weighted MR image (440/14) shows that most of the tumor, including all enhancing components, was removed. (e) Contrast-enhanced transverse T1-weighted MR image (440/14) 2 years after surgery shows no tumor recurrence.

View larger version (131K): [in this window] [in a new window] [Download PPT slide]   Figure 4d: GBM in 43-year-old man. Transverse (a) preoperative T2-weighted MR image (3600/96), (b) contrast-enhanced T1-weighted MR image (440/14), and (c) ADC map show ill-defined tumor (arrows in a) in right insulo-opercular region. Irregular enhancing area is noted in center of tumor (arrow in b). Minimum ADC value was 1.07 x 10–3 mm2 · sec–1. (d) Postoperative contrast-enhanced transverse T1-weighted MR image (440/14) shows that most of the tumor, including all enhancing components, was removed. (e) Contrast-enhanced transverse T1-weighted MR image (440/14) 2 years after surgery shows no tumor recurrence.

View larger version (131K): [in this window] [in a new window] [Download PPT slide]   Figure 4e: GBM in 43-year-old man. Transverse (a) preoperative T2-weighted MR image (3600/96), (b) contrast-enhanced T1-weighted MR image (440/14), and (c) ADC map show ill-defined tumor (arrows in a) in right insulo-opercular region. Irregular enhancing area is noted in center of tumor (arrow in b). Minimum ADC value was 1.07 x 10–3 mm2 · sec–1. (d) Postoperative contrast-enhanced transverse T1-weighted MR image (440/14) shows that most of the tumor, including all enhancing components, was removed. (e) Contrast-enhanced transverse T1-weighted MR image (440/14) 2 years after surgery shows no tumor recurrence.

View larger version (12K): [in this window] [in a new window] [Download PPT slide]   Figure 5: Empiric and fitted receiver operating characteristic curves of minimum ADC values for use in differentiation of stable patients from progressive patients. Area under the receiver operating characteristic curve was 0.854. When the minimum ADC is 0.90 x 10–3 mm2 · sec–1, the best combination of sensitivity (79%) and specificity (81%) is provided (arrow).

View larger version (12K): [in this window] [in a new window] [Download PPT slide]   Figure 6: Graph shows comparison of postoperative prognosis between two groups of patients classified according to cutoff value of 0.90 x 10–3 mm2 · sec–1 for minimum ADC by using Kaplan-Meier method. The significantly better outcome was noted in the group with a minimum ADC value above the cutoff value.