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Original Artitle Alterations of Contralateral White Matter in Glioma and Meningioma Patients: a Numerical Diffusion-Weighted Imaging Approach

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Original Artitle Alterations of Contralateral White Matter in Glioma and Meningioma Patients: a Numerical Diffusion-Weighted Imaging Approach Int J Clin Exp Med 2019;12(3):2575-2582 www.ijcem.com /ISSN:1940-5901/IJCEM0082310 Original Artitle Alterations of contralateral white matter in glioma and meningioma patients: a numerical diffusion-weighted imaging approach Teodora A Albu1,2, Iosif Malaescu1 1Department of Physics, West University of Timisoara, Timisoara, Romania; 2Neuromed Diagnostic Imaging Centre, Timisoara, Romania Received July 8, 2018; Accepted September 12, 2018; Epub March 15, 2019; Published March 30, 2019 Abstract: Few studies have examined apparent diffusion coefficient (ADC) values of white matter (WM) in the oppo- site hemisphere of the cranial tumor. Therefore, this study aimed to assess the utility of ADC obtained from quantifi- cation of diffusion weighted (DW) magnetic resonance imaging (MRI) for differentiation between healthy and patho- logical contralateral normal-appearing white matter (CNAWM) in patients diagnosed with glioma or meningioma. A total number of 1,306 subjects (979 regular individuals, 250 diagnosed with glioma, and 77 having meningioma) underwent DWI examinations, considering factors such as age, gender, hemisphere, and histopathological findings. Bilateral ADC values were calculated in healthy WM participants and unilateral measurements were evaluated on the remote opposite NAWM from the tumor containing hemisphere. ADC ranges in CNAWM of high-grade gliomas (0.823 ± 0.016 × 10-3 mm2/s) differed significantly from ADC spectrum of low-grade gliomas (0.797 ± 0.018 × 10-3 mm2/s) and meningiomas (0.778 ± 0.008 × 10-3 mm2/s). Compared to ADC values of healthy individuals (0.752 ± 0.017 × 10-3 mm2/s), these results suggest that quantification of DWI encompasses high sensitivity in early detec- tion and specificity in differentiating abnormalities in macroscopically unsuspicious WM structures. In conclusion, an increase of apparent diffusion coefficient was found in the normal appearing white matter from the opposite area to the lesion (both benign and malign), statistically correlating to the grading of the tumor. Keywords: Apparent diffusion coefficient, contralateral hemisphere, white matter, glioma, meningioma Introduction more advanced grades [2, 3, 8]. Although the classification clearly differentiates between gr- According to the World Health Organization ades, in practical medicine, reality often pr- (WHO), brain tumors are categorized into two oves that there are mixed gliomas with elevated categories, benign (noncancerous) and malig- levels of malignancy intra lesion and lower lev- nant (cancerous). Furthermore, each category els at the periphery [1, 9-11]. Accordingly, this is divided into different types of tumors depend- research will consider low-grade gliomas label- ing on the nature of cells involved [1-4]. ed as grade I, I/II, and II and high-grade gliomas will encompass the following levels: II/III, III, III/ Meningiomas usually belong to the benign divi- IV, and IV. Concerning the benign category, this sion, with only 8% of these lesions being atypi- study will consider only WHO grade I meningio- cal and potentially harmful [4]. Diagnos-tics are ma. The WHO grading criteria for each lesion generally established with routine MRIs, using was obtained from histopathological laboratory combined information from different sequenc- analysis. es, appearance of the tissues, and location in the brain [5-7]. The nature and grading of a brain mass is, pref- erably, established through a histopathological In contrast, concerning the malignant category, method. However, there are cases when biopsy gliomas are the most common form of ce-rebral and/or surgery are not preferable options. On neoplasia. WHO provides a classification of gli- that premise, noninvasive investigations are omas into 4 grades, with worse prognosis for considered [12-20]. One of these is magnetic Alterations of CWM in glioma and meningioma patients with DWI resonance spectroscopy (MRS), which has pr- their data stored and used for research pur- oven its feasibility due to accurate values of poses. metabolic changes that occur in tumors, app- earing tissues [21, 22]. The main disadvantag- During a period of 35 months, 1,306 subjects es of MRS are the limited area of evaluation, were scanned using the MRI procedure. Of long scanning times, and elaborate post-pro- these, 979 participants were from a healthy cessing of image data. Consequently, the pres- population, 250 patients received a glioma ent study aimed to discover if DWI might poten- radiological and histopathological result (low tially be a shortened alternative to noninvasive- and high grade), and 77 individuals were diag- ly assess extensive regions of the brain [23- nosed with typical benign meningioma. 25], such as the contralateral white matter side in the cerebral neoplasia. General exclusion criteria for all participants, regardless of the inclusion group (normal or Anterior studies of DWI applied in characteriza- pathological) were as follows: inability to ex- tion of white matter were conducted solely to press informed consent, claustrophobic pa- determine the tissue in or around the tumor tients, comatose/under anesthesia patients, [26-34]. Few studies have examined apparent pediatric patients, insufficient compliance, cog- diffusion coefficient values of white matter in nitive status impairment, language impedi- the opposite hemisphere of cranial tumors [9, ments, motion/metallic/susceptibility artifacts, 35-37]. The added value of studying this part of allergic reactions to gadolinium based contrast the brain, compared to lesions directly, con- agents, chemotherapy or radiotherapy in histo- sists of displaying the extension of alteration ry, evidence of neoplasm across the body, his- processes concerning the normal appearing tory of any neurologic or systemic disease that white matter. In consideration of establishing might have affected the brain (for example, the pathological values for CNAWM, measure- diabetes, chronic obstructive pulmonary dis- ments of normal white matter of healthy partici- ease, hypertension, metabolic disorders, de- pants were established. Although current litera- mentia), and none were taking medication regu- ture computes various normal ranges of ADC larly (except for topical drugs). [38], there are previous studies demonstrating that ADC values alter due to post processing Concerning the normal group of participants, methods [39], configuration of MRI equipment apart from the general restrictions metioned [40, 41], laterality, age, and gender [42-44]. above, volunteers had to receive a normal Therefore, it was mandatory to begin this re- radiological result, described no brain lesions search by first evaluating the quantification whatsoever (minor white matter changes in the data of DWI in normal patients, grouped by fac- older subjects, named leukoaraiosis, were con- tors such as age, sex, and brain hemisphere. sidered as normal), and absence of a family history of psychiatric disorders, dementia, or The purpose of this study consisted of estab- multiple sclerosis. lishing normal white matter ADC values on a large cohort, analyzing results concerning age Other than the nature of the tumor, the follow- and gender, calculating the spectrum of vari- ing exclusion criteria were applied in the pro- ability for ADC alterations in CNAWM from pa- cess of participant selection for the tumoral tients with gliomas (low and high grade), as well group: status of post brain surgery in history, as meningiomas, and determining the extent of recidival tumor, and evidence of abnormal ch- modification that could lead to early detection anges on MRI images that revealed unexpected of progressive/invasive malignant status. cerebral lesions in the CNWM. Another impor- tant issue was the presence of histopathologi- Materials and methods cal proof of the stated form of lesion, meaning that the MRI examination was preceded or fol- Patient recruitment lowed by resection of the tumor and laboratory analysis. This study was approved by the appropriate Institutional Review Board and all enrolled sub- The normal group consisted of 979 partici- jects provided written informed consent to sa- pants, with 364 males (37.2%) and 615 femal- fely undergo the MRI examination and have es (62.8%). Ages ranged from 18 to 84 years 2576 Int J Clin Exp Med 2019;12(3):2575-2582 Alterations of CWM in glioma and meningioma patients with DWI old (mean age was 36 years old). The menin- a TR/TE of 7000/103, 40 slices, 3 mm thick gioma category had 77 subjects: 17 men sections, and a field of view of 230/230 mm2. (22.1%) and 60 women (77.9%), aged between Diffusion was measured in three orthogonal 29 and 84 years old (average 60 years old). directions (x, y, and z) with three b values (0, Concerning patients with gliomas, this study 500 and 1000 s/mm2). The total acquisition divided the participants into a low-grade cate- time for DW images was approximately 4 gory, encompassing 73 subjects (almost equal- minutes. ly distributed to 36 female participants and 37 male participants, aged between 18-75, The technique can be performed at a rapid mean 40 years old) and hi-gh-grade category scanning time, without the necessity of con- with 183 subjects (105 males, 54.3% and 72 trast agent administration. It is cost effective females 40.7%, aged between 22-86, mean 48 with reduced sensitivity to motion artifacts, years old). providing both qualitative and quantitative in- Imaging techniques formation. The qualitative part refers to the visual repre- All studies were performed with a Magnetom Avanto Imager
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