Characterization of active and infiltrative tumorous subregions from normal tissue in brain gliomas using multiparametric MRI

Background: Targeted localized biopsies and treatments for diffuse gliomas rely on accurate identification of tissue subregions, for which current MRI techniques lack specificity.

Purpose: To explore the complementary and competitive roles of a variety of conventional and quantitative MRI methods for distinguishing subregions of brain gliomas.

Study Type: Prospective.

Population: Fifty‐one tissue specimens were collected using image‐guided localized biopsy surgery from 10 patients with newly diagnosed gliomas.

Field Strength/Sequence: Conventional and quantitative MR images consisting of pre‐ and postcontrast T1w, T2w, T2‐FLAIR, T2‐relaxometry, DWI, DTI, IVIM, and DSC‐MRI were acquired preoperatively at 3T.

Assessment: Biopsy specimens were histopathologically attributed to glioma tissue subregion categories of active tumor (AT), infiltrative edema (IE), and normal tissue (NT) subregions. For each tissue sample, a feature vector comprising 15 MRI‐based parameters was derived from preoperative images and assessed by a machine learning algorithm to determine the best multiparametric feature combination for characterizing the tissue subregions.

Statistical Tests: For discrimination of AT, IE, and NT subregions, a one‐way analysis of variance (ANOVA) test and for pairwise tissue subregion differentiation, Tukey honest significant difference, and Games‐Howell tests were applied (P < 0.05). Cross‐validated feature selection and classification methods were implemented for identification of accurate multiparametric MRI parameter combination.

Results: After exclusion of 17 tissue specimens, 34 samples (AT = 6, IE = 20, and NT = 8) were considered for analysis. Highest accuracies and statistically significant differences for discrimination of IE from NT and AT from NT were observed for diffusion‐based parameters (AUCs >90%), and the perfusion‐derived parameter as the most accurate feature in distinguishing IE from AT. A combination of “CBV, MD, T2_ISO, FLAIR” parameters showed high diagnostic performance for identification of the three subregions (AUC ∼90%).

Data Conclusion: Integration of a few quantitative along with conventional MRI parameters may provide a potential multiparametric imaging biomarker for predicting the histopathologically proven glioma tissue subregions.