PT  - JOURNAL ARTICLE
AU  - White, N.S.
AU  - McDonald, C.R.
AU  - Farid, N.
AU  - Kuperman, J.M.
AU  - Kesari, S.
AU  - Dale, A.M.
TI  - Improved Conspicuity and Delineation of High-Grade Primary and Metastatic Brain Tumors Using “Restriction Spectrum Imaging”: Quantitative Comparison with High B-Value DWI and ADC
AID  - 10.3174/ajnr.A3327
DP  - 2013 May 01
TA  - American Journal of Neuroradiology
PG  - 958--964
VI  - 34
IP  - 5
4099  - http://www.ajnr.org/content/34/5/958.short
4100  - http://www.ajnr.org/content/34/5/958.full
SO  - Am. J. Neuroradiol.2013 May 01; 34
AB  - BACKGROUND AND PURPOSE: Restriction spectrum imaging is a sensitive DWI technique for probing separable water diffusion compartments in tissues. Here, we evaluate RSI-CMs derived from the spherically-restricted water compartment for improved tumor conspicuity and delineation from nontumor tissue and reduced sensitivity to edema compared with high-b-value DWI and ADC. MATERIALS AND METHODS: RSI was performed in 10 presurgical patients: 4 with glioblastoma, 3 with primary CNS lymphoma, and 3 with metastatic brain tumors. Multidirectional DWI data were collected at b = 500, 1500, and 4000 s/mm2. Quantification of tumor conspicuity, edema conspicuity, and relative sensitivity to edema for RSI-CMs; DWI at b = 4000 (DWI-4000); and ADC were compared in manually drawn VOIs. Receiver operating characteristic curves were used to evaluate the sensitivity and specificity of each method for delineating tumor from normal-appearing WM. RESULTS: Significant TC was seen with both RSI-CMs and DWI-4000, but not ADC. Significant EC was seen with ADC, but not RSI-CMs or DWI-4000. Significantly greater TC was seen with RSI-CMs compared with DWI-4000. Significantly reduced RSE was seen with RSI-CMs compared with both DWI-4000 and ADC. Greater sensitivity and specificity for delineating tumor from normal-appearing WM were seen with RSI-CMs (AUC = 0.91) compared with both DWI-4000 (AUC = 0.77) and ADC (AUC = 0.66). CONCLUSIONS: RSI-CMs offer improved conspicuity and delineation of high-grade primary and metastatic brain tumors and reduced sensitivity to edema compared with high-b-value DWI and ADC. AUCarea under the receiver operating characteristic curveECedema conspicuityRSErelative sensitivity to edemaRSIrestriction spectrum imagingRSI-CMRSI cellularity mapTCtumor conspicuity