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Grading of IDH‑mutant astrocytoma using diffusion, susceptibility, and perfusion‑weighted imaging

Original author: Yang X, Xing Z, She D, et al. (2022) (DOI: 10.1186/s12880-022-00832-3)


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Content writer – Clinical

January 17, 2023


The accurate grading of IDH-mutant astrocytoma is essential to develop therapeutic strategies and evaluating the prognosis of patients. A preoperative classification of these entities could be beneficial for the treatments of patients, particularly in those who have a contraindication to surgery or in cases where the lesions are unresectable. With the aid of apparent diffusion coefficient (ADC) measurements, diffusion-weighted imaging (DWI) can noninvasively evaluate the Brownian motion of water molecules in vivo. The grading of gliomas may benefit from using dynamic susceptibility contrast perfusion-weighted imaging (DSC-PWI), which can offer hemodynamic parameters with tumor angiogenesis. Susceptibility-weighted imaging (SWI), a more improved approach, may semi-quantitatively evaluate tumor micro-hemorrhages and vasculature via intratumoral susceptibility signal intensity (ITSS). These techniques have all been used to distinguish between different glioma grades. IDH-mutant astrocytic glioma grading is a topic that is rarely covered in studies. The combination of DWI, DSC-PWI, and SWI may help to increase the accuracy of diagnosis in IDH-mutant astrocytic gliomas. Therefore, the researchers in the present study investigated the usefulness of DWI, SWI, and DSC-PWI in grading IDH-mutant astrocytoma.


In the present study, 107 patients with IDH-mutant astrocytoma who underwent DWI, SWI, and DSC-PWI were retrospectively evaluated. Values for the minimum apparent diffusion coefficient (ADCmin), maximum relative cerebral blood volume (rCBVmax), and intratumoral susceptibility signal intensity (ITSS) were evaluated. ADCmin, ITSS, and rCBVmax values were studied between grade 2 vs. grade 3, grade 3 vs. grade 4, and grade 2 + 3 vs. grade 4 tumors. To rate their diagnostic abilities, receiver operating characteristic (ROC) curve analysis, tenfold cross-validation, and logistic regression were performed.


The results of the present investigation showed that, in comparison to grade 3 tumors, Grade 4 IDH-mutant astrocytoma’s displayed considerably lower ADCmin and greater rCBVmax (adjusted p <0.001). When compared to grade 4 tumors, grade 3 IDH-mutant astrocytomas had considerably reduced ITSS levels (adjusted p <0.001). Grade 2 and grade 3 IDH-mutant astrocytomas had significantly different ITSS levels (adjusted p = 0.002). The highest AUC for differentiating grade 2 and grade 3 cancers from grade 4 tumors was obtained when the ADCmin, ITSS, and rCBVmax were combined.

Impact of research

This study demonstrated that DWI, SWI, and DSC-PWI are useful for assessing the tumor grade in IDH-mutant astrocytomas. The diagnostic precision of grading IDH mutant astrocytomas may be enhanced by the combination of ADCmin, ITSS, and rCBVmax. This study proposed that the combination of these advanced techniques could improve the diagnostic efficacy in grading IDH-mutant astrocytic gliomas.

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