• Anirban Sengupta, Sumeet Agarwal, Pradeep Kumar Gupta, Sunita Ahlawat, Rana Patir, Rakesh Kumar Gupta, and Anup Singh.
• Centre for Biomedical Engineering, IIT Delhi, New Delhi, India.
• Eur J Radiol. 2018 Sep 1; 106: 199-208.

PurposeHigh grade gliomas (HGGs) are infiltrative in nature. Differentiation between vasogenic edema and non-contrast enhancing tumor is difficult as both appear hyperintense in T2-W/FLAIR images. Most studies involving differentiation between vasogenic edema and non-enhancing tumor consider radiologist-based tumor delineation as the ground truth. However, analysis by a radiologist can be subjective and there remain both inter- and intra-rater differences. The objective of the current study is to develop a methodology for differentiation between non-enhancing tumor and vasogenic edema in HGG patients based on T1 perfusion MRI parameters, using a ground truth which is independent of a radiologist's manual delineation of the tumor.Material And MethodsThis study included 9 HGG patients with pre- and post-surgery MRI data and 9 metastasis patients with pre-surgery MRI data. MRI data included conventional T1-W, T2-W, and FLAIR images and DCE-MRI dynamic images. In this study, the authors hypothesize that surgeried non-enhancing FLAIR hyperintense tissue, which was obtained using pre- and post-surgery MRI images of glioma patients, should be largely comprised of non-enhancing tumor. Hence this could be used as an alternative ground truth for the non-enhancing tumor region. Histological examination of the resected tissue was done for validation. Vasogenic edema was obtained from the non-enhancing FLAIR hyperintense region of metastasis patients, as they have a clear boundary between enhancing tumor and edema. DCE-MRI data analysis was performed to obtain T1 perfusion MRI parameters. Support Vector Machine (SVM) classification was performed using T1 perfusion MRI parameters to differentiate between non-enhancing tumor and vasogenic edema. Receiver-operating-characteristic (ROC) analysis was done on the results of the SVM classifier. For improved classification accuracy, the SVM output was post-processed via neighborhood smoothing.ResultsHistology results showed that resected tissue consists largely of tumorous tissue with 7.21 ± 4.05% edema and a small amount of healthy tissue. SVM-based classification provided a misclassification error of 8.4% in differentiation between non-enhancing tumor and vasogenic edema, which was further reduced to 2.4% using neighborhood smoothing.ConclusionThe current study proposes a semiautomatic method for segmentation between non-enhancing tumor and vasogenic edema in HGG patients, based on an SVM classifier trained on an alternative ground truth to a radiologist's manual delineation of a tumor. The proposed methodology may prove to be a useful tool for pre- and post-operative evaluation of glioma patients.Copyright © 2018 Elsevier B.V. All rights reserved.

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