• Yan Bai, Yusong Lin, Jie Tian, Dapeng Shi, Jingliang Cheng, E Mark Haacke, Xiaohua Hong, Bo Ma, Jinyuan Zhou, and Meiyun Wang.
• From the Department of Radiology, Henan Provincial People's Hospital & the People's Hospital of Zhengzhou University, No. 7 Weiwu Road, Zhengzhou, Henan 450003, China (Y.B., D.S., B.M., M.W.); Software Technology School of Zhengzhou University (Y.L.); Institute of Automation, Chinese Academy of Sciences, Beijing, China (J.T.); Division of MRI, First Affiliated Hospital of Zhengzhou University, Zhengzhou Henan, China (J.C.); Department of Radiology, Wayne State University, Detroit, Mich (E.M.H.); Magnetic Resonance Innovations, Detroit, Mich (E.M.H.); and Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Md (X.H., B.M., J.Z., M.W.).
• Radiology. 2016 Feb 1; 278 (2): 496-504.

PurposeTo quantitatively compare the potential of various diffusion parameters obtained from monoexponential, biexponential, and stretched exponential diffusion-weighted imaging models and diffusion kurtosis imaging in the grading of gliomas.Materials And MethodsThis study was approved by the local ethics committee, and written informed consent was obtained from all subjects. Both diffusion-weighted imaging and diffusion kurtosis imaging were performed in 69 patients with pathologically proven gliomas by using a 3-T magnetic resonance (MR) imaging unit. An isotropic apparent diffusion coefficient (ADC), true ADC, pseudo-ADC, and perfusion fraction were calculated from diffusion-weighted images by using a biexponential model. A water molecular diffusion heterogeneity index and distributed diffusion coefficient were calculated from diffusion-weighted images by using a stretched exponential model. Mean diffusivity, fractional anisotropy, and mean kurtosis were calculated from diffusion kurtosis images. All values were compared between high-grade and low-grade gliomas by using a Mann-Whitney U test. Receiver operating characteristic and Spearman rank correlation analysis were used for statistical evaluations.ResultsADC, true ADC, perfusion fraction, water molecular diffusion heterogeneity index, distributed diffusion coefficient, and mean diffusivity values were significantly lower in high-grade gliomas than in low-grade gliomas (U = 109, 56, 129, 6, 206, and 229, respectively; P < .05). Pseudo-ADC and mean kurtosis values were significantly higher in high-grade gliomas than in low-grade gliomas (U = 98 and 8, respectively; P < .05). Both water molecular diffusion heterogeneity index (area under the receiver operating characteristic curve [AUC] = 0.993) and mean kurtosis (AUC = 0.991) had significantly greater AUC values than ADC (AUC = 0.866), mean diffusivity (AUC = 0.722), and fractional anisotropy (AUC = 0.500) in the differentiation of low-grade and high-grade gliomas (P < .05).ConclusionWater molecular diffusion heterogeneity index and mean kurtosis values may provide additional information and improve the grading of gliomas compared with conventional diffusion parameters.© RSNA, 2015.

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