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Updated: Feb 25, 2026
Diffusion Tensor Magnetic Resonance Imaging in the Analysis of Neurodegenerative Diseases
Published on: July 28, 2013
Grading and outcome prediction of pediatric diffuse astrocytic tumors with diffusion and arterial spin labeling
Giovanni Morana1, Arnoldo Piccardo2, Domenico Tortora3
1Neuroradiology Unit, Istituto Giannina Gaslini, via G. Gaslini 5, 16147, Genoa, Italy. giovannimorana@gaslini.org.
Purpose:
The aim of this study was to investigate MRI-derived diffusion weighted imaging (DWI) and arterial spin labeling (ASL) perfusion imaging in comparison with 18F-dihydroxyphenylalanine (DOPA) PET with respect to diagnostic performance in tumor grading and outcome prediction in pediatric patients with diffuse astrocytic tumors (DAT).
Methods:
We retrospectively analyzed 26 children with histologically proven treatment naïve low and high grade DAT who underwent ASL and DWI performed within 2 weeks of 18F-DOPA PET. Relative ASL-derived cerebral blood flow max (rCBF max) and DWI-derived minimum apparent diffusion coefficient (rADC min) were compared with 18F-DOPA uptake tumor/normal tissue (T/N) and tumor/striatum (T/S) ratios, and correlated with World Health Organization (WHO) tumor grade and progression-free survival (PFS). Statistics included Pearson's chi-square and Mann-Whitney U tests, Spearman's rank correlation, receiver operating characteristic (ROC) analysis, discriminant function analysis (DFA), Kaplan-Meier survival curve, and Cox analysis.
Results:
A significant correlation was demonstrated between rCBF max, rADC min, and 18F-DOPA PET data (p < 0.001). Significant differences in terms of rCBF max, rADC min, and 18F-DOPA uptake were found between low- and high-grade DAT (p ≤ 0.001). ROC analysis and DFA demonstrated that T/S and T/N values were the best parameters for predicting tumor progression (AUC 0.93, p < 0.001). On univariate analysis, all diagnostic tools correlated with PFS (p ≤ 0.001); however, on multivariate analysis, only 18F-DOPA uptake remained significantly associated with outcome (p ≤ 0.03), while a trend emerged for rCBF max (p = 0.09) and rADC min (p = 0.08). The combination of MRI and PET data increased the predictive power for prognosticating tumor progression (AUC 0.97, p < 0.001).
Conclusions:
DWI, ASL and 18F-DOPA PET provide useful complementary information for pediatric DAT grading. 18F-DOPA uptake better correlates with PFS prediction. Combining MRI and PET data provides the highest predictive power for prognosticating tumor progression suggesting a synergistic role of these diagnostic tools.
Insights
MRI-derived diffusion weighted imaging (DWI) and arterial spin labeling (ASL), along with 18F-DOPA PET, aid in grading pediatric diffuse astrocytic tumors (DAT). Combining these imaging techniques offers the highest accuracy for predicting tumor progression and patient outcomes.
Area of Science:
- Neuro-oncology
- Medical imaging
- Pediatric oncology
Background:
- Diffuse astrocytic tumors (DAT) are a significant challenge in pediatric neuro-oncology.
- Accurate tumor grading and outcome prediction are crucial for effective treatment planning in pediatric DAT.
- Advanced imaging techniques are needed to non-invasively assess DAT characteristics.
Purpose of the Study:
- To compare the diagnostic performance of MRI-derived diffusion weighted imaging (DWI) and arterial spin labeling (ASL) perfusion imaging with 18F-dihydroxyphenylalanine (DOPA) Positron Emission Tomography (PET).
- To evaluate the utility of these imaging modalities in tumor grading and outcome prediction for pediatric DAT.
- To determine the synergistic role of combined MRI and PET data in prognosticating tumor progression.
Main Methods:
- Retrospective analysis of 26 treatment-naïve pediatric DAT patients.
- Comparison of ASL-derived relative cerebral blood flow max (rCBF max) and DWI-derived minimum apparent diffusion coefficient (rADC min) with 18F-DOPA PET uptake ratios (tumor/normal tissue [T/N] and tumor/striatum [T/S]).
- Correlation with World Health Organization (WHO) tumor grade and progression-free survival (PFS) using statistical analyses including ROC and DFA.
Main Results:
- Significant correlations were found between rCBF max, rADC min, and 18F-DOPA PET data (p < 0.001).
- Distinct differences in imaging parameters were observed between low- and high-grade DAT (p ≤ 0.001).
- 18F-DOPA uptake (T/S and T/N) showed the highest accuracy in predicting tumor progression (AUC 0.93). The combination of MRI and PET data achieved superior prediction (AUC 0.97).
Conclusions:
- DWI, ASL, and 18F-DOPA PET provide complementary information for pediatric DAT grading.
- 18F-DOPA PET uptake is a strong predictor of progression-free survival.
- Combining MRI and PET imaging enhances the predictive power for tumor progression, indicating a synergistic diagnostic role.
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