On differentiation between vasogenic edema and non-enhancing tumor in high-grade glioma patients using a support...

High 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.

This 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.

Histology 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.

The 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.