Diagnostic Value of Apparent Diffusion Coefficient Statistics in Differentiating the Glioblastoma Tumors with an Oligodendroglioma and Glioblastomas Without Such Moiety


avatar Mersad Mehrnahad 1 , * , avatar Morteza Sanei Taheri ORCID 2 , avatar Farnaz Kimia 1 , avatar Hamidreza Saligheh Rad 3 , avatar Robabeh Ghodssi GhassemAbadi 4

Department of Radiology, Qom University of Medical Sciences, Qom, Iran
Department of Radiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Quantitative MR Imaging and Spectroscopy Group (QMISG), Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Tehran, Iran
Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran

how to cite: Mehrnahad M, Sanei Taheri M, Kimia F, Saligheh Rad H, Ghodssi GhassemAbadi R. Diagnostic Value of Apparent Diffusion Coefficient Statistics in Differentiating the Glioblastoma Tumors with an Oligodendroglioma and Glioblastomas Without Such Moiety. Int J Cancer Manag. 2023;16(1):e119301. https://doi.org/10.5812/ijcm-119301.



Differentiating types of brain tumors using magnetic resonance imaging (MRI) as a non-invasive element is essential.


The study aimed at evaluating the difference in the first-order histogram (FOH) features obtained from apparent diffusion coefficients (ADCs) between glioblastoma (GBM) tumors with or without oligodendroglial (ODG) components.


MRIs were taken before surgical resection of the brain tumors. The brain lesions were analyzed and ADC maps were plotted to calculate FOH. Brain lesions were surgically removed, diagnosed using pathological methods, and categorized as GBM with an ODG (GBM-ODG) or without ODG. A comparison of ADC values was performed between GBM-ODG and GBM. Receiver-operator characteristic (ROC) curves were used to determine the cut-off sensitivity and specificity values.


In the GBM group, 26 patients were included; 20 cases were male and 6 were female; the mean ± SD of age was 54.1 ± 1.2 and 55.2 ± 1.6 years, respectively. In the GBM-ODG group, 31 patients were included; 22 cases were male and 9 cases were female; the mean ± SD of 52.1 ± 0.8 and 55.3 ± 1.5 years, respectively. The results of peritumoral edema had several significant FOHs. In the MRIs of tumor and T1W groups, the third moment and minimum-ADC had significant results, respectively. Cut-off values of the FOHs were statistically significant outcomes in the peritumoral edema region when compared between GBM-ODG and GBM categories: Median > 1.3516, normal mean > 0.6671, third moment ≤ -0.0001, 25 percentile > 0.5929, 75 percentile > 0.7336, and 95 percentile > 0.8542. The highest sensitivity and specificity values for these FOHs were higher than 80% and sometimes near 99.9%.


The results showed that ADC values from peritumoral edema regions differ between these two types of tumors. Then, an MRI from the edematous areas is suggested when evaluating the patient's status and deciding to make interventions.

1. Background

When selecting proper interventional approaches, distinguishing the brain’s tumor types is essential for clinicians. Radiological methods and indices may play a good role in this area of diagnosis, as mentioned in a few previous published articles (1-3). These methods are necessary, especially because of relieving neurosurgeons to make operations only for diagnosis for curing, lowering the risk of interventions (4). GBM differential diagnosis using radiological evaluations is essential because of its high prevalence among adults (5). Oligodendrocytes produce the myelin material supporting the axons of the neuronal cells; with myelin's help, electrical conductivity is facilitated in the central nervous system (6). Oligodendroglial tumors develop when the oligodendrocytes become malignant. The ODG may be detectable using diffusion-weighed imaging (DWI) (7). The ADC, calculated for DWIs, has been mentioned to help diagnose some brain tumors (7-10). In addition to the images prepared from MRI from tumoral regions, with or without enhancing material, the photos from peritumoral edema have been mentioned to be worth diagnosing brain lesions and tumors (8, 11, 12). However, reports are rare in comparing ADC values among MRIs from oligodendroglial tumors without enhancement and images from edematous regions.

This study hypothesized that as the ADC values obtained from images relating to the water diffusion in the brain environment, each tumor and its environment could have its specific behavior; this behavior may help differentiate the GBM from GBMs with ODG.

2. Objectives

The present study aimed at comparing the FOHs, from ADC statistical values between GBM tumors and GBMs containing ODG components (GBM-ODG). The study purposed to analyze the MRIs from flair images of tumors, gadopentetate dimeglumine-enhanced pictures of tumors, and MRIs from edematous regions. Also, the study aimed at assessing some cut-off values for the FOH feature that could be valuable for the clinical radiologist, who reports information such as the tumor type, GBM, or GMB-ODG to a neurosurgeon.

3. Methods

3.1. Studied Groups

The Institutional Review Board approved this study. According to the surgical pathology results and three radiologic patterns, two types of malignancies were studied: 1. Flair images from tumoral regions in GBM and GBM-ODG groups (tumor group); 2. gadopentetate dimeglumine enhanced T1-weighted MRI images in GBM and GBM-ODG groups (T1W+GAD group); and 3. MRIs from peritumoral edematous regions in GBM and GBM-ODG groups (edema group). In total, 134 MRIs were studied, 57 of which were in the tumor group (GBM = 26 and GBM-ODG = 31 MRIs), 50 were in the T1W+GAD group (GBM = 26 and GBM-ODG = 24 MRIs), and 27 MRIs were in the edema group (GBM = 10 and GBM-ODG = 17 MRIs).

3.2. Magnetic Resonance Imaging

MRI (magnetic resonance imaging) was done, using a 1.5 Tesla machine (Siemens®, Avanto, Rel 16.0). Contrast-enhanced images were taken after administration of gadopentetate dimeglumine intravenously and with a concentration of 0.1 mmol/Kg of body weight. In 3 orthogonal directions, diffusion-weighted photos of the axial plan were taken, using the T2-weighted protocol. A highly experienced radiologist reviewed MRIs, and regions of interest (ROI) were selected for ADC statistical features calculations. As the control ADC values, the radiologist determined the white matter or contralateral hemisphere with average views (Figure 1).

Schematic presentation represents 3 types of MRI evaluation. Left: Tumor and edema group MRI without contrast. Right: Contrast-enhanced imaging performed at T1 weighted imaging.
Schematic presentation represents 3 types of MRI evaluation. Left: Tumor and edema group MRI without contrast. Right: Contrast-enhanced imaging performed at T1 weighted imaging.

3.3. MRI Analysis and First-Order Histogram Features

FOHs (first-order histogram) were calculated from ADC values; for this purpose, the pixel in the selected ROIs was considered independently from neighbor ones. ROIs were chosen via the manual method, and each pixel's gray level within ROIs was the base of ADC statistical calculations. In the contrast-enhanced T1W and spin-echo images, the margin of tumors and enhanced regions were manually selected. The experienced radiologist was blinded to the patient’s identities, surgical pathology results, and the purpose of the study. Edematous areas also were included in the delineation selection and determining ROIs in each slice.

FMRIB Software Library v5.0 was used for similarity measure analysis of ADC maps. The ADC maps were submitted digitally to the picture archiving and communication systems (PACS) database in medicine. The image analysis was done, using ImageJ offline software accessible on the URL: https://rsb.info