Findings of DTI-p maps in comparison with T2/T2-FLAIR to assess postoperative hyper-signal abnormal regions in patients with glioblastoma

Manijeh Beigi, Mojtaba Safari, Ahmad Ameri, Mohsen Shojaee Moghadam, Azim Arbabi, Morteza Tabatabaeefar and Hamidreza SalighehRad


DTI, Glioblastoma, Isotropic map, Treatment planning


Purpose: The aim of this study was to compare diffusion tensor imaging (DTI) isotropic map (p-map) with current
radiographically (T2/T2-FLAIR) methods based on abnormal hyper-signal size and location of glioblastoma tumor
using a semi-automatic approach.
Materials and methods: Twenty-five patients with biopsy-proved diagnosis of glioblastoma participated in this study.
T2, T2-FLAIR images and diffusion tensor imaging (DTI) were acquired 1 week before radiotherapy. Hyper-signal regions on T2, T2-FLAIR and DTI p-map were segmented by means of semi-automated segmentation. Manual segmentation was used as ground truth. Dice Scores (DS) were calculated for validation of semiautomatic method. Discordance Index (DI) and area difference percentage between the three above regions from the three modalities were calculated for each patient.
Results: Area of abnormality in the p-map was smaller than the corresponding areas in the T2 and T2-FLAIR images in 17 patients; with mean difference percentage of 30 ± 0.15 and 35 ± 0.15, respectively. Abnormal region in the p-map was larger than the corresponding areas in the T2-FLAIR and T2 images in 4 patients; with mean difference percentage of 26 ± 0.17 and 29 ± 0.28, respectively. This region in the p-map was larger than the one in the T2 image and smaller than the one in the T2-FLAIR image in 3 patients; with mean difference percentage of 34 ± 0.08 and 27 ± 0.06, respectively. Lack of concordance was observed ranged from 0.214–0.772 for T2-FLAIR/p-map (average: 0.462 ± 0.18), 0. 266–0.794 for T2 /p-map (average: 0.468 ± 0.13) and 0.123–0.776 for T2/ T2-FLAIR (average: 0.423 ± 0.2). These regions on three modalities were segmented using a semi-automatic segmentation method with over 86% sensitivity, 90% specificity and 89% dice score for three modalities.
Conclusion: It is noted that T2, T2-FLAIR and DTI p-maps represent different but complementary information for
delineation of glioblastoma tumor margins. Therefore, this study suggests DTI p-map modality as a candidate to improve target volume delineation based on conventional modalities, which needs further investigations with follow-up data to be confirmed.