Diagnostic utility of fractional anisotropy in differentiating glioma grades

Abstract

Objective: This study investigates the diagnostic potential of fractional anisotropy (FA), derived from diffusion tensor imaging (DTI), for distinguishing low-grade (grade 1–2) from high-grade (grade 3–4) gliomas by evaluating the tumor core, tumor margin, and peritumoral region. Patients and Methods: Sixty patients with histopathologically confirmed gliomas (grade 1–2, n=30; grade 3–4, n=30) underwent preoperative 3T Magnetic Resonance Imaging (MRI) including DTI. FA was measured in the tumor core (solid component), tumor margin, peritumoral region, and contralateral normal-appearing white matter (NAWM). NAWM-normalized FA ratios were also evaluated. Groups were compared using independent-samples t tests, and diagnostic performance was evaluated with receiver operating characteristic (ROC) analysis including AUC, optimal cut-off, sensitivity, and specificity. Results: Fractional anisotropy in tumor-related regions was lower than contralateral NAWM in both groups. Grade 3–4 gliomas showed significantly lower raw FA in the tumor core, tumor margin, and peritumoral region, whereas NAWM FA did not differ between groups. NAWM-normalized FA ratios were also significantly reduced in grade 3–4 gliomas (all p < 0.05). Tumor core raw FA showed the highest discrimination (AUC = 0.842, 95% CI: 0.734–0.932, cut-off = 0.150, sensitivity = 0.80, specificity = 0.73). Conclusion: Raw and NAWM-normalized FA metrics, particularly in the tumor core and peritumoral region, differentiated grade 1–2 from grade 3–4 gliomas and may serve as supportive noninvasive markers for preoperative grading.

Keywords

• Diffusion tensor imaging
• Fractional anisotropy
• Glioma
• Tumor grading

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