Application Value Of Diffusion Kurtosis Imaging(DKI) In Distinguishing Progressive And Pseudoprogression Of Glioma

Objective To investigate the clinical application value of diffusion kurtosis imaging(DKI)in differentiating progressive disease(PD)from pseudoprogression(PsP)in glioma patients.Methods After informed consent of the patients,a total of 40 patients with glioma who received surgical treatment and postoperative radiotherapy and chemotherapy in General Hospital of Ningxia Medical University from October 2018 to December 2020 were retrospectively collected through inclusion and exclusion criteria.All patients received conventional magnetic resonance imaging and DKI sequence scanning.Forty patients were divided into PD group(24 cases)and PsP group(16 cases)through secondary surgical pathology or MRI enhanced scan follow-up for more than 6 months.Mean kurtosis(MK),axial kurtosis(AK),radial kurtosis(RK),mean diffusion coefficient(MD)and fractional anisotropy(FA)of DKI values in enhanced lesions and periumoral edema were measured in PD group and PSP group,respectively.Two independent samples t-test or Mann-Whitneyu test were used to compare the differences of each parameter value between glioma PD and PsP.Receiver operating characteristic curves(ROC)were drawn to evaluate the differential diagnostic efficacy of each parameter.The area under the curve(AUC),optimal diagnostic threshold,sensitivity and specificity of different parameter values were calculated.Results1.The relative mean kurtosis value(r MK)and relative radial kurtosis value(r RK)of enhanced lesions in the glioma PD group were significantly higher than those in the PsP group(P < 0.001,P < 0.001),and the relative mean diffusion value(r MD)was significantly lower than that in the PsP group(P = 0.025).Comparing the area under curve of r RK value and r MD value(AUC=0.828,AUC=0.701),the area under curve of r MK value was the largest(AUC=0.935).When 0.801 was used as the optimal diagnostic threshold,the sensitivity and specificity of diagnosis were 87.50% and 99.37%,respectively.2.The relative mean kurtosis value(r MK)was significantly higher in the glioma PD group than that in the PsP group(P <0.001),and the relative mean diffusion coefficient(r MD)was significantly lower in the PsP group than that in the PsP group(P=0.012).Compared with the area under the curve of r MD value(AUC=0.734),the area under the curve of r MK value was larger(AUC=0.816).When 0.817 was used as the optimal diagnostic threshold,the sensitivity and specificity of diagnosis were 79.20% and 78.70%,respectively.Conclusion1.In enhanced lesions of glioma PD and PsP patients,DKI parameter values MK,RK and DTI parameter values MD have differential diagnostic value.Compared with PsP patients,MK and RK values of enhanced lesions of glioma PD patients are increased,while MD value is decreased.2.In the periumoral edema of glioma patients with PD and PsP,the parameter value of DKI(MK)and the parameter value of DTI(MD)are of differential diagnostic value.Compared with PsP patients,the MK value of PD patients with periumoral edema is increased,while the MD value is decreased.3.DKI technique has good sensitivity and specificity in differentiating PD from PsP in glioma,among which the parameter value MK of DKI has the highest diagnostic efficiency and may be used as a better independent predictor in the future.