Comparative Analysis of Diffusional Kurtosis Imaging, Diffusion Tensor Imaging, and Diffusion-Weighted Imaging in Grading and Assessing Cellular Proliferation of Meningiomas

L Lin, R Bhawana, Y Xue, Q Duan, R Jiang, H Chen, X Chen, B Sun, H Lin

An accurate evaluation of the World Health Organization grade and cellular proliferation is particularly important in meningiomas. Our aim was to prospectively evaluate and compare diffusional kurtosis imaging, DTI, and DWI metrics in determining the grade and cellular proliferation of meningiomas. Ninety-six consecutive patients with histopathologically confirmed meningiomas were included in this study. Mean kurtosis, radial kurtosis, axial kurtosis, fractional anisotropy, mean diffusivity, and ADC were semiautomatically obtained in the solid components of tumors. Each normalized diffusion value was compared between high-grade meningiomas and low-grade meningiomas using the Mann-Whitney U test. Receiver operating characteristic, multiple logistic regression, and Pearson correlation analysis were used for statistical evaluations. Diffusional kurtosis imaging metrics (mean kurtosis, radial kurtosis, and axial kurtosis) were significantly higher in high-grade meningiomas than in low-grade meningiomas (P ≤ .001). Mean diffusivity and ADC were significantly lower in high-grade meningiomas than in low-grade meningiomas (P = .003 and .002). Mean kurtosis had significantly greater area the under curve values than mean diffusivity and fractional anisotropy in differentiating high-grade meningiomas from low-grade meningiomas (P = .038 and .002). Mean kurtosis was the only variable that could be used to independently differentiate high-grade meningiomas and low-grade meningiomas (P < .001). Significant correlations were found between the Ki-67 labeling index and kurtosis metrics (P < .001), as well as for mean diffusivity and ADC (P = .004, and .007). Compared with other diffusion metrics, mean kurtosis may serve as an optimal parameter for evaluating and predicting the meningioma grade. Moreover, diffusion metrics may potentially reflect cellular proliferation.