Neurooncol Adv. 2025 Jan-Dec;7(1):7(1): vdaf076
Urs Würtemberger,
Alexander Rau,
Marco Reisert,
Lucas Becker,
Samer Elsheikh,
Till-Karsten Hauser,
Jürgen Grauvogel,
Marc Hohenhaus,
Daniel Erny,
Horst Urbach,
Theo Demerath,
Martin Diebold.
Background: Microstructural tumor characteristics discriminate metastases, glioblastoma, meningioma, and primary CNS lymphoma. We aimed to assess these intracranial neoplasms utilizing multiparametric diffusion imaging as a translational measure of morphology.
Methods: We investigated 101 newly diagnosed intracranial tumors (35 metastases, 34 glioblastomas [GB], 21 meningiomas, 11 primary CNS lymphomas [PCNSL]) with advanced diffusion MRI including Diffusion Tensor Imaging (DTI), Neurite Orientation and Dispersion Density Imaging (NODDI), and Diffusion Microstructure Imaging (DMI). Beyond DTI-derived metrics (aD, fractional anisotropy [FA], mD, rD), we extracted the NODDI and DMI intra-axonal (NODDI intra-cellular volume fraction, DMI V-intra), extra-axonal cellular (DMI V-extra), and free water (NODDI ISO-VF, DMI V-CSF) fractions using a multi-compartment model. These metrics were read from contrast-enhancing tumor portions and compared across the entities.
Results: Various microstructural parameters served as effective discriminators in pairwise comparisons: ISO-VF demonstrated high accuracy in distinguishing metastases from PCNSL (accuracy 90.13%) and meningiomas (accuracy 80.69%). aD was most accurate in discriminating GB from PCNSL (accuracy 89.57%) and meningioma from PCNSL (accuracy 74.03%), similar to MD which distinguished GB from meningiomas (accuracy 77.73%). FA performed best in discriminating GB from metastases (accuracy 83.11%). Discrimination on two axes of directionality and compartmentalization illustrate the comprehensive approach to tumor assessment.
Conclusion: Advanced microstructural imaging facilitates discrimination of four common intracranial neoplasms. Features such as cell density, extent of free water, and directional cellular elements are reflected in the diffusion metrics to varying degrees. As part of a first non-invasive assessment, they may direct early diagnostic and therapeutic procedures.
Keywords: DMI; DTI; NODDI; brain tumor; diffusion microstructure imaging