MR-IMAGING OF HIGH-GRADE CEREBRAL GLIOMAS - VALUE OF DIFFUSION-WEIGHTED ECHOPLANAR PULSE SEQUENCES

OBJECTIVE. The purpose of this study was to evaluate the usefulness of diffusion-weighted echoplanar MR imaging in the examination of high-g rade brain gliomas compared with that of conventional spin-echo (SE) o r fast spin-echo (FSE) MR imaging. We hypothesize that diffusion-weigh ted MR imaging may enable us to differentiate various tumor components on the basis of differences in the diffusion of water. SUBJECTS AND M ETHODS. Conventional SE and FSE MR images were obtained in 10 patients with high-grade brain glioma. Diffusion-weighted echoplanar MR images were obtained with a head gradient coil capable of providing diffusio n-weighted imaging along the cephalocaudal axis. Using SE and FSE MR i mages as a baseline, we evaluated the diffusion weighted MR images for usefulness in distinguishing tumor components on the basis of differe nces in diffusion. RESULTS. Areas of tumor that showed significant enh ancement on T1-weighted SE MR images obtained after injection of contr ast material were markedly hyperintense on diffusion-weighted images a nd had a lower apparent diffusion coefficient (ADC) than the ADCs for nonenhancing tumor and peritumoral edema. Cystic or necrotic portions of tumor showed the most signal suppression on diffusion-weighted imag es and were associated with the highest ADCs. On TP-weighted FSE MR im ages, areas of hyperintensity observed in white matter oriented parall el to the direction of the diffusion gradient could be differentiated into two patterns on the basis of findings on diffusion-weighted image s: areas that showed marked signal suppression with a higher ADC, most likely representing areas of predominantly peritumoral edema, and are as that showed a lesser degree of signal suppression with similar but slightly lower ADCs than those of edema, most likely representing area s of predominantly nonenhancing tumor. CONCLUSION. Diffusion-weighted echoplanar MR imaging is a useful technique for examining high-grade c erebral gliomas. It enabled us to differentiate various components of the tumor (e.g., enhancing, nonenhancing, cystic, or necrotic) and to distinguish areas of predominantly nonenhancing tumor from areas of pr edominantly peritumoral edema when the abnormality was located in the white matter aligned in the direction of the diffusion-weighted gradie nt. Diffusion-weighted echoplanar MR imaging appears to be a powerful tool in the characterization of brain neoplasms.