Background/Objectives: The purpose of this study was to evaluate the performance of diffusion kurtosis imaging (DKI), neurite orientation dispersion and density imaging (NODDI), and diffusion microstructure imaging (DMI) in differentiating molecular subtypes of adult-type gliomas.Methods: Standardized MRI was performed and evaluated in 59 patients with adult-type glioma. DKI, NODDI, and DMI parameter values were quantitatively evaluated in ROIs in contrast-enhancing/solid tumor tissue and five concentric shells with peritumoral tissue. DKI, NODDI, and DMI parameters of (i) glioblastomas, Isocitrate dehydrogenase (IDH) wildtype; (ii) astrocytomas, IDH mutant; and (iii) oligodendrogliomas, IDH mutant were compared with analysis of variance (ANOVA). Receiver operating characteristic curve (ROC) curve analysis was conducted to discriminate firstly between IDH mutant and IDH wildtype gliomas and then between IDH mutant astrocytomas and oligodendrogliomas.Results: Significant differences between the three aforementioned subtypes were found for the apparent diffusion coefficient (ADC) and mean kurtosis (MK) and again for the orientation dispersion index (ODI) and intra-axonal volume fraction (v-intra). The diagnostic accuracy depended on the distance to the contrast-enhancing/solid tumor tissue. Some NODDI and DMI parameters significantly predicted the IDH status and significantly discriminated between astrocytomas and oligodendrogliomas; however, ADC and MK showed the best prediction in both ROC analyses (maximum AUC 0.910 (CI 0.824–0.995)).Conclusions: The evaluation of peritumoral tissue can be a valuable procedure, while NODDI and DMI appear to be promising but are currently inferior to DKI in predicting glioma subtypes categorized according to the WHO 2021 classification.
背景/目的：本研究旨在评估扩散峰度成像（DKI）、神经突方向离散度与密度成像（NODDI）以及扩散微结构成像（DMI）在鉴别成人型胶质瘤分子亚型中的效能。方法：对59例成人型胶质瘤患者进行标准化磁共振成像（MRI）检查与评估。在对比增强/实体肿瘤组织及五个同心环状瘤周组织区域内，定量评估DKI、NODDI和DMI参数值。采用方差分析（ANOVA）比较以下三类肿瘤的参数差异：（1）异柠檬酸脱氢酶（IDH）野生型胶质母细胞瘤；（2）IDH突变型星形细胞瘤；（3）IDH突变型少突胶质细胞瘤。通过受试者工作特征曲线（ROC）分析，首先区分IDH突变型与IDH野生型胶质瘤，进而鉴别IDH突变型星形细胞瘤与少突胶质细胞瘤。结果：上述三种亚型在表观扩散系数（ADC）、平均峰度（MK）、方向分散指数（ODI）及轴突内体积分数（v-intra）参数上均存在显著差异。诊断准确性取决于与对比增强/实体肿瘤组织的距离。部分NODDI与DMI参数能显著预测IDH状态并有效区分星形细胞瘤与少突胶质细胞瘤，但在两项ROC分析中，ADC与MK显示出最佳预测效能（最大曲线下面积达0.910，95%置信区间0.824–0.995）。结论：瘤周组织评估具有重要临床价值；NODDI与DMI技术虽展现出应用潜力，但在依据WHO 2021分类标准预测胶质瘤亚型方面，目前仍逊色于DKI技术。
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