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Peer-reviewedCC BY-NC-NDBMC medical imaging

Multiparametric MRI with DWI, SWI, and DSC-PWI for preoperative prediction of Ki-67, IDH, and ATRX in adult-type diffuse gliomas.

  • Muhammet Arif Kursun1
  • Begumhan Baysal2
  • Gulnihal Ay3
  • Fatih Calis4
  • Mehmet Sabri Gurbuz4
4 affiliations
  1. 1Department of Radiology, Faculty of Medicine, Istanbul Medeniyet University, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Fahrettin Kerim Gokay Street No:161 Kadikoy, İstanbul, 34722, Türkiye.
  2. 2Department of Radiology, Faculty of Medicine, Istanbul Medeniyet University, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Fahrettin Kerim Gokay Street No:161 Kadikoy, İstanbul, 34722, Türkiye. [email protected].
  3. 3Department of Pathology, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Türkiye.
  4. 4Department of Neurosurgery, Faculty of Medicine, Istanbul Medeniyet University, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Türkiye.
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Abstract

Background

Imaging-based assessment of proliferative and molecular features in adult-type diffuse gliomas may support preoperative tumor characterization. This study evaluated conventional MRI combined with diffusion-weighted imaging (DWI), susceptibility-weighted imaging (SWI), and dynamic susceptibility contrast perfusion-weighted imaging (DSC-PWI) for their associations with Ki-67 index, IDH status, and ATRX expression status.Materials and methods

This retrospective study included 126 patients with adult-type diffuse gliomas who underwent conventional MRI, DWI, and SWI; rCBV from DSC-PWI was available in 59 patients. Quantitative ADC and rCBV measurements were independently performed by two readers. Histopathological and molecular data were obtained from pathology reports. Ki-67 expression was dichotomized as low (< 10%) and high (≥ 10%). ROC analysis assessed the diagnostic performance of MRI parameters for high Ki-67 expression and WHO grade ≥ 3 tumors; sensitivity analyses were performed using alternative Ki-67 thresholds of ≥ 15%, ≥ 20%, ≥ 25%, and ≥ 30%. Potential selection bias related to rCBV availability was assessed, and multivariable logistic regression was performed.Results

Among 126 patients, 84.1% had WHO grade 4 tumors. ADCmin, rADCmin, ADCmean, and rADCmean were significantly lower, whereas rCBVmax and ITSS grade were significantly higher, in tumors with high Ki-67 expression (all p < 0.001). High Ki-67 expression was also associated with necrosis, peritumoral edema, and heterogeneous enhancement. ADC-derived parameters differed significantly between IDH-mutant and IDH-wildtype tumors. rCBVmax was higher in tumors with retained ATRX expression (p = 0.016). rCBVmax showed the highest diagnostic performance for high Ki-67 expression (AUC = 0.967; 95% CI: 0.920-1.000). In multivariable analysis, lower ADCmin and rADCmin remained independently associated with high Ki-67 expression, whereas ITSS grade did not. Interobserver agreement was excellent for quantitative ADC and rCBV measurements.Conclusion

Multiparametric MRI features, particularly diffusion-derived metrics and rCBVmax, were associated with proliferative activity in adult-type diffuse gliomas and may support preoperative noninvasive tumor characterization, but validation in larger and more balanced cohorts is required.

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Cite

BibTeXRIS
BibTeX
@article{kursun2026multiparametric,
  title = {{Multiparametric MRI with DWI, SWI, and DSC-PWI for preoperative prediction of Ki-67, IDH, and ATRX in adult-type diffuse gliomas.}},
  author = {Muhammet Arif Kursun and Begumhan Baysal and Gulnihal Ay and Fatih Calis and Mehmet Sabri Gurbuz},
  journal = {BMC medical imaging},
  year = {2026},
  month = jul,
  doi = {10.1186/s12880-026-02607-6},
  url = {https://europepmc.org/article/MED/42928153},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Multiparametric MRI with DWI, SWI, and DSC-PWI for preoperative prediction of Ki-67, IDH, and ATRX in adult-type diffuse gliomas.
AU  - Muhammet Arif Kursun
AU  - Begumhan Baysal
AU  - Gulnihal Ay
AU  - Fatih Calis
AU  - Mehmet Sabri Gurbuz
PY  - 2026
DA  - 2026/07/23
JO  - BMC medical imaging
DO  - 10.1186/s12880-026-02607-6
UR  - https://europepmc.org/article/MED/42928153
AB  - Background  Imaging-based assessment of proliferative and molecular features in adult-type diffuse gliomas may support preoperative tumor characterization. This study evaluated conventional MRI combined with diffusion-weighted imaging (DWI), susceptibility-weighted imaging (SWI), and dynamic susceptibility contrast perfusion-weighted imaging (DSC-PWI) for their associations with Ki-67 index, IDH status, and ATRX expression status.Materials and methods  This retrospective study included 126 patients with adult-type diffuse gliomas who underwent conventional MRI, DWI, and SWI; rCBV from DSC-PWI was available in 59 patients. Quantitative ADC and rCBV measurements were independently performed by two readers. Histopathological and molecular data were obtained from pathology reports. Ki-67 expression was dichotomized as low (< 10%) and high (≥ 10%). ROC analysis assessed the diagnostic performance of MRI parameters for high Ki-67 expression and WHO grade ≥ 3 tumors; sensitivity analyses were performed using alternative Ki-67 thresholds of ≥ 15%, ≥ 20%, ≥ 25%, and ≥ 30%. Potential selection bias related to rCBV availability was assessed, and multivariable logistic regression was performed.Results  Among 126 patients, 84.1% had WHO grade 4 tumors. ADCmin, rADCmin, ADCmean, and rADCmean were significantly lower, whereas rCBVmax and ITSS grade were significantly higher, in tumors with high Ki-67 expression (all p < 0.001). High Ki-67 expression was also associated with necrosis, peritumoral edema, and heterogeneous enhancement. ADC-derived parameters differed significantly between IDH-mutant and IDH-wildtype tumors. rCBVmax was higher in tumors with retained ATRX expression (p = 0.016). rCBVmax showed the highest diagnostic performance for high Ki-67 expression (AUC = 0.967; 95% CI: 0.920-1.000). In multivariable analysis, lower ADCmin and rADCmin remained independently associated with high Ki-67 expression, whereas ITSS grade did not. Interobserver agreement was excellent for quantitative ADC and rCBV measurements.Conclusion  Multiparametric MRI features, particularly diffusion-derived metrics and rCBVmax, were associated with proliferative activity in adult-type diffuse gliomas and may support preoperative noninvasive tumor characterization, but validation in larger and more balanced cohorts is required.
SN  - 1471-2342
ER  -