, Volume 60, Issue 4, pp 391–401 | Cite as

Usefulness of perfusion- and diffusion-weighted imaging to differentiate between pilocytic astrocytomas and high-grade gliomas: a multicenter study in Japan

  • Kazufumi Kikuchi
  • Akio Hiwatashi
  • Osamu Togao
  • Koji Yamashita
  • Ryotaro Kamei
  • Mika Kitajima
  • Masafumi Kanoto
  • Hiroto Takahashi
  • Yusuke Uchiyama
  • Masafumi Harada
  • Yuki Shinohara
  • Takashi Yoshiura
  • Yuki Wakata
  • Hiroshi Honda
Diagnostic Neuroradiology



Imaging findings of pilocytic astrocytoma (PA) vary widely, sometimes resembling those of high-grade glioma (HGG). This study aimed to identify the imaging parameters that can be used to differentiate PA from HGG.


Altogether, 60 patients with PAs and 138 patients with HGGs were included in the study. Tumor properties and the presence of hydrocephalus, peritumoral edema, and dissemination were evaluated. We also measured the maximum relative cerebral blood flow (rCBFmax) and volume (rCBVmax) and determined the minimum apparent diffusion coefficient (ADCmin) in the tumor’s solid components. The relative T1 (rT1), T2 (rT2), and contrast-enhanced T1 (rCE-T1) intensity values were evaluated. Parameters were compared between PAs and HGGs using the Mann–Whitney U test. Receiver operating characteristic (ROC) curve analysis was also used to evaluate these imaging parameters. A value of P < .05 was considered to indicate significance.


Intratumoral hemorrhage and calcification were observed in 10.0% and 21.7% of PAs, respectively. The rCBFmax and rCBVmax values were significantly lower in PAs (0.50 ± 0.35, 1.82 ± 1.21) than those in HGGs (2.98 ± 1.80, 9.54 ± 6.88) (P < .0001, P = .0002, respectively). The ADCmin values were significantly higher in PAs (1.36 ± 0.56 × 10−3 mm2/s) than those in HGGs (0.86 ± 0.37 × 10−3 mm2/s) (P < .0001). ROC analysis showed that the best diagnostic performance was achieved with rCBFmax.


The rCBFmax, rCBVmax, and ADCmin can differentiate PAs from HGGs.


Pilocytic astrocytoma High-grade glioma Multicenter study Perfusion-weighted imaging Diffusion-weighted imaging 


Compliance with ethical standards


This study was funded by Bayer Yakuhin Ltd. The study data were independently analyzed and interpreted by the funder.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Informed consent

For this type of retrospective study formal consent is not required.

Supplementary material

234_2018_1991_FIG4_ESM.gif (402 kb)
Supplementary Figure S1

Placement of regions of interests (ROIs). Neuroradiologists in each institution independently placed three circular ROIs (circles, at left) in the solid component of a tumor. Cystic, necrotic, or hemorrhagic components were avoided with reference to conventional magnetic resonance imaging. An ROI (single circle, at right) was also placed in the contralateral normal-appearing gray matter. (GIF 402 kb)

234_2018_1991_MOESM1_ESM.tif (2.7 mb)
High resolution (TIFF 2753 kb)
234_2018_1991_FIG5_ESM.gif (9 kb)
Supplementary Figure S2

ROC analysis of all pilocytic astrocytomas and high-grade gliomas. ROC analysis shows the best diagnostic performance with rCBFmax. Sensitivity, specificity, and area under the curve are 100%, 91.7%, and 0.98 for rCBFmax; 100%, 76.7%, and 0.92 for rCBVmax; 63.3%, 91.3%, and 0.78 for ADCmin; 41.7%, 79.0%, and 0.60 for rT1; 30.0%, 83.3%, and 0.55 for rCE-T1; and 30.0%, 78.3%, and 0.51 for rT2, respectively. ROC receiver operating characteristic, rCBF max maximum relative cerebral blood flow, AUC area under the curve, rCBV max maximum relative cerebral blood flow, ADC min minimum apparent diffusion coefficient, rT1 relative non-contrast T1-weighted imaging, rT2 relative T2-weighted imaging, rCE-T1 relative contrast-enhanced T1-weighted imaging (GIF 8 kb)

234_2018_1991_MOESM2_ESM.tif (260 kb)
High resolution (TIFF 260 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Kazufumi Kikuchi
    • 1
  • Akio Hiwatashi
    • 1
  • Osamu Togao
    • 1
  • Koji Yamashita
    • 1
  • Ryotaro Kamei
    • 1
  • Mika Kitajima
    • 2
  • Masafumi Kanoto
    • 3
  • Hiroto Takahashi
    • 4
  • Yusuke Uchiyama
    • 5
  • Masafumi Harada
    • 6
  • Yuki Shinohara
    • 7
  • Takashi Yoshiura
    • 8
  • Yuki Wakata
    • 9
  • Hiroshi Honda
    • 1
  1. 1.Department of Clinical Radiology, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
  2. 2.Department of Diagnostic Radiology, Graduate School of Medical SciencesKumamoto UniversityKumamotoJapan
  3. 3.Department of Radiology, Division of Diagnostic RadiologyYamagata University Graduate School of Medical Science MedicineYamagataJapan
  4. 4.Department of RadiologyOsaka University Graduate School of MedicineSuitaJapan
  5. 5.Department of RadiologyKurume University School of MedicineKurumeJapan
  6. 6.Department of Radiology and Radiation Oncology, Graduate School of Biomedical SciencesTokushima UniversityTokushimaJapan
  7. 7.Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of MedicineTottori UniversityTottoriJapan
  8. 8.Department of Radiology, Graduate School of Medical and Dental SciencesKagoshima UniversityKagoshimaJapan
  9. 9.Department of RadiologyHyogo College of MedicineNishinomiyaJapan

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