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Selective Size Imaging via Diffusion MRI for Preoperative IDH Mutation Status, Grading, and Progression‐Free Survival Risk Stratification in Adult‐Type Diffuse Glioma

Year: 2026

Type: article

Abstract: BACKGROUND: Selective size imaging using filters through diffusion times (SSIFT) MRI provides cell size-weighted contrast, but its value in adult-type diffuse gliomas remains unclear. PURPOSE: To evaluate SSIFT MRI for preoperative isocitrate dehydrogenase (IDH) mutation status assessment, World Health Organization (WHO) central nervous system (CNS) grading and progression-free survival (PFS) risk stratification were compared with apparent diffusion coefficient (ADC) metrics. STUDY TYPE: Prospective, single-center. POPULATION: Seventy-one patients with pathologically confirmed adult-type diffuse gliomas (median age, 52 years; 42 men, 29 women) with Grades 2, 3, and 4 gliomas (n = 17, 12, and 42). FIELD STRENGTH/SEQUENCE: 3 T; conventional MRI included T1-weighted imaging, T2-weighted FLAIR imaging, and diffusion-weighted imaging with ADC mapping. Oscillating and pulsed gradient spin-echo diffusion encoding. ASSESSMENT: Whole-solid-tumor regions of interest were delineated, and extracted metrics were compared to pathologic and molecular findings. SSIFT-derived incremental area under the curve (iAUC) quantified normalized diffusion-weighted signal changes with diffusion time. Extracted metrics included mean and 90th-percentile iAUC values (iAUC_mean, iAUC_90Percentile) and mean and 10th-percentile ADC values (ADC_mean, ADC_10Percentile). STATISTICAL TESTS: Kruskal-Wallis and Jonckheere-Terpstra tests, ROC analysis with paired DeLong tests, Cox regression, Kaplan-Meier analysis, and bootstrap comparison of integrated time-dependent AUC (AUCint). p < 0.05 indicated statistical significance. RESULTS: Both iAUC metrics yielded AUCs of 0.839 for IDH assessment (95% confidence intervals [CIs], 0.731-0.938 and 0.731-0.941), significantly outperforming ADC_mean (0.697; 0.573-0.821). iAUC_90Percentile differentiated Grade 2 from Grade 3 gliomas (AUC = 0.789; 95% CI: 0.571-0.966) and outperformed ADC_10Percentile (AUC = 0.520; 95% CI: 0.284-0.722). During median follow-up of 469 days, 26 patients progressed. iAUC_mean remained significantly associated with PFS after multivariable adjustment (HR = 1.206; 95% CI: 1.048-1.387). Adding iAUC_mean increased bootstrapped AUCint from 0.788 to 0.815, although the increase was not significant (ΔAUCint = 0.027; 95% CI: -0.003 to 0.078; p = 0.0899). DATA CONCLUSION: SSIFT-derived iAUC might provide cell size-related microstructural information complementary to ADC and may aid preoperative IDH mutation status assessment and glioma grading. EVIDENCE LEVEL: 1. TECHNICAL EFFICACY: Stage 2.

Source: Journal of Magnetic Resonance Imaging

DOI: 10.1002/jmri.70615