BackgroundTo understand the pathological correlations of multi-b-value diffusion-weighted imaging (MDWI) stretched-exponential model (SEM) parameters of α and diffusion distribution index (DDC) in patients with glioma. SEM parameters, as promising biomarkers, played an important role in histologically grading gliomas.MethodsBiopsy specimens were grouped as high-grade glioma (HGG) or low-grade glioma (LGG). MDWI-SEM parametric mapping of DDC1500, α1500fitted by 15b-values (0-1,500 sec/mm2)and DDC5000and α5000fitted by 22b-values (0-5,000 sec/mm2) were matched with pathological samples (stained by MIB-1 and CD34) by coregistered localized biopsies, and all SEM parameters were correlated with these pathological indices pMIB-1(percentage of MIB-1 expression positive rate) and CD34-MVD (CD34 expression positive microvascular density for each specimen). The two-tailed Spearman’s correlation was calculated for pathological indexes and SEM parameters, as well as WHO grades and SEM parameters.ResultsMDWI-derived α1500negatively correlated with CD34-MVD in both LGG (6 specimens) and HGG (26 specimens) (r=-0.437,P=0.012). MDWI-derived DDC1500and DDC5000negatively correlated with MIB-1 expression in all glioma patients (P<0.05). WHO grades negatively correlated with α1500(r=-0.485;P=0.005) and α5000(r=-0.395;P=0.025).ConclusionsSEM-derived DDC and α are significant in histologically grading gliomas, DDC may indicate the proliferative ability, and CD34 stained microvascular perfusion may be an important determinant of water diffusion inhomogeneity α in glioma.