Differentiating Primary Central Nervous System Lymphomas From Glioblastomas and Inflammatory Demyelinating Pseudotumor Using Relative Minimum Apparent Diffusion Coefficients

Abstract

Relative ADCmin value is helpful in differentiating PCNSL from GBM and IDP. Thus, ADC values may provide a useful supplement to the information obtained from conventional contrast-enhanced magnetic resonance imaging and assist in future treatment planning.

Primary CNS Lymphomas: Challenges in Diagnosis and Monitoring

“…GBMs have a solid portion, which can show a restricted diffusion, but their cystic-necrotic areas display high water molecules diffusion [ 15 , 17 – 19 ]. Some authors have shown that the relative minimum apparent diffusion coefficient (rADCmin) is the most accurate parameter to differentiate PCNSL from GBM [ 22 , 25 , 26 ], and a cut-off value of 0.722 has been suggested, with 74.5% sensitivity and 74.1% specificity [ 26 ]. Another study [ 27 ] demonstrated that the initial area under the curve (IAUC) derived from dynamic contrast-enhanced MRI (DCE) may be a useful parameter together with ADC for differentiating PCNSL from atypical GBM (i.e., GBM with absent or limited necrosis), and thus the combination of quantitative ADC and permeability parameters from DCE MRI in tumor and peritumoral areas could help in discriminating PCNSL versus HGG [ 28 ].…”

“…Myelin destruction and vasogenic edema can cause ADC increase [ 30 , 42 ], but TDLs can also show reduced ADC values due to infiltration of inflammatory cells, especially in the periphery of the lesions [ 43 ]. Overall, TDLs consist of hypocellular lesions with ADC values higher than PCNSL, which conversely shows lower, homogeneous ADC values given the high cellularity [ 26 , 44 ].…”

Usefulness of Dual Isotope 123I-IMP and 201Tl SPECT for the Diagnosis of Primary Central Nervous System Lymphoma and Glioblastoma

“…ADC value on MR imaging is reported to be useful for the diagnosis of brain tumor. ADC value of PCNSL is lower than that of GBM re ecting the higher cellular density [3][4][5][6]. The best sensitivity and speci city for differentiation between PCNSL and GBM are 85% and 90%, respectively [5].…”

“…Apparent diffusion coe cient (ADC) obtained from magnetic resonance (MR) imaging and 2-deoxy-2-[ uorine-18] uoro-D-glucose ([ 18 F]FDG) positron emission tomography (PET) are reported to be useful for differentiation between PCNSL and high-grade glioma [3][4][5][6][7][8]. The ADC value of PCNSL is lower than that of high-grade glioma re ecting the higher cellular density [3][4][5][6]. Standardized uptake value (SUV) of [ 18 F]FDG PET of PCNSL is higher than those of high-grade glioma and metastatic brain tumor re ecting the more active glucose metabolism [7,8].…”

“…Standardized uptake value (SUV) of [ 18 F]FDG PET of PCNSL is higher than those of high-grade glioma and metastatic brain tumor re ecting the more active glucose metabolism [7,8]. The accuracy of differentiation between these tumors based on ADC varies, but recent studies found sensitivity and speci city of around 70%, which are inadequate for de nitive diagnosis [3,4]. [ 18 F]FDG PET also involves limitations such as the in uence of blood glucose level [9], and accumulation into non-neoplastic lesions [10][11][12].…”