Accuracy of apparent diffusion coefficients and enhancement ratios on magnetic resonance imaging in differentiating primary cerebral lymphomas from glioblastoma

Abstract

Background and purpose This study aimed to determine the accuracy of apparent diffusion coefficient (ADC) and enhancement ratio (ER) in discriminating primary cerebral lymphomas (PCL) and glioblastomas. Materials and methods Circular regions of interest were randomly placed centrally within the largest solid-enhancing area of all lymphomas and glioblastomas on both post-contrast T1-weighted images and corresponding ADC maps. Regions of interest were also drawn in the contralateral hemisphere to obtain enhancement and ADC values of normal-appearing white matter. This helped us to calculate the ER and ADC ratio. Results Mean enhancement and ADC (mm2/s) values for PCL were 2220.56 ± 2948.30 and 712.00 ± 137.87, respectively. Mean enhancement and ADC values for glioblastoma were 1537.07 ± 1668.33 and 1037.93 ± 280.52, respectively. Differences in ADC values, ratios and ERs were all statistically significant between the two groups ( p < 0.05). ADC values correctly predicted 71.4% of the lesions as glioblastoma and 83.3% as PCL (area under the curve (AUC) = 0.86 on receiver operating characteristic curve analysis). ADC ratios correctly predicted 85.7% of the lesions as glioblastoma and 100% as PCL (AUC = 0.93). ERs correctly predicted 71.4% of the lesions as glioblastoma and 88.9% as PCL (AUC = 0.92). The combination of ADC ratio and ER correctly predicted 100% tumour type in both patient subgroups. Conclusions ADC values, ADC ratios and ERs may serve as useful variables to distinguish PCL from glioblastoma. The combination of ADC ratio and ER yielded the best results in identification of both patient subgroups.

Differentiation Between Primary Central Nervous System Lymphoma and Atypical Glioblastoma Based on MRI Morphological Feature and Signal Intensity Ratio: A Retrospective Multicenter Study

“…Although the rT 1 CE of PCNSL was slightly higher than that of GBM, there was no significant difference between the two groups. This result differs from that of the study by Anwar et al ( 9 ), which reported a sensitivity of 83.3%, specificity of 85.7%, and AUC of 0.92 for differentiating PCNSL and GBM. Different study populations, MRI sequence parameters, and timing and dosage of MRI contrast administration may contribute to this inconsistency.…”

“…Both conventional and advanced MR techniques have been reported to be helpful in differentiating PCNSL from GBM (7)(8)(9)(10)(11)(12). However, most of these studies enrolled all GBM patients, which can be differentiated from PCNSL based on findings of conventional MRI in most cases.…”

Can apparent diffusion coefficient predict the grade, genotype, or proliferation index of oligodendrogliomas

“…[28] Similarly, Anwar et al report a significant difference in ADC mapping for different tumors. [29] However, data in our study does not demonstrate a significant (P < 0.05) difference between mean ADC of OD Grade II and III. These findings are reflected in literature by Hilario et al and Fellah et al who also found no significant correlation between grade of OD and the mean value of ADC.…”

Diffuse large B-cell lymphoma relapse presenting as extensive neurolymphomatosis

“…Advanced MRI techniques such as diffusion and texture analysis have been reported to help differentiate primary CNS lymphoma from other neoplasms and inflammatory conditions. 15,16 But there are no reports of their utility in neurolymphomatosis. MRI can also be limited in patients with claustrophobia, implants, pacemaker, or severe renal insufficiency that prevents contrast administration.…”