Diagnostic Accuracy of T1-Weighted Dynamic Contrast-Enhanced–MRI and DWI-ADC for Differentiation of Glioblastoma and Primary CNS Lymphoma

Abstract

Background Glioblastoma and primary CNS lymphoma (PCNSL) dictate different neurosurgical strategies; it is critical to distinguish between them preoperatively. However, current imaging modalities do not effectively differentiate them. We aim to examine the use of DWI and T1-weighted dynamic contrast-enhanced (DCE)-MRI as potential discriminative tools. Methods We retrospectively reviewed 18 PCNSL and 36 matched glioblastoma patients with pretreatment DWI- and DCE-MRI. VOIs were drawn around the tumor on contrast-enhanced T1WI and FLAIR images; these images were transferred onto coregistered ADC maps to obtain ADC, and onto DCE perfusion maps to obtain plasma volume (Vp) and permeability transfer constant (Ktrans). Histogram analysis was performed to determine mean (ADCmean) and relative ADCmean (rADCmean), and relative 90th percentile values for plasma volume (rVp90%tile) and permeability transfer constant (rKtrans90%tile). Non-parametric tests were used to assess differences and ROC analysis was performed for optimal threshold calculations. Results The enhancing component of PCNSL was found to have significantly lower ADCmean (1.1 × 103 vs 1.4 × 103; p<0.001) and rADCmean (1.5 vs 1.9; p<0.001) and rVp90%tile (3.7 vs 5.0; p<0.05) than the enhancing component of glioblastoma, but not significantly different rKtrans90%tile (5.4 vs 4.4; p=0.83). The non-enhancing portions of GBM and PCNSL did not differ in these parameters. Based on ROC analysis, mean ADC provided the best threshold (AUC 0.83) to distinguish primary CNS lymphoma from glioblastoma, which was not improved with normalized ADC or addition of perfusion parameters. Conclusion ADC was superior to DCE-MRI perfusion alone or in combination in differentiating PCNSL from glioblastoma.

MRI as a diagnostic biomarker for differentiating primary central nervous system lymphoma from glioblastoma: A systematic review and meta‐analysis

“…Detailed information of excluded studies is described in the Supplementary Materials. One further relevant study was also identified, resulting in a final total of 22 studies investigating the diagnostic performance of MRI for differentiating PCNSL from glioblastoma, with these studies covering 1182 patients.…”

“…Seven studies enrolled patients in a consecutive manner, while the enrollment was not explicit in the others. Nineteen studies used only histopathology as the reference standard, while two studies used histopathology and clinicoradiologic diagnosis for patients with PCNSL …”

“…During the last decade, multiple MRI sequences have been introduced for differentiating PCNSL from glioblastoma . These sequences, which include diffusion‐weighted imaging (DWI), dynamic susceptibility‐weighted contrast‐enhanced imaging (DSC), dynamic contrast‐enhanced imaging (DCE), arterial spin labeling (ASL), susceptibility‐weighted imaging (SWI), intravoxel incoherent motion (IVIM), and magnetic resonance spectroscopy (MRS), have demonstrated variable diagnostic performance.…”

Brain metastases: neuroimaging

“…7.3D) (Masdeu et al, 2000; Siri et al, 2015; Abdoli et al, 2016). Primary central nervous system lymphoma is typically solidly enhancing in immunocompetent patients, is superficial or periventricular, and also shows decreased diffusion due to its high cellularity (Yamasaki et al, 2005; Lin et al, 2017). Thus careful assessment of standard imaging, including the ADC map, usually prevents tumefactive multiple sclerosis or lymphoma from being confused with metastatic disease.…”

Usefulness of enhancement-perfusion mismatch in differentiation of CNS lymphomas from other enhancing malignant tumors of the brain

“…DCE perfusion was also found effective in differentiating primary central nervous system lymphomas (PCNSL) from GBM (14,15). More recent studies have suggested the moderate effectiveness of DCE perfusion imaging for differentiation of GBM and PCNL (16). However, the purpose of current study is to further explore the imaging role of DSC-MR perfusion.…”