Differentiation of Primary Central Nervous System Lymphomas and Glioblastomas: Comparisons of Diagnostic Performance of Dynamic Susceptibility Contrast-Enhanced Perfusion MR Imaging without and with Contrast-Leakage Correction

Abstract

BACKGROUND AND PURPOSE:Contrast leakage results in underestimation of the CBV of brain tumors. Our aim was to compare the diagnostic performance of DSC perfusion MR imaging without and with mathematic contrast-leakage correction in differentiating PCNSLs and glioblastomas.

Evaluation of Microvascular Permeability with Dynamic Contrast-Enhanced MRI for the Differentiation of Primary CNS Lymphoma and Glioblastoma: Radiologic-Pathologic Correlation

“…As a principal finding, our study shows that PCNSL demonstrates significantly higher K trans and K ep values on DCE-MR imaging com- pared with GB, thereby implying a greater degree of BBB disruption and thus higher vascular permeability in PCNSL, ultimately confirming initial observations from perfusion CT and DSC-MR imaging studies. 13,14 Furthermore, we could demonstrate that these findings correlate with underlying histopathologic features, with intact vascular integrity for GB and destroyed vessel architecture in PCNSL, thereby promoting vascular disintegrity in the latter group.…”

“…Therefore Boxerman et al 21,22 and Weisskoff et al 23 proposed a mathematic leakage-correction model in which linear fitting is used to determine the voxelwise deviation from nonleaky reference tissue and, by removing the leakage term, allowing generation of both corrected CBV maps and first-order estimates of vascular permeability. Although direct comparison is limited by differences in study populations and methodology, the diagnostic performance of DCE-derived K trans in the present study was superior compared with the mathematic leakage-corrected DSC-derived K 2 in the study of Toh et al 14 (area under the curve on receiver operating characteristic analysis, 95.6% versus 77.1%). Due to the complex relationship between contrast agent concentration in tissue and the measured change in signal intensity on DSC-PWI, a positive relationship between DSC-PWI and DCE-MR imaging-derived vascular permeability parameters (ie, K 2 and K trans ) may only exist with high flip angles on DSC-PWI (90°).…”

“…14,[28][29][30] These results may be explained by the differences in neovascularization, which is a hallmark in GB, 31 however, an unusual feature in (non-AIDS-related) PCNSL. 32 Thus, the microvascular blood flow to the tumor tissue in GB is often hampered by an abnormal tumor vasculature due to neovascularization comprising immature or defective endothelium, tortuosity, and thrombosis.…”

“…9,10 Thereby the diffusive transport of low-molecular-weight contrast agent across the capillary endothelium from the blood plasma to the ex- Distinct structural and ultrastructural differences in the microenvironment of the tumor vasculature on histologic assessment have been reported for PCNSL and GB, suggesting increased vascular permeability for PCNSL. 11 However, radiologic comparison of vascular permeability in PCNSL and GB has as yet only been performed with perfusion CT 12,13 or with DSC-PWI processed with a mathematic leakage-correction model, 14 which, in part, confirmed the increased vascular permeability for PCNSL. The aim of our study was to evaluate the diagnostic performance of DCE-MR imaging-derived vascular permeability parameters, including K trans , K ep , and V e for the preoperative differentiation of PCNSL and GB.…”

Assessment of Angiographic Vascularity of Meningiomas with Dynamic Susceptibility Contrast-Enhanced Perfusion-Weighted Imaging and Diffusion Tensor Imaging

“…5,12,13 The CBV for each voxel was estimated by integrating the relaxivity-time curve converted from the dynamic signal intensity curve. Contrast leakage correction was performed by use of a technique outlined by Boxerman et al 14,15 …”