Single brain metastasis versus glioblastoma multiforme: a VOI-based multiparametric analysis for differential diagnosis

Abstract

Purpose The authors’ purpose was to create a valid multiparametric MRI model for the differential diagnosis between glioblastoma and solitary brain metastasis. Materials and methods Forty-one patients (twenty glioblastomas and twenty-one brain metastases) were retrospectively evaluated. MRIs were analyzed with Olea Sphere® 3.0. Lesions’ volumes of interest (VOIs) were drawn on enhanced 3D T1 MP-RAGE and projected on ADC and rCBV co-registered maps. Another two VOIs were drawn in the region of hyperintense cerebral edema, surrounding the lesion, respectively, within 5 mm around the enhancing tumor and into residual edema. Perfusion curves were obtained, and the value of signal recovery (SR) was reported. A two-sample T test was obtained to compare all parameters of GB and BM groups. Receiver operating characteristics (ROC) analysis was performed. Results According to ROC analysis, the area under the curve was 88%, 78% and 74%, respectively, for mean ADC VOI values of the solid component, the mean and max rCBV values in the perilesional edema and the PSR. The cumulative ROC curve of these parameters reached an area under the curve of 95%. Using perilesional max rCBV > 1.37, PSR > 75% and mean lesional ADC < 1 × 10−3 mm2 s−1 GB could be differentiated from solitary BM (sensitivity and specificity of 95% and 86%). Conclusion Lower values of ADC in the enhancing tumor, a higher percentage of SR in perfusion curves and higher values of rCBV in the peritumoral edema closed to the lesion are strongly indicative of GB than solitary BM.

The role of 3-Tesla magnetic resonance perfusion and spectroscopy in distinguishing glioblastoma from solitary brain metastasis

“…This conclusion is similar to those of the previous studies. [ 12 , 25 , 26 ] On the other hand, the pCBV of the GBM group was significantly higher than that of the SBM group (1.978 ± 0.976 vs. 0.943 ± 0.615; P < 0.05). This difference is due to the histology of the peritumoral area of these two tumor types.…”

“…Peritumoral edema in GBM is a combination of vasogenic edema and tumor cell infiltration, whereas that in SBM is pure vasogenic edema. [ 12 , 17 , 25 ] Advanced MR techniques such as perfusion and spectroscopy, which evaluate peritumoral tumor infiltrates, help to differentiate between these two tumors.…”

Diffusion Weighted Imaging in Neuro-Oncology: Diagnosis, Post-Treatment Changes, and Advanced Sequences—An Updated Review

“…Neoplastic cells intermingled with areas of vasogenic edema within infiltrative NEPSA will create biological barriers that prevent the free passage of water molecules, resulting in lower ADC values than pure vasogenic edema [17]. Supporting this hypothesis, peritumoral ADC is lower in anaplastic astrocytoma and glioblastoma compared to metastases [151][152][153][154]. The non-infiltrative NEPSA vasogenic edema exhibits greater ADC values than the infiltrating NEPSA because there are no neoplastic cells to restrict the water molecules' movement [17].…”

“…Diffusion imaging has also been used to discriminate glioblastoma from solitary brain metastases. Unfortunately, whereas tumoral ADC aids in tumor-type differentiation in some cases, it does not seem to be able to distinguish glioblastomas from metastases [13,[150][151][152]. DWI can also be used to assess the ability of water molecules to move freely within non-enhancing peritumoral signal abnormalities (NEPSA) of CNS lesions.…”

Artificial Intelligence in Brain Tumor Imaging: A Step toward Personalized Medicine

“…Differentiating these two entities is essential, considering they are the most common brain tumors in the adult population and have quite different treatments [ 47 ]. Thus, several researchers have focused on this topic, showing the advantages of multiparametric MRI [ 48 , 49 ] and, more recently, evaluating the performances of different AI-based classifiers compared to expert neuroradiologists.…”