Differentiating Between Primary Central Nervous System Lymphomas and Glioblastomas: Combined Use of Perfusion-Weighted and Diffusion-Weighted Magnetic Resonance Imaging

• Published in: World neurosurgery Vol. 112; pp. e1 - e6
• Main Authors: Makino, Keishi, Hirai, Toshinori, Nakamura, Hideo, Kuroda, Jun-ichiro, Shinojima, Naoki, Uetani, Hiroyuki, Kitajima, Mika, Yano, Shigetoshi
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2018
• Subjects: Diagnosis; Glioblastomas; Magnetic resonance imaging; Primary central nervous system lymphoma; ADC; PWI; MRI; ROC; Primary central nervous system lymphoma; FOV; ROI; AUC; rCBV; TE; Glioblastomas; PCNSL; GBM; Magnetic resonance imaging; DSC; CBV; DWI; FLAIR; Diagnosis; TR
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2017.10.141

The purpose of this study was to determine whether combined diffusion-weighted imaging and dynamic susceptibility contrast-enhanced perfusion-weighted imaging magnetic resonance imaging can be used to differentiate between common malignant brain tumors, including lymphomas and high-grade gliomas. We evaluated 87 patients with histologically confirmed brain tumors, including 33 primary central nervous system lymphomas (PCNSLs) and 54 glioblastomas (GBMs). All patients underwent conventional magnetic resonance imaging, diffusion-weighted imaging, and perfusion-weighted imaging before surgical removal of the lesion or stereotactic biopsy. The maximum relative cerebral blood volume (rCBV) ratios of GBMs were significantly higher than those of PCNSLs (P < 0.0001). The maximum rCBVs helped to distinguish PCNSLs from GBMs with 97.0% sensitivity, 90.7% specificity, and 0.98 area under the curve. The minimum apparent diffusion coefficients (ADCs) of PCNSLs were significantly lower than those of GBMs (P < 0.0001). At an rCBV cutoff value of 4.0 and a minimum ADC of 1.0 × 10−3 mm2/second, it was possible to differentiate between PCNSLs and GBMs. The combination of rCBV and ADC can facilitate the differentiation between PCNSLs and GBMs.