Differentiation between primary cerebral lymphoma and glioblastoma using the apparent diffusion coefficient: comparison of three different ROI methods

• Published in: PloS one Vol. 9; no. 11; p. e112948
• Main Authors: Ahn, Sung Jun, Shin, Hyun Joo, Chang, Jong-Hee, Lee, Seung-Koo
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 13.11.2014; Public Library of Science (PLoS)
• Subjects: Adult; Age; Aged; Biopsy; Brain cancer; Brain Neoplasms - diagnostic imaging; Central nervous system; Correlation analysis; Cut-off; Differentiation; Diffusion; Diffusion coefficient; Female; Gangrene; Glioblastoma; Glioblastoma - diagnostic imaging; Hospitals; Humans; Image processing; Lymphoma; Lymphoma - diagnostic imaging; Lymphomas; Male; Medical imaging; Medicine; Medicine and Health Sciences; Middle Aged; Nervous system; NMR; Nuclear magnetic resonance; Radiography; Reproducibility; Retrospective Studies; Sensitivity; Tumors; Volumetric analysis
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0112948

Apparent diffusion coefficients (ADC) can help differentiate between central nervous system (CNS) lymphoma and Glioblastoma (GBM). However, overlap between ADCs for GBM and lymphoma have been reported because of various region of interest (ROI) methods. Our aim is to explore ROI method to provide the most reproducible results for differentiation. We studied 25 CNS lymphomas and 62 GBMs with three ROI methods: (1) ROI1, whole tumor volume; (2) ROI2, multiple ROIs; and (3) ROI3, a single ROI. Interobserver variability of two readers for each method was analyzed by intraclass correlation(ICC). ADCs were compared between GBM and lymphoma, using two-sample t-test. The discriminative ability was determined by ROC analysis. ADCs from ROI1 showed most reproducible results (ICC >0.9). For ROI1, ADCmean for lymphoma showed significantly lower values than GBM (p = 0.03). The optimal cut-off value was 0.98×10(-3) mm2/s with 85% sensitivity and 90% specificity. For ROI2, ADCmin for lymphoma was significantly lower than GBM (p = 0.02). The cut-off value was 0.69×10(-3) mm2/s with 87% sensitivity and 88% specificity. ADC values were significantly dependent on ROI method. ADCs from the whole tumor volume had the most reproducible results. ADCmean from the whole tumor volume may aid in differentiating between lymphoma and GBM. However, multi-modal imaging approaches are recommended than ADC alone for differentiation.