Differentiation of Glioblastoma from Brain Metastasis: Qualitative and Quantitative Analysis Using Arterial Spin Labeling MR Imaging

• Published in: PloS one Vol. 11; no. 11; p. e0166662
• Main Authors: Sunwoo, Leonard, Yun, Tae Jin, You, Sung-Hye, Yoo, Roh-Eul, Kang, Koung Mi, Choi, Seung Hong, Kim, Ji-Hoon, Sohn, Chul-Ho, Park, Sun-Won, Jung, Cheolkyu, Park, Chul-Kee
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 18.11.2016; Public Library of Science (PLoS)
• Subjects: Adult; Age; Aged; Biology and Life Sciences; Blood; Blood flow; Brain; Brain cancer; Brain Neoplasms - diagnostic imaging; Brain Neoplasms - secondary; Brain tumors; Cancer metastasis; Cerebral blood flow; Diagnosis, Differential; Diagnostic systems; Differentiation; Evaluation; Female; Glioblastoma; Glioblastoma - diagnostic imaging; Glioblastomas; Grading; Humans; Image Processing, Computer-Assisted; Labeling; Labelling; Magnetic resonance; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Medical diagnosis; Medical imaging; Medical research; Medicine; Medicine and Health Sciences; Metastases; Metastasis; Middle Aged; Neuroimaging; NMR; Nuclear magnetic resonance; Perfusion; Physical Sciences; Population studies; Qualitative analysis; Qualitative research; Quantitative analysis; Research and Analysis Methods; Retrospective Studies; ROC Curve; Spin labeling; Studies; Substantia grisea; Surgery; Tumors; Germany
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0166662

To evaluate the diagnostic performance of cerebral blood flow (CBF) by using arterial spin labeling (ASL) perfusion magnetic resonance (MR) imaging to differentiate glioblastoma (GBM) from brain metastasis. The institutional review board of our hospital approved this retrospective study. The study population consisted of 128 consecutive patients who underwent surgical resection and were diagnosed as either GBM (n = 89) or brain metastasis (n = 39). All participants underwent preoperative MR imaging including ASL. For qualitative analysis, the tumors were visually graded into five categories based on ASL-CBF maps by two blinded reviewers. For quantitative analysis, the reviewers drew regions of interest (ROIs) on ASL-CBF maps upon the most hyperperfused portion within the tumor and upon peritumoral T2 hyperintensity area. Signal intensities of intratumoral and peritumoral ROIs for each subject were normalized by dividing the values by those of contralateral normal gray matter (nCBFintratumoral and nCBFperitumoral, respectively). Visual grading scales and quantitative parameters between GBM and brain metastasis were compared. In addition, the area under the receiver-operating characteristic curve was used to evaluate the diagnostic performance of ASL-driven CBF to differentiate GBM from brain metastasis. For qualitative analysis, GBM group showed significantly higher grade compared to metastasis group (p = 0.001). For quantitative analysis, both nCBFintratumoral and nCBFperitumoral in GBM were significantly higher than those in metastasis (both p < 0.001). The areas under the curve were 0.677, 0.714, and 0.835 for visual grading, nCBFintratumoral, and nCBFperitumoral, respectively (all p < 0.001). ASL perfusion MR imaging can aid in the differentiation of GBM from brain metastasis.