Abstract
BACKGROUND AND PURPOSE: Glioblastomas, brain metastases, and PCLs may have similar enhancement patterns on MR imaging, making the differential diagnosis difficult or even impossible. The purpose of this study was to determine whether a combination of DTI and DSC can assist in the differentiation of glioblastomas, solitary brain metastases, and PCLs.
MATERIALS AND METHODS: Twenty-six glioblastomas, 25 brain metastases, and 16 PCLs were retrospectively identified. DTI metrics, including FA, ADC, CL, CP, CS, and rCBV were measured from the enhancing, immediate peritumoral and distant peritumoral regions. A 2-level decision tree was designed, and a multivariate logistic regression analysis was used at each level to determine the best model for classification.
RESULTS: From the enhancing region, significantly elevated FA, CL, and CP and decreased CS values were observed in glioblastomas compared with brain metastases and PCLs (P < .001), whereas ADC, rCBV, and rCBVmax values of glioblastomas were significantly higher than those of PCLs (P < .01). The best model to distinguish glioblastomas from nonglioblastomas consisted of ADC, CS (or FA) from the enhancing region, and rCBV from the immediate peritumoral region, resulting in AUC = 0.938. The best predictor to differentiate PCLs from brain metastases comprised ADC from the enhancing region and CP from the immediate peritumoral region with AUC = 0.909.
CONCLUSIONS: The combination of DTI metrics and rCBV measurement can help in the differentiation of glioblastomas from brain metastases and PCLs.
Abbreviations
- ADC
- apparent diffusion coefficient
- AUC
- area under the curve
- CBV
- cerebral blood volume
- CL
- linear anisotropy coefficient
- CP
- planar anisotropy coefficient
- CS
- spheric anisotropy coefficient
- DPR
- distant peritumoral region
- DSC
- dynamic susceptibility contrast-enhanced
- DTI
- diffusion tensor imaging
- ER
- enhancing region
- FA
- fractional anisotropy
- FLAIR
- fluid-attenuated inversion recovery
- GRAPPA
- generalized autocalibrating partially parallel acquisition
- IPR
- immediate peritumoral region
- LRM
- logistic regression model
- MPRAGE
- magnetization-prepared rapid acquisition of gradient echo
- PCL
- primary cerebral lymphoma
- PWI
- perfusion-weighted imaging
- rCBV
- relative cerebral blood volume
- rCBVmax
- maximum relative cerebral blood volume
- ROC
- receiver operating characteristic analysis
- ROI
- region of interest
- WM
- white matter
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