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Research ArticleBrainF
Open Access

Differentiation of Tumefactive Demyelinating Lesions from High-Grade Gliomas with the Use of Diffusion Tensor Imaging

C.H Toh, K.-C. Wei, S.-H. Ng, Y.-L. Wan, M. Castillo and C.-P. Lin
American Journal of Neuroradiology May 2012, 33 (5) 846-851; DOI: https://doi.org/10.3174/ajnr.A2871
C.H Toh
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K.-C. Wei
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S.-H. Ng
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Y.-L. Wan
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M. Castillo
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C.-P. Lin
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    Fig 1.

    A 28-year-old woman with a large TDL in the right frontal lobe. A, There is heterogeneous enhancement at the medial margin (arrows) of the lesion on the axial contrast-enhanced T1-weighted image. B and C, On the axial DWI (B) and MD map (C), the peripheral portion of the lesion shows restricted diffusion (arrows). D and E, Intralesional hyperintensities (arrow) are seen in both the lesion center (arrow) and periphery (arrowheads) on axial (D) and coronal (E) FA maps. F, Directional-coded FA map displays the directionality of these intralesional hyperintensities. The FA values are 0.06 for central nonenhancing portion and 0.21 for peripheral enhancing portion. The MD values (× 10−3 mm2/s) are 1.966 for central nonenhancing portion and 0.704 for peripheral enhancing portion.

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    Fig 2.

    A, A 68-year-old man with a left frontal glioblastoma, which appears as a rim-enhancing mass on the axial contrast-enhanced T1-weighted image. B and C, On the axial DWI (B) and MD map (C), restricted diffusion is present at the lesion periphery (arrow). D and E, Intralesional hyperintensities (arrow) are seen on axial (D) and coronal (E) FA maps. A red scattered ROI representing a contrast-enhancing rim is overlaid on the FA map (D). F, Note that there is a hyperintense FA rim (arrowheads in D, E, and F) in the perifocal edema, external to the enhancing rim. Directional-coded (F) FA map displays the directionality of hyperintense FA rim and intralesional hyperintensity. The FA values are 0.09 for the central nonenhancing portion and 0.13 for the peripheral enhancing portion. The MD values (× 10−3 mm2/s) are 1.530 for the central nonenhancing portion and 1.252 for the peripheral enhancing portion.

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    Table 1:

    Results of visual inspection of TDLs and high-grade gliomas

    Imaging SignsTDLsHigh-Grade GliomasP ValueORSENSPEAccuracy
    Intralesional hyperintensities on FA maps6 (75%)4 (30.8%).0496.875%69.2%71.4%
    Restricted diffusion in lesion periphery7 (87.5%)7 (53.8%).112
    Perilesional hyperintense FA rim1 (12.5%)12 (92.3%)<.0018492.3%87.5%90.4%
    • Note:—OR indicates odds ratio; SEN, sensitivity; SPE, specificity.

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    Table 2:

    MD and FA of TDLs and high-grade gliomasa

    Region/MetricsTDLsHigh-Grade GliomasP Value95% CI
    Nonenhancing portion
        FA0.06 ± 0.020.07 ± 0.03.526−0.035–0.018
        MD1.702 ± 0.4141.806 ± 0.578.663−0.597–0.388
    Enhancing portion
        FA0.18 ± 0.050.12 ± 0.01.0040.020-.088
        MD0.887 ± 0.2651.237 ± 0.124.001−0.528–0.172
    Perilesional edema
        FA0.11 ± 0.010.17 ± 0.03.001−0.091–0.028
        MD1.411 ± 0.2621.270 ± 0.121.158−0.062–0.346
    • Note:—CI indicates confidence interval.

    • ↵a Data are the mean. Unit is × 10−3 mm2/s for MD values.

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American Journal of Neuroradiology: 33 (5)
American Journal of Neuroradiology
Vol. 33, Issue 5
1 May 2012
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C.H Toh, K.-C. Wei, S.-H. Ng, Y.-L. Wan, M. Castillo, C.-P. Lin
Differentiation of Tumefactive Demyelinating Lesions from High-Grade Gliomas with the Use of Diffusion Tensor Imaging
American Journal of Neuroradiology May 2012, 33 (5) 846-851; DOI: 10.3174/ajnr.A2871

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Differentiation of Tumefactive Demyelinating Lesions from High-Grade Gliomas with the Use of Diffusion Tensor Imaging
C.H Toh, K.-C. Wei, S.-H. Ng, Y.-L. Wan, M. Castillo, C.-P. Lin
American Journal of Neuroradiology May 2012, 33 (5) 846-851; DOI: 10.3174/ajnr.A2871
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