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

Keishi Makino; Toshinori Hirai; Hideo Nakamura; Jun-Ichiro Kuroda; Naoki Shinojima; Hiroyuki Uetani; Mika Kitajima; Shigetoshi Yano

doi:10.1016/j.wneu.2017.10.141

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

World Neurosurg. 2018 Apr:112:e1-e6. doi: 10.1016/j.wneu.2017.10.141. Epub 2018 Feb 13.

Authors

Keishi Makino¹, Toshinori Hirai², Hideo Nakamura³, Jun-Ichiro Kuroda³, Naoki Shinojima³, Hiroyuki Uetani⁴, Mika Kitajima⁴, Shigetoshi Yano³

Affiliations

¹ Department of Neurosurgery, Kumamoto University, Kumamoto, Japan. Electronic address: kmakino@kuh.kumamoto-u.ac.jp.
² Department of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
³ Department of Neurosurgery, Kumamoto University, Kumamoto, Japan.
⁴ Department of Radiology, Kumamoto University, Kumamoto, Japan.

PMID: 29104150
DOI: 10.1016/j.wneu.2017.10.141

Abstract

Objective: 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.

Methods: 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.

Results: 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.

Conclusions: The combination of rCBV and ADC can facilitate the differentiation between PCNSLs and GBMs.

Keywords: Diagnosis; Glioblastomas; Magnetic resonance imaging; Primary central nervous system lymphoma.

MeSH terms

Adult
Aged
Aged, 80 and over
Brain Neoplasms / diagnostic imaging*
Female
Glioblastoma / diagnostic imaging*
Humans
Lymphoma / diagnostic imaging*
Magnetic Resonance Imaging / methods*
Male
Middle Aged
Neuroimaging / methods*