Accuracy of apparent diffusion coefficient in differentiation of glioblastoma from metastasis

Abstract

Background Brain metastasis and glioblastoma multiforme are two of the most common malignant brain neoplasms. There are many difficulties in distinguishing these diseases from each other. Purpose The purpose of this study was to determine whether the mean apparent diffusion coefficient and absolute standard deviation derived from apparent diffusion coefficient measurements can be used to differentiate glioblastoma multiforme from brain metastasis based on cellularity levels. Material and methods Magnetic resonance images of 34 patients with histologically verified brain tumors were evaluated retrospectively. Apparent diffusion coefficient and standard deviation values were measured in the enhancing tumor, peritumoral region, and contralateral healthy white matter. Then, to determine whether there was a statistical difference between brain metastasis and glioblastoma multiforme, we analyzed different variables between the two groups. Results Neither mean apparent diffusion coefficient values and ratios nor standard deviation values and ratios were significantly different between glioblastoma multiforme and brain metastasis. Receiver operating characteristic curve analysis of the logistic model with backward stepwise feature selection yielded an area under the curve of 0.77, a specificity of 84%, a sensitivity of 67%, a positive predictive value of 83.33%, and a negative predictive value of 78.26% for distinguishing between glioblastoma multiforme and brain metastasis. The absolute standard deviation and standard deviation ratios were significantly higher in the peritumoral edema compared to the tumor region in each case. Conclusion Apparent diffusion coefficient values and ratios, as well as standard deviation values and ratios in peritumoral edema, cannot be used to differentiate edema with infiltration of tumor cells from vasogenic edema. However, standard deviation values could successfully characterize areas of peritumoral edema from the tumoral region in each case.

Differentiation of multiple brain metastases and glioblastoma with multiple foci using MRI criteria

“…In a study from Iran, the ADC values/ratios of GBM, metastases and of edemas did not differ significantly [ 28 ]. This is largely consistent with our results, in which we did not detect any differences if the ADC values were measured within the area of 1 cm and 2 cm away from the tumor edge.…”

Application of magnetic resonance imaging-related techniques in the diagnosis of sepsis-associated encephalopathy: present status and prospect

“…Diffusion-weighted imaging is a non-invasive MR technique for measuring the dispersion of water in the brain ( Messina et al, 2020 ). The Apparent Diffusion Coefficient (ADC) is a quantitative index calculated from DWI to quantify the diffusing capacity of water in tissues ( Beig Zali et al, 2021 ). DWI reflects whether the activity of water is restricted, showing a high or low signal if water activity is restricted or not, respectively.…”

Neuroinflammation and immunoregulation in glioblastoma and brain metastases: Recent developments in imaging approaches

“…Also, intratumoral creatine suggests GBM, whereas its absence indicates metastasis when single-voxel proton MR spectroscopy is used for imaging [10,67]. A study examining the use of the mean apparent diffusion coefficient and absolute standard deviation derived from apparent diffusion coefficient measurements based on cellularity levels could not find marked differences between GBM tumors from brain metastasis [68]. However, other studies found that the apparent diffusion coefficient could differentiate GBM from metastasis, and that homogeneity and the inverse difference moment of GBM were significantly higher than those of metastases in the regions of interest placements examined [10,69].…”

“…The presence of intratumoral creatine indicates GBM, whereas its absence indicates metastasis, in samples consisting of 11 anaplastic gliomas, 20 GBMs and 25 metastases [67] MRI No differentiation between GBM tumors and brain metastases when using the mean apparent diffusion coefficient and absolute standard deviation derived from apparent diffusion coefficient measurements based on cellularity levels (n = 34 patients) [68] MRI Use of the apparent diffusion coefficient could differentiate GBM from metastasis [69] Higher homogeneity and inverse difference moment in GBM compared to metastases (n = 36 GBMs and 26 metastases) MRI Heterogeneity of the GBMs peritumoral edema was significantly higher than the edema surrounding MET by texture analysis, allowing a differentiation with a sensitivity of 80% and specificity of 90% (n = 22 GBM tumors and 21 metastases) [ A prediction accuracy to 98.6% was reached by applying a confidence rate of 0.999 when images with substantial artifacts were excluded (n = 25 patients with GBM, brain metastasis or meningioma)…”