Differentiating between Central Nervous System Lymphoma and High-grade Glioma Using Dynamic Susceptibility Contrast and Dynamic Contrast-enhanced MR Imaging with Histogram Analysis

Abstract

Purpose:We evaluated the diagnostic performance of histogram analysis of data from a combination of dynamic susceptibility contrast (DSC)-MRI and dynamic contrast-enhanced (DCE)-MRI for quantitative differentiation between central nervous system lymphoma (CNSL) and high-grade glioma (HGG), with the aim of identifying useful perfusion parameters as objective radiological markers for differentiating between them.Methods:Eight lesions with CNSLs and 15 with HGGs who underwent MRI examination, including DCE and DSC-MRI, were enrolled in our retrospective study. DSC-MRI provides a corrected cerebral blood volume (cCBV), and DCE-MRI provides a volume transfer coefficient (Ktrans) for transfer from plasma to the extravascular extracellular space. Ktrans and cCBV were measured from a round region-of-interest in the slice of maximum size on the contrast-enhanced lesion. The differences in t values between CNSL and HGG for determining the most appropriate percentile of Ktrans and cCBV were investigated. The differences in Ktrans, cCBV, and Ktrans/cCBV between CNSL and HGG were investigated using histogram analysis. Receiver operating characteristic (ROC) analysis of Ktrans, cCBV, and Ktrans/cCBV ratio was performed.Results:The 30th percentile (C30) in Ktrans and 80th percentile (C80) in cCBV were the most appropriate percentiles for distinguishing between CNSL and HGG from the differences in t values. CNSL showed significantly lower C80 cCBV, significantly higher C30 Ktrans, and significantly higher C30 Ktrans/C80 cCBV than those of HGG. In ROC analysis, C30 Ktrans/C80 cCBV had the best discriminative value for differentiating between CNSL and HGG as compared to C30 Ktrans or C80 cCBV.Conclusion:The combination of Ktrans by DCE-MRI and cCBV by DSC-MRI was found to reveal the characteristics of vascularity and permeability of a lesion more precisely than either Ktrans or cCBV alone. Histogram analysis of these vascular microenvironments enabled quantitative differentiation between CNSL and HGG.

Differentiating between Glioblastoma and Primary CNS Lymphoma Using Combined Whole-tumor Histogram Analysis of the Normalized Cerebral Blood Volume and the Apparent Diffusion Coefficient

“…Average nCBV was the most sensitive parameter in the differential diagnosis of GBMs from PCNSLs and showed the highest AUC in the ROC analysis, with the nCBV of GBM significantly higher than that of PCNSL. This result is consistent with many previous reports, though CBV parameters, such as mean CBV value, 7,18 maximum CBV value, 20,28,43 and 80th percentile of CBV 11 have been shown to be variable. Our results showed that the maximum CBV of PCNSLs tended to be significantly lower than that of GBMs, with a large AUC of 0.848.…”

“…Several studies have demonstrated that histogram analyses adapted to CBV or ADC values are superior or comparable to the visually guided ROI-based method for distinguishing tumor type, 11,12,20,30 glioma grading, 21,31–33 and recurrence of glioma 34–38 and can provide multiple useful parameters in addition to mean and maximum value. Manual ROI methods to evaluate CBV and ADC were highly operator-dependent, and whole-tumor histogram analysis using semi-automatic tumor definition is quantitative and reproducible.…”

“…12,18,29,30,44 While most studies have only compared DWI and PWI results, some have combined these results to distinguish GBM from PCNSL. 7,11,18 Recently, multiparametric imaging has been used to differentiate brain tumor types, and with advances in analysis software, multiparametric imaging is a promising tool for distinguishing tumor characteristics. 18,23,35,45–49 In our results, the 25th percentile of ADC and the mean of nCBV values overlapped in many cases (Fig.…”

Cortically based cystic supratentorial RELA fusion-positive ependymoma: a case report with unusual presentation and appearance and review of literature

“…The extraventricular ependymomas are usually in close proximity to the ventricles and contacting them, but the cortically based ependymomas do not contact the ependymal margin at all. However, definitive diagnosis cannot be made with conventional imaging alone [9] , [10] , [11] .…”

Preoperative and intraoperative perfusion magnetic resonance imaging in a RELA fusion-positive anaplastic ependymoma: A case report

“…MR perfusion involves dynamic susceptibility contrast (DSC) and dynamic contrast-enhanced techniques that allow for quantification of several tumor parameters, including cerebral blood volume (CBV), cerebral blood flow (CBF), and other contrast-diffusion parameters. [ 17 ] Various studies have suggested the potential use of MR perfusion imaging in the diagnosis of high-grade gliomas,[ 8 ] differentiation of gliomas from lymphomas,[ 12 ] and prediction of tumor aggression and treatment response. [ 1 ] To date, the role of perfusion intraoperative magnetic resonance imaging (iMRI) in the surgical treatment of RELA-fusion positive ependymomas has not been thoroughly explored.…”