Differentiation between glioblastomas and solitary brain metastases using diffusion tensor imaging

Abstract

The purpose of this study is to determine whether diffusion tensor imaging (DTI) metrics including tensor shape measures such as linear and planar anisotropy coefficients (CL and CP) can help differentiate glioblastomas from solitary brain metastases. Sixty-three patients with histopathologic diagnosis of glioblastomas (22 men, 16 women, mean age 58.4 years) and brain metastases (13 men, 12 women, mean age 56.3 years) were included in this study. Contrast-enhanced T1-weighted, fluid attenuated inversion recovery (FLAIR) images, fractional anisotropy (FA), apparent diffusion coefficient (ADC), CL and CP maps were co-registered and each lesion was semi-automatically subdivided into four regions: central, enhancing, immediate peritumoral and distant peritumoral. DTI metrics as well as the normalized signal intensity from the contrast-enhanced T1-weighted images were measured from each region. Univariate and multivariate logistic regression analyses were employed to determine the best model for classification. The results demonstrated that FA, CL and CP from glioblastomas were significantly higher than those of brain metastases from all segmented regions (p < 0.05), and the differences from the enhancing regions were most significant (p < 0.001). FA and CL from the enhancing region had the highest prediction accuracy when used alone with an area under the curve of 0.90. The best logistic regression model included three parameters (ADC, FA and CP) from the enhancing part, resulting in 92% sensitivity, 100% specificity and area under the curve of 0.98. We conclude that DTI metrics, used individually or combined, have a potential as a noninvasive measure to differentiate glioblastomas from metastases.

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

“…15,[25][26][27] We speculate that these hyperintensities may represent tumor parts with focal high cellularity. 13 On visual inspection, the perilesional hyperintense FA rim is the most sensitive, specific, and accurate sign in differentiating TDLs from high-grade gliomas. The lower incidence of a hyperintense FA rim associated with TDLs was concurrently supported by quantitative analysis finding that perilesional FA values were significantly lower in TDLs than in high-grade gliomas.…”

“…Malhotra et al 11 found peripheral restricted diffusion on DWI in 11 of 18 patients with TDLs, while Masu et al 12 observed that intralesional fibers appeared to be a pyramidal tract on diffusion tractography in a patient with TDL. Conversely, the perilesional hyperintense FA rim that is frequently found in the perifocal edema of high-grade gliomas 13 has not been described in TDLs. We aimed to differentiate TDLs from highgrade gliomas with DTI because the contributory role of DTI in differentiating TDLs from high-grade gliomas is not clear and quantitative comparison between the 2 has not been reported, to our knowledge.…”

Morphometric model for discrimination between glioblastoma multiforme and solitary metastasis using three‐dimensional shape analysis

“…Wang et al (18) investigated the application of a combination of scalar DTI parameters for the classification of solitary GBM and MET tumours, and achieved an area under receiver operating characteristic (ROC) curve (AUC) of 0.98. However, Wang et al (18) delineated several ROIs both inside and outside the tumour core, which potentially provides a subjectivity that may reduce experimental reproducibility.…”

“…However, Wang et al (18) delineated several ROIs both inside and outside the tumour core, which potentially provides a subjectivity that may reduce experimental reproducibility.…”

Diagnostic Utility of Diffusion Tensor Imaging in Differentiating Glioblastomas from Brain Metastases

“…In contrast, another study reported that glioblastomas have higher FA in the enhancing regions than metastases. 12 The potential reasons for these conflicting results may include differ-ences in analysis methods, particularly in defining the region of interest, as well as the relatively small size of cohorts used in individual studies (n ϭ 24 -66). 4,5,7,10,13 Hence, a primary objective of this study was to investigate the DTI characteristics of glioblastomas and brain metastases in a substantially larger cohort of patients, in order to determine whether they may have diagnostic utility.…”