Differentiation of Glioblastoma Multiforme and Single Brain Metastasis by Peak Height and Percentage of Signal Intensity Recovery Derived from Dynamic Susceptibility-Weighted Contrast-Enhanced Perfusion MR Imaging

Abstract

BACKGROUND AND PURPOSE: Glioblastoma multiforme (GBM) and single brain metastasis (MET) are the 2 most common malignant brain tumors that can appear similar on anatomic imaging but require vastly different treatment strategy. The purpose of our study was to determine whether the peak height and the percentage of signal intensity recovery derived from dynamic susceptibility-weighted contrast-enhanced (DSC) perfusion MR imaging could differentiate GBM and MET.

Tumour enhancing fraction (EnF) in glioma: relationship to tumour grade

“…Other studies have been able to differentiate grade III from grade II but not from grade IV [9]. The development of imaging biomarkers to accurately identify grade III tumours is hampered by considerable variability in the accuracy of pathological classification and by the frequent occurrence of grade II tumours with an oligodendroglial component which are known to be relatively vascular [21]. This was the case in the current study as 62% of low grade tumours had significant oligodendroglioma components.…”

Diagnostic Dilemma of Pseudoprogression in the Treatment of Newly Diagnosed Glioblastomas: The Role of Assessing Relative Cerebral Blood Flow Volume and Oxygen-6-Methylguanine-DNA Methyltransferase Promoter Methylation Status

“…7,20,21 Because the contrast enhancement induced by radiation effect is also a consequence of vascular permeability, effort has been made to differentiate tumor progression and treatment-related necrosis by assessing CBV. [22][23][24][25][26][27] To date, measurement of the rCBV ratio is believed to be essential for predicting real tumor progression in a variety of fields.…”

MR perfusion‐weighted imaging may help in differentiating between nonenhancing gliomas and nonneoplastic lesions in the cervicomedullary junction

“…The peak height is defined as the maximal signal intensity drop from the precontrast baseline during the first bolus pass of gadolinium. The percentage of signal intensity recovery represents the percentage of signal intensity recovery at the end of the first bolus pass relative to the precontrast baseline level (11). These two parameters are derived directly from the time-signal intensity curve obtained within the lesion; thus, their measurements do not rely on information from contralateral, normal reference tissue.…”

“…Pathologic lesions in this region may involve most of the medulla/cord; thus, it is often difficult to obtain an accurate reference rCBV value from the medulla/cord at the same level. There are two other, recently described hemodynamic variables derived from DSC perfusion MR imaging: 1) peak height, and 2) percentage of signal intensity recovery, which can provide additional information on tumor vasculature (11). The peak height is defined as the maximal signal intensity drop from the precontrast baseline during the first bolus pass of gadolinium.…”