Evaluation of Microvascular Permeability with Dynamic Contrast-Enhanced MRI for the Differentiation of Primary CNS Lymphoma and Glioblastoma: Radiologic-Pathologic Correlation

Kickingereder, Philipp; Sahm, Felix; Wiestler, Benedikt; Roethke, Matthias; Heiland, Sabine; Schlemmer, Heinz–Peter; Wick, Wolfgang; Deimling, Andreas von; Bendszus, Martin; Radbruch, Alexander

doi:10.3174/ajnr.a3915

Cited by 88 publications

(71 citation statements)

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“…DTItractography is very helpful for surgical planning and navigational purposes [34] as well as functional MRI [35]. Recent studies with dynamic contrast-enhanced (DCE) perfusion MRI that provides in vivo assessment of tumors microvasculature have shown that this technique may be useful in distinguishing PCNSL from GBM [36]. DCE perfusion imaging offers potential advantage over dynamic susceptibility contrast-enhanced (DSC) perfusion imaging due to its resilience to susceptibility artifact, higher spatial resolution, and 3D acquisition.…”

Section: Discussionmentioning

confidence: 98%

Diagnostic delay and prognosis in primary central nervous system lymphoma compared with glioblastoma multiforme

et al. 2015

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Glioblastoma multiforme (GBM) and primary central nervous system lymphoma (PCNSL) are malignant cerebral neoplasms associated with poor prognosis. Early diagnosis and subsequent planning of adequate treatment strategy are relevant to improve survival and reduce neurological deficit. Two groups of patients affected by GBM and PCNSL were compared to identify: (1) factors influencing the time necessary to obtain a correct diagnosis; (2) the influence of the interval time from clinical onset to diagnosis on the prognosis. Fifty-six patients (28 PCNSL and 28 GBM, 23 females and 33 males) referred to the same hospital setting were retrospectively evaluated. The mean age at diagnosis was 61 years. The two groups were comparable in terms of age, sex, clinical symptoms at onset and performance status. There was no relevant difference in time span from clinical onset to first neuroimaging examination, while time span from first neuroimaging to final morphological diagnosis was much longer in PCNSL patients (p = 0.008). Multivariate Cox regression analysis, including both PCNSL and GBM cases, showed a significant association of the overall survival with: time to diagnosis (HR 0.06), age at onset (HR 1.04). Our results show a significant diagnostic delay in PCNSL cases. Age at onset of disease and time to diagnosis emerge as clinical factors affecting overall survival in both groups. Stereotactic-guided biopsy should be chosen as routine method to early diagnose PCNSL. The clinical relevance of early diagnosis in GBM and PCNSL needs to be emphasized to maximize the overall survival in both neoplasms.

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Section: Discussionmentioning

confidence: 98%

Diagnostic delay and prognosis in primary central nervous system lymphoma compared with glioblastoma multiforme

et al. 2015

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“…PCNSL has been shown to have lower vascularity and higher permeability than glioblastoma. 7,14,19,20,25 These differences are considered to reflect their histological changes. PCNSL lacks abundant neovascularisation, but grows angiocentrically and tends to cluster around preexisting brain vessels.…”

Section: Discussionmentioning

confidence: 99%

Differentiation between primary central nervous system lymphoma and glioblastoma: a comparative study of parameters derived from dynamic susceptibility contrast-enhanced perfusion-weighted MRI

et al. 2015

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“…Cerebral blood volume maps obtained by CT and MR perfusion are useful to identify primary brain tumors or lymphomas. The latter is characterized by the typical leakage in MR perfusion due to higher vascular permeability [15].…”

Section: Discussionmentioning

confidence: 99%

CT and MRI Findings in Cerebral Aspergilloma

Gärtner

Forstenpointner²,

Ertl‐Wagner

et al. 2017

Fortschr Röntgenstr

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ZUSAMMENFASSUNG Ziel Zerebrale Aspergillose betrifft meist immunsupprimiertePatienten und weist aufgrund der oftmals unspezifischen Klinik ein hohes Morbiditäts-und Mortalitätsrisiko auf. Eine frühe Diagnosestellung ermöglicht die effektivere Einleitung der Therapiemaßnahmen und die Verbesserung des Outcome.Material und Methoden Die CT-und MRT-Aufnahmen von neun Patienten aus zwei Zentren wurden ausgewertet. Die Diagnose der zerebralen Aspergillose wurde mittels Biopsie und histopathologischer Begutachtung verifiziert. Die MRT wurde an 1,5T-und 3T-Geräten durchgeführt, die Untersuchungsprotokolle enthielten jeweils DWI, T2-und T1-gewichtete Bilder mit und ohne Kontrastmittel.Ergebnisse In der CT wiesen die Aspergillome kein typisches Erscheinungsbild auf. In der MRT waren die Aspergillome zu 100 % randständig diffusionsgestört (9/9). Mehrere hypointense Schichten in der Aspergilluswand, insbesondere an der Innenseite, waren typisch in den Aufnahmen mit T2-Wichtung (100 %, 9/9). Die Aspergillome waren sowohl T1-hypointens (66 %, 6/9), sowie in 33 % anteilig T1-hyperintens (3/9). In 78 % (7/9) der Fälle fand sich ein randständiges Enhancement nach Gadoliniumapplikation.Schlussfolgerung Aspergillome weisen typischerweise eine kräftige, ringförmige Diffusionsrestriktion auf (9/9). Typische Befunde in Aufnahmen der T2-gewichteten Bilder sind zwiebelschalenartig angeordnete hypointense Schichten, die innere Zone der Aspergilluswand ist aufgrund paramagnetischer Effekte besonders signalarm (9/9). Der Großteil der Aspergillome weist nach Kontrastmittelapplikation ein ringförmiges Enhancement auf (7/9). ABSTR AC TPurpose Invasive aspergillosis usually affects immunocompromised patients. It carries a high risk of morbidity and mortality and usually has a nonspecific clinical presentation. Early diagnosis is essential in order to start effective treatment and improve clinical outcome. Materials and MethodsIn a retrospective search of the PACS databases from two medical centers, we identified 9 patients with histologically proven cerebral aspergilloma. We systematically analyzed CT and MRI imaging findings to identify typical imaging appearances of cerebral aspergilloma.Results CT did not show a typical appearance of the aspergillomas. In 100 % (9/9) there was a rim-attenuated diffusion restriction on MRI imaging. Multiple hypointense layers in the aspergillus wall, especially on the internal side, were detected in 100 % on T2-weighted imaging (9/9). Aspergillomas were T1-hypointense in 66 % of cases (6/9) and partly T1-hyperintense in 33 % (3/9). In 78 % (7/9) of cases, a rim-attenuated diffusion restriction was detected after contrast agent application.Conclusion Nine cases were identified. Whereas CT features were less typical, we observed the following imaging features on MRI: A strong, rim-attenuated diffusion restriction (9/9); onion layer-like hypointense zones, in particular in the innermost part of the abscess wall on T2-weighted images (9/9). Enhancement of the lesion border was present in the majority of the cas...

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Evaluation of Microvascular Permeability with Dynamic Contrast-Enhanced MRI for the Differentiation of Primary CNS Lymphoma and Glioblastoma: Radiologic-Pathologic Correlation

Cited by 88 publications

References 25 publications

Diagnostic delay and prognosis in primary central nervous system lymphoma compared with glioblastoma multiforme

Diagnostic delay and prognosis in primary central nervous system lymphoma compared with glioblastoma multiforme

Differentiation between primary central nervous system lymphoma and glioblastoma: a comparative study of parameters derived from dynamic susceptibility contrast-enhanced perfusion-weighted MRI

CT and MRI Findings in Cerebral Aspergilloma

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