Classification of Primary Cerebral Lymphoma and Glioblastoma Featuring Dynamic Susceptibility Contrast and Apparent Diffusion Coefficient.

Felix Eisenhut,Manuel A Schmidt,Hannes Luecking,Florian Putz,Rainer Fietkau,Roland Coras,Kilian Fröhlich,Stefan Lang,Arnd Doerfler,Soheil Arinrad,Sebastian Lettmaier

doi:10.3390/brainsci10110886

Felix Eisenhut, Manuel A Schmidt + Show 9 more

Open Access

https://doi.org/10.3390/brainsci10110886

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Journal: Brain sciences	Publication Date: Nov 20, 2020
Citations: 15	License type: CC BY 4.0

Affiliation: University of Erlangen-Nuremberg

Abstract

This study aimed to differentiate primary central nervous system lymphoma (PCNSL) and glioblastoma (GBM) via multimodal MRI featuring radiomic analysis. MRI data sets of patients with histological proven PCNSL and GBM were analyzed retrospectively. Diffusion-weighted imaging (DWI) and dynamic susceptibility contrast (DSC) perfusion imaging were evaluated to differentiate contrast enhancing intracerebral lesions. Selective (contrast enhanced tumor area with the highest mean cerebral blood volume (CBV) value) and unselective (contouring whole contrast enhanced lesion) Apparent diffusion coefficient (ADC) measurement was performed. By multivariate logistic regression, a multiparametric model was compiled and tested for its diagnostic strength. A total of 74 patients were included in our study. Selective and unselective mean and maximum ADC values, mean and maximum CBV and ratioCBV as quotient of tumor CBV and CBV in contralateral healthy white matter were significantly larger in patients with GBM than PCNSL; minimum CBV was significantly lower in GBM than in PCNSL. The highest AUC for discrimination of PCNSL and GBM was obtained for selective mean and maximum ADC, mean and maximum CBV and ratioCBV. By integrating these five in a multiparametric model 100% of the patients were classified correctly. The combination of perfusion imaging (CBV) and tumor hot-spot selective ADC measurement yields reliable radiological discrimination of PCNSL from GBM with highest accuracy and is readily available in clinical routine.

Highlights

Glioblastoma (GBM) is the most common malignant central nervous system neoplasm [1].Despite current advances in multimodal treatment—including radical surgical resection, radiation and chemotherapy—this glioma subtype remains highly aggressive with a poor prognosis and a high reoccurrence rate [2,3]
74 patients (49 males, 25 females, median age 68.3 years) with full multimodal magnetic resonance imaging (MRI) ahead of any medical treatment were included in our study: 37 patients with histologically diagnosed primary central nervous system lymphoma (PCNSL)
We evaluated two different approaches of Apparent diffusion coefficient (ADC) region of interests (ROI) measurement—first by unselective contouring the whole contrast enhancing lesion, second by selective ROI placing in the tumor area with the highest CBV value—in combination with dynamic susceptibility contrast (DSC) CBV perfusion imaging for differentiation of glioblastoma from primary central nervous system lymphoma

Summary

Introduction

Glioblastoma (GBM) is the most common malignant central nervous system neoplasm [1].Despite current advances in multimodal treatment—including radical surgical resection, radiation and chemotherapy—this glioma subtype remains highly aggressive with a poor prognosis and a high reoccurrence rate [2,3]. Glioblastoma (GBM) is the most common malignant central nervous system neoplasm [1]. Primary central nervous system lymphomas (PCNSL)—up to 95% are diffuse large B-cell lymphomas—are aggressive tumors with a median untreated survival of just a few months. E.g., corticosteroids, methotrexate-based chemotherapy and radiation, are effective attempts, but the relapse rate is high [4]. PCNSL (basal ganglia or periventricular white matter location, homogenous contrast enhancement, rarely hemorrhage or necrosis) and GBM (peripheral ring enhancement, intralesional hemorrhage, central necrosis) can usually be differentiated.

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