Abstract
ObjectivesTo investigate the value of morphological feature and signal intensity ratio (SIR) derived from conventional magnetic resonance imaging (MRI) in distinguishing primary central nervous system lymphoma (PCNSL) from atypical glioblastoma (aGBM).MethodsPathology-confirmed PCNSLs (n = 93) or aGBMs (n = 48) from three institutions were retrospectively enrolled and divided into training cohort (n = 98) and test cohort (n = 43). Morphological features and SIRs were compared between PCNSL and aGBM. Using linear discriminant analysis, multiple models were constructed with SIRs and morphological features alone or jointly, and the diagnostic performances were evaluated via receiver operating characteristic (ROC) analysis. Areas under the curves (AUCs) and accuracies (ACCs) of the models were compared with the radiologists’ assessment.ResultsIncision sign, T2 pseudonecrosis sign, reef sign and peritumoral leukomalacia sign were associated with PCNSL (training and overall cohorts, P < 0.05). Increased T1 ratio, decreased T2 ratio and T2/T1 ratio were predictive of PCNSL (all P < 0.05). ROC analysis showed that combination of morphological features and SIRs achieved the best diagnostic performance for differentiation of PCNSL and aGBM with AUC/ACC of 0.899/0.929 for the training cohort, AUC/ACC of 0.794/0.837 for the test cohort and AUC/ACC of 0.869/0.901 for the overall cohort, respectively. Based on the overall cohort, two radiologists could distinguish PCNSL from aGBM with AUC/ACC of 0.732/0.724 for radiologist A and AUC/ACC of 0.811/0.829 for radiologist B.ConclusionMRI morphological features can help differentiate PCNSL from aGBM. When combined with SIRs, the diagnostic performance was better than that of radiologists’ assessment.
Highlights
Preoperative distinguishing primary central nervous system lymphoma (PCNSL) from glioblastoma (GBM) is of highly clinical relevance because treatment strategies for the two diseases vary substantially
Inclusion criteria were as follows: 1) no prior treatment history before magnetic resonance (MR) examination, including biopsy, surgery, radiotherapy, chemotherapy, or corticosteroid treatment; 2) pretreatment MRI with conventional sequences available, including axial T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), and T1CE imaging; 3) no hemorrhage inside the tumor based on T1WI and T2WI; 4) all PCNSL patients were immunocompetent
Patients in the PCNSL group were pathologically confirmed as diffuse large B-cell lymphoma
Summary
Preoperative distinguishing primary central nervous system lymphoma (PCNSL) from glioblastoma (GBM) is of highly clinical relevance because treatment strategies for the two diseases vary substantially. In patients with GBM, surgical resection followed by concurrent chemoradiation is the first-line treatment, whereas patients with PCNSL usually undergo stereotactic biopsy followed by high-dose methotrexate [1, 2]. Typical GBM usually exhibits an irregular rim-like enhancement with necrosis [3, 4]. This enhancement pattern is not reliable in cases of atypical glioblastoma (aGBM) with no visible necrosis, which complicates the discrimination between aGBM and PCNSL [5, 6]
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