Primary Cerebral Lymphoma and Glioblastoma Multiforme: Differences in Diffusion Characteristics Evaluated with Diffusion Tensor Imaging

C.-H Toh,S.-H Ng,M Castillo,Y.-L Wan,H.-F Wong,A.M.-C Wong,K.-C Wei

doi:10.3174/ajnr.a0872

Abstract

Differentiating between primary cerebral lymphoma and glioblastoma multiforme (GBM) based on conventional MR imaging sequences may be impossible. Our hypothesis was that there are significant differences in fractional anisotropy (FA) and apparent diffusion coefficient (ADC) between lymphoma and GBM, which will allow for differentiation between them. Preoperative diffusion tensor imaging (DTI) was performed in 10 patients with lymphoma and 10 patients with GBM. Regions of interest were placed in only solid-enhancing tumor areas and the contralateral normal-appearing white matter (NAWM) to measure the FA and ADC values. The differences in FA and ADC between lymphoma and GBM, as well as between solid-enhancing areas of each tumor type and contralateral NAWM, were analyzed statistically. Cutoff values of FA, FA ratio, ADC, and ADC ratio for distinguishing lymphomas from GBMs were determined by receiver operating characteristic curve analysis. FA and ADC values of lymphoma were significantly decreased compared with NAWM. Mean FA, FA ratio, ADC (x10(-3) mm(2)/s), and ADC ratios were 0.140 +/- 0.024, 0.25 +/- 0.04, 0.630 +/- 0.155, and 0.83 +/- 0.14 for lymphoma, respectively, and 0.229 +/- 0.069, 0.40 +/- 0.12, 0.963 +/- 0.119, and 1.26 +/- 0.13 for GBM, respectively. All of the values were significantly different between lymphomas and GBM. Cutoff values to differentiate lymphomas from GBM were 0.192 for FA, 0.33 for FA ratio, 0.818 for ADC, and 1.06 for ADC ratio. The FA and ADC of primary cerebral lymphoma were significantly lower than those of GBM. DTI is able to differentiate lymphomas from GBM.

Highlights

AND PURPOSE: Differentiating between primary cerebral lymphoma and glioblastoma multiforme (GBM) based on conventional MR imaging sequences may be impossible
fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of lymphoma were significantly decreased compared with normal-appearing white matter (NAWM)
The changes in FA in solid-enhancing areas of lymphoma and GBM and NAWM were plotted against ADC (Fig 3)

Summary

Methods

Preoperative diffusion tensor imaging (DTI) was performed in 10 patients with lymphoma and 10 patients with GBM. Regions of interest were placed in only solid-enhancing tumor areas and the contralateral normal-appearing white matter (NAWM) to measure the FA and ADC values. The differences in FA and ADC between lymphoma and GBM, as well as between solidenhancing areas of each tumor type and contralateral NAWM, were analyzed statistically. Patients Approval for this study was obtained from the institutional board of research associates. MR examinations were performed in 10 patients (4 men and 6 women; mean age, 53.3 years; age range, 22–75 years) with biopsyproven primary cerebral lymphomas and 10 patients (5 men and 5 women; mean age, 51.9 years; age range, 23– 80 years) with biopsyproven GBMs (WHO grade IV). None of the patients had begun corticosteroid treatment, radiation therapy, or chemotherapy or had had a previous brain biopsy at the time of MR imaging.

Results

Discussion

Conclusion