Abstract
ObjectiveDifferentiation of glioblastomas from solitary brain metastases using conventional MRI remains an important unsolved problem. In this study, we introduced the conception of the cerebral blood flow (CBF) gradient in peritumoral edema—the difference in CBF values from the proximity of the enhancing tumor to the normal-appearing white matter, and investigated the contribution of perfusion metrics on the discrimination of glioblastoma from a metastatic lesion.Materials and MethodsFifty-two consecutive patients with glioblastoma or a solitary metastatic lesion underwent three-dimensional arterial spin labeling (3D-ASL) before surgical resection. The CBF values were measured in the peritumoral edema (near: G1; Intermediate: G2; Far: G3). The CBF gradient was calculated as the subtractions CBFG1 –CBFG3, CBFG1 – CBFG2 and CBFG2 – CBFG3. A receiver operating characteristic (ROC) curve analysis was used to seek for the best cutoff value permitting discrimination between these two tumors.ResultsThe absolute/related CBF values and the CBF gradient in the peritumoral regions of glioblastomas were significantly higher than those in metastases(P < 0.038). ROC curve analysis reveals, a cutoff value of 1.92 ml/100g for the CBF gradient of CBFG1 –CBFG3 generated the best combination of sensitivity (92.86%) and specificity (100.00%) for distinguishing between a glioblastoma and metastasis.ConclusionThe CBF gradient in peritumoral edema appears to be a more promising ASL perfusion metrics in differentiating high grade glioma from a solitary metastasis.
Highlights
Glioblastomas and solitary brain metastases often have similar imaging appearances at conventional MRI
receiver operating characteristic (ROC) curve analysis reveals, a cutoff value of 1.92 ml/100g for the cerebral blood flow (CBF) gradient of CBFG1 –CBFG3 generated the best combination of sensitivity (92.86%) and specificity (100.00%) for distinguishing between a glioblastoma and metastasis
We aimed to investigate whether the CBF gradient can be helpful to discriminate glioblastomas from solitary metastases
Summary
Glioblastomas and solitary brain metastases often have similar imaging appearances at conventional MRI. Functional and molecular imaging significantly improve diagnostic specificity and provide an insight into the underlying biological characteristics of brain tumors [6, 7]. Advanced modalities such as spectroscopy imaging [8, 9], diffusion imaging [9,10,11] and perfusion imaging [11,12,13,14] have demonstrated various degrees of success in differentiating glioblastomas from metastases. Perfusion imaging provides non-invasive quantitative methods in assessing tumor vascularity, and can be mainly divided into two techniques: dynamic susceptibility contrast-enhanced perfusion weighted imaging (DSC-PWI) and arterial spin labeling (ASL)
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