Abstract
PurposeDifferentiation of high-grade gliomas and solitary brain metastases is an important clinical issue because the treatment strategies differ greatly. Our study aimed to investigate the potential value of diffusion tensor imaging (DTI) in differentiating high-grade gliomas from brain metastases using a meta-analytic approach.Materials and MethodsWe searched Pubmed, Embase and the Cochrane Library for relevant articles published in English. Studies that both investigated high-grade gliomas and brain metastases using DTI were included. Random effect model was used to compare fractional anisotropy (FA) and mean diffusivity (MD) values in the two tumor entities.ResultsNine studies were included into the meta-analysis. In the peritumoral region, compared with brain metastases, high-grade gliomas had a significant increase of FA (SMD = 0.47; 95% CI, 0.22–0.71; P<0.01) and a significant decrease of MD (SMD = −1.49; 95% CI, −1.91 to −1.06; P<0.01). However, in the intratumoral area, no significant change in FA (SMD = 0.16; 95% CI, −0.49 to 0.82; P = 0.73) or MD (SMD = 0.34; 95% CI, −0.91 to 1.60; P = 0.59) was detected between gliomas and metastases.ConclusionsHigh-grade gliomas may be distinguished from brain metastases by comparing the peritumoral FA and MD values. DTI appears to be a promising tool in diagnosing solitary intracranial lesions.
Highlights
High-grade gliomas and brain metastases are two of the most common malignant brain tumors in adults
In the peritumoral region, compared with brain metastases, high-grade gliomas had a significant increase of fractional anisotropy (FA) (SMD = 0.47; 95% CI, 0.22–0.71; P,0.01) and a significant decrease of mean diffusivity (MD) (SMD = 21.49; 95% CI, 21.91 to 21.06; P,0.01)
High-grade gliomas may be distinguished from brain metastases by comparing the peritumoral FA and MD values
Summary
High-grade gliomas and brain metastases are two of the most common malignant brain tumors in adults. DTI has the advantage of giving more detailed information about the involvement and integrity of the matter tracts in the peritumoral regions [3]. Both primary and metastatic intracranial tumors are surrounded by some degree of hyperintensity on T2-weighted images, which has been recognized as vasogenic edema. Compared with contralateral normal appearing white matter, FA values in lesions of gliomas or metastases have been reported to be consistently reduced [2,5,6,7]. Some authors reported significantly higher FA from the peritumoral region of high-grade gliomas compared with brain metastases [8,9,10]. Similar controversy existed in the value of MD for discerning gliomas from brain metastases [8,12]
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