Abstract
BackgroundMorphologically similar appearing ring enhancing lesions in the brain parenchyma can be caused by a number of distinct pathologies, however, they consistently represent life-threatening conditions. The two most frequently encountered diseases manifesting as such are glioblastoma multiforme (GBM) and brain abscess (BA), each requiring disparate therapeutical approaches. As a result of their morphological resemblance, essential treatment might be significantly delayed or even ommited, in case results of conventional imaging remain inconclusive. Therefore, our study aimed to investigate, whether ADC histogram profiling reliably can distinguish between both entities, thus enhancing the differential diagnostic process and preventing treatment failure in this highly critical context.Methods103 patients (51 BA, 52 GBM) with histopathologically confirmed diagnosis were enrolled. Pretreatment diffusion weighted imaging (DWI) was obtained in a 1.5T system using b values of 0, 500, and 1000 s/mm2. Whole lesion ADC volumes were analyzed using a histogram-based approach. Statistical analysis was performed using SPSS version 23.ResultsAll investigated parameters were statistically different in comparison of both groups. Most importantly, ADCp10 was able to differentiate reliably between BA and GBM with excellent accuracy (0.948) using a cutpoint value of 70 × 10−5 mm2 × s−1.ConclusionsADC whole lesion histogram profiling provides a valuable tool to differentiate between morphologically indistinguishable mass lesions. Among the investigated parameters, the 10th percentile of the ADC volume distinguished best between GBM and BA.
Highlights
Ring enhancing lesions (REL) within the brain parenchyma in most cases represent a serious, potentially life-threatening disease [1,2,3,4,5,6,7,8,9]
apparent diffusion coefficient (ADC) whole lesion histogram profiling provides a valuable tool to differentiate between morphologically indistinguishable mass lesions
Statistically significant differences were identified for lesion volume, all ADC fractions and histogram-based parameters as well
Summary
Ring enhancing lesions (REL) within the brain parenchyma in most cases represent a serious, potentially life-threatening disease [1,2,3,4,5,6,7,8,9]. Attribution of REL to an incorrect underlying pathology most certainly delays essential treatment and possibly leads to unnecessary extensive brain surgery of a non-surgical lesion, resulting in significant therapy-related morbidity and mortality [11]. In the clinical setting it is most frequently of great importance to distinguish glioblastoma multiforme (GBM) from BA (BA). Both entities present strikingly similar in neuroimaging, but prognosis and management is very distinct. Similar appearing ring enhancing lesions in the brain parenchyma can be caused by a number of distinct pathologies, they consistently represent life-threatening conditions. Our study aimed to investigate, whether ADC histogram profiling reliably can distinguish between both entities, enhancing the differential diagnostic process and preventing treatment failure in this highly critical context
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