Utility of percentage signal recovery derived from dynamic susceptibility contrast perfusion magnetic resonance imaging for differentiating glioblastoma, lymphoma, metastasis and meningioma: An observational prospective study

Abstract

Abstract Background: Pre-operative differentiation of brain neoplasm (gliomas, metastasis, lymphoma and meningiomas) is important for staging, intra-operative management and post-operative treatment. Dynamic susceptibility contrast (DSC)-enhanced perfusion magnetic resonance imaging (MRI) based on microvasculature assessment can aid in differentiating these intracranial mass lesions. Methods: Thirty three patients referred to the radiology department for MRI with a presumptive diagnosis of primary intracranial tumour were included in the study. DSC imaging was performed by using a gradient-recalled T2*-weighted echo-planar imaging sequence. These data were used to calculate mean and maximum relative cerebral blood volume (rCBVmean and rCBVmax) and also percentage signal recovery (PSR) and relative PSR (rPSR) values. Results: The final histopathology was glioblastoma multiforme (GBM, n = 10, 30.3%), followed by metastasis in 9 (27.3%), lymphoma in 8 (24.2%) and meningioma in 6 cases (18.2%). All PSR parameters (maximum PSR, mean PSR, minimum PSR [minPSR] and rPSR) and rCBVmean were observed to be helpful (P < 0.05) in differentiating GBM (glioblastoma) from lymphoma; of these, the rCBVmean and rPSR (P = 0.0001) were most useful. Only rCBVmean could differentiate GBM from metastasis (P < 0.05); rCBVmean (P < 0.05) and minPSR (P <0.05) could differentiate GBM from meningioma. Conclusions: DSC-enhanced perfusion MRI based on microvasculature assessment can aid in differentiating intracranial mass lesions.