Atypical primary central nervous system lymphoma and glioblastoma: multiparametric differentiation based on non-enhancing volume, apparent diffusion coefficient, and arterial spin labeling

• Published in: European radiology Vol. 33; no. 8; pp. 5357 - 5367
• Main Authors: Yu, Xiaojun, Hong, Weiping, Ye, Minting, Lai, Mingyao, Shi, Changzheng, Li, Linzhen, Ye, Kunlin, Xu, Jiali, Ai, Ruyu, Shan, Changguo, Cai, Linbo, Luo, Liangping
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-08-2023; Springer Nature B.V
• Subjects: Blood flow; Brain cancer; Brain Neoplasms - diagnostic imaging; Brain Neoplasms - pathology; Central nervous system; Central Nervous System - pathology; Cerebral blood flow; Diagnosis, Differential; Diagnostic Radiology; Diagnostic systems; Differentiation; Diffusion coefficient; Glioblastoma; Glioblastoma - diagnostic imaging; Glioblastoma - pathology; Hemorrhage; Humans; Imaging; Internal Medicine; Interventional Radiology; Labeling; Lymphoma; Lymphoma - diagnostic imaging; Lymphoma - pathology; Magnetic Resonance Imaging; Mathematical models; Medicine; Medicine & Public Health; Necrosis; Nervous system; Neuro; Neuroradiology; Parameters; Performance evaluation; Radiology; Spin labeling; Spin Labels; Standardization; Substantia alba; Tumors; Ultrasound; Tumor volume; Magnetic resonance imaging; Lymphoma; Central nervous system; Glioblastoma
• ISSN: 1432-1084; 0938-7994; 1432-1084
• DOI: 10.1007/s00330-023-09681-2

Objectives
To evaluate the multiparametric diagnostic performance with non-enhancing tumor volume, apparent diffusion coefficient (ADC), and arterial spin labeling (ASL) to differentiate between atypical primary central nervous system lymphoma (PCNSL) and glioblastoma (GBM).
Methods
One hundred and fifty-eight patients with pathologically confirmed typical PCNSL (
n
 = 59), atypical PCNSL (hemorrhage, necrosis, or heterogeneous contrast enhancement,
n
 = 29), and GBM (
n
 = 70) were selected. Relative minimum ADC (rADC
min
), mean (rADC
mean
), maximum (rADC
max
), and rADC
max-min
(rADC
dif
) were obtained by standardization of the contralateral white matter. Maximum cerebral blood flow (CBF
max
) was obtained according to the ASL-CBF map. The regions of interests (ROIs) were manually delineated on the inner side of the tumor to further generate a 3D-ROI and obtain the non-enhancing tumor (nET) volume. The area under the curve (AUC) was used to evaluate the diagnostic performance.
Results
Atypical PCNSLs showed significantly lower rADC
max
, rADC
mean
, and rADC
dif
than that of GBMs. GBMs showed significantly higher CBF
max
and nET volume ratios than that of atypical PCNSLs. Combined three-variable models with rADC
mean
, CBF
max
, and nET volume ratio were superior to one- and two-variable models. The AUC of the three-variable model was 0.96, and the sensitivity and specificity were 90% and 96.55%, respectively.
Conclusion
The combined evaluation of rADC
mean
, CBF
max
, and nET volume allowed for reliable differentiation between atypical PCNSL and GBM.
Key Points
•
Atypical PCNSL is easily misdiagnosed as glioblastoma, which leads to unnecessary surgical resection.
•
The nET volume, ADC, and ASL-derived parameter (CBF) were lower for atypical PCNSL than that for glioblastoma.
•
The combination of multiple parameters performed well (AUC = 0.96) in the discrimination between atypical PCNSL and glioblastoma.