Permeability measurement using dynamic susceptibility contrast magnetic resonance imaging enhances differential diagnosis of primary central nervous system lymphoma from glioblastoma
To test if adding permeability measurement to perfusion obtained from dynamic susceptibility contrast MRI (DSC-MRI) improves diagnostic performance in the differentiation of primary central nervous system lymphoma (PCNSL) from glioblastoma.
Materials and methods
DSC-MRI was acquired in 145 patients with pathologically proven glioblastoma (n = 89) or PCNSL (n = 56). The permeability metrics of contrast agent extraction fraction (Ex), apparent permeability (Ka), and leakage-corrected perfusion of normalized cerebral blood volume (nCBVres) and cerebral blood flow (nCBFres) were derived from a tissue residue function. For comparison purposes, the leakage-corrected normalized CBV (nCBV) and relative permeability constant (K2) were also obtained using the established Weisskoff-Boxerman leakage correction method. The area under the receiver operating characteristics curve (AUC) and cross-validation were used to compare the diagnostic performance of the single DSC-MRI parameters with the performance obtained with the addition of permeability metrics.
PCNSL demonstrated significantly higher permeability (Ex, p < .001) and lower perfusion (nCBVres, nCBFres, and nCBV, all p < .001) than glioblastoma. The combination of Ex and nCBVres showed the highest performance (AUC, 0.96; 95% confidence interval, 0.92–0.99) for differentiating PCNSL from glioblastoma, which was a significant improvement over the single perfusion (nCBV: AUC, 0.84; nCBVres: AUC, 0.84; nCBFres: AUC, 0.82; all p < .001) or Ex (AUC, 0.80; p < .001) parameters.
Analysis of the combined permeability and perfusion metrics obtained from a single DSC-MRI acquisition improves the diagnostic value for differentiating PCNSL from glioblastoma in comparison with single-parameter nCBV analysis.
• Permeability measurement can be calculated from DSC-MRI with a tissue residue function-based leakage correction.
• Adding Exto CBV aids in the differentiation of PCNSL from glioblastoma.
• CBV and Exmeasurements from DSC-MRI were highly reproducible.
KeywordsGlioblastoma Lymphoma Perfusion magnetic resonance imaging Magnetic resonance imaging Permeability
Area under the receiver operating characteristics curve
Dynamic susceptibility contrast
Relative permeability constant
Contrast agent transfer constant
Leakage-corrected normalized cerebral blood flow from a tissue residue function-based method
Normalized cerebral blood volume from a Weisskoff-Boxerman method
Leakage-corrected normalized cerebral blood volume from a tissue residue function-based method
This research was supported by the National Research Foundation of Korea (NRF) Grant by the Korean government (MSIP) (grant nos. NRF-2017R1A2A2A05001217 and NRF-2017R1C1B2007258).
Compliance with ethical standards
The scientific guarantor of this publication is Ho Sung Kim.
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was waived by the Institutional Review Board.
Institutional Review Board approval was obtained.
• cross-sectional study
• performed at one institution
- 11.Weisskoff R, Boxerman J, Sorensen A, Kulke S, Campbell T, Rosen B (1994) Simultaneous blood volume and permeability mapping using a single Gd-based contrast injection. Proceedings of the Society of Magnetic Resonance, Second Annual Meeting, San Francisco, Calif. Berkeley, pp p.279Google Scholar
- 13.Bjornerud A, Kleppesto M, Batchelor TT, Wen P, Sorensen AG, Emblem KE (2016) Test-retest stability of MTT insensitive CBV leakage correction in DSC-MRI Proceedings of the 24th Annual Meeting of International Society of Magnetic Resonance in Medicine (ISMRM), Singapore, SingaporeGoogle Scholar
- 14.Boxerman JL, Schmainda KM, Weisskoff RM (2006) Relative cerebral blood volume maps corrected for contrast agent extravasation significantly correlate with glioma tumor grade, whereas uncorrected maps do not. AJNR Am J Neuroradiol 27:859–867Google Scholar
- 25.Emblem KE, Bjornerud A, Mouridsen K et al (2011) T1- and T2*-dominant extravasation correction in DSC-MRI: Part II— predicting patient outcome after a single dose of cediranib in recurrent glioblastoma patients J Cereb Blood Flow Metab 31:2054–2064Google Scholar
- 26.Grovik E, Redalen KR, Storas TH et al (2017) Dynamic multi-echo DCE- and DSC-MRI in rectal cancer: Low primary tumor Ktrans and ΔR2* peak are significantly associated with lymph node metastasis. J Magn Reson Imaging 46:194–206Google Scholar