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European Radiology

, Volume 28, Issue 9, pp 3801–3810 | Cite as

Differentiation between primary CNS lymphoma and glioblastoma: qualitative and quantitative analysis using arterial spin labeling MR imaging

  • Sung-Hye You
  • Tae Jin Yun
  • Hye Jeong Choi
  • Roh-Eul Yoo
  • Koung Mi Kang
  • Seung Hong Choi
  • Ji-hoon Kim
  • Chul-Ho Sohn
Neuro

Abstract

Objectives

To evaluate the diagnostic performance of arterial spin labelling perfusion weighted images (ASL-PWIs) to differentiate primary CNS lymphoma (PCNSL) from glioblastoma (GBM).

Methods

ASL-PWIs of pathologically confirmed PCNSL (n = 21) or GBM (n = 93) were analysed. For qualitative analysis, tumours were visually scored into five categories based on ASL-CBF maps. For quantitative analysis, normalised CBF values were derived by contralateral grey matter (GM) in intra- and peritumoral areas (nCBFintratumoral and nCBFperitumoral, respectively). Visual scoring scales and quantitative parameters from PCNSL and GBM were compared. In addition, the area under the receiver-operating characteristic (ROC) curve was used to determine the diagnostic accuracy of ASL-PWI for differentiating PCNSL from GBM. Weighted kappa or intraclass correlation coefficients (ICCs) were used to assess reliability between two observers.

Results

In qualitative analysis, scores 5 (CBFintratumoral>CBFGM, 68.8% [64/93]) and 4 (CBFintratumoral ≈ CBFGM, 47.6% [10/21]) were the most frequently reported scores for GBM and PCNSL, respectively. In quantitative analysis, both nCBFintratumoral and nCBFperitumoral in PCNSL were significantly lower than those in the GBM (nCBFintratumoral, 0.89 ± 0.59 [mean and SD] vs. 2.68 ± 1.89, p < 0.001; nCBFperitumoral, 0.17 ± 0.08 vs. 0.45 ± 0.28, p < 0.001). nCBFperitumoral demonstrated the best diagnostic performance (area under the ROC curve: visual scoring, 0.814; nCBFintratumoral, 0.849; nCBFperitumoral, 0.908; p < 0.001 for all). Interobserver agreements for visual scoring (weighted kappa = 0.869), nCBFintratumoral_GM (ICC = 0.958) and nCBFperitumoral_GM (ICC = 0.947) were all excellent.

Conclusions

ASL-PWI performs well in differentiating PCNSL from GBM in both qualitative and quantitative analyses.

Key Points

ASL-PWI performs well (AUC > 0.8) in differentiating PCNSL from GBM.

The visual scoring template demonstrated good diagnostic performance, similar to quantitative analysis.

nCBFperitumoral demonstrated better diagnostic performance than nCBFintratumoral or visual scoring.

Keywords

Lymphoma Glioblastoma Brain neoplasms Magnetic resonance imaging Perfusion imaging 

Abbreviations

ASL-PWI

Arterial spin labelling perfusion weighted images

CBFintratumoral

Intratumoral CBF

CBFperitumoral

Peritumoral CBF

CBFGM

Contralateral grey matter CBF

CBFWM

Contralateral white matter CBF

GBM

Glioblastoma

nCBFintratumoral_GM

CBFintratumoral/CBFcontralateral grey matter

nCBFintratumoral_WM

CBFintratumoral/CBFcontralateral white matter

nCBFperitumoral_GM

CBFperitumoral/CBFcontralateral grey matter

nCBFperitumoral_WM

CBFperitumoral/CBFcontralateral white matter

PCNSL

Primary CNS lymphoma

Notes

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Tae Jin Yun.

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.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

Supplementary material

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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Institute of Radiation MedicineSeoul National University Medical Research CenterSeoulRepublic of Korea
  2. 2.Department of RadiologySeoul National University HospitalSeoulKorea

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