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

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.

journal_name

Eur Radiol

journal_title

European radiology

authors

You SH,Yun TJ,Choi HJ,Yoo RE,Kang KM,Choi SH,Kim JH,Sohn CH

doi

10.1007/s00330-018-5359-5

subject

Has Abstract

pub_date

2018-09-01 00:00:00

pages

3801-3810

issue

9

eissn

0938-7994

issn

1432-1084

pii

10.1007/s00330-018-5359-5

journal_volume

28

pub_type

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