Differentiation of infective from neoplastic brain lesions by dynamic contrast-enhanced MRI
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It is not always possible to differentiate infective from neoplastic brain lesions with conventional MR imaging. In this study, we assessed the utility of various perfusion indices in the differentiation of infective from neoplastic brain lesions.
A total of 103 patients with infective brain lesions (group I, n=26) and neoplastic brain lesions (high-grade glioma, HGG, group II, n=52; low-grade glioma, LGG, group III, n=25) underwent dynamic contrast-enhanced MR imaging. The perfusion indices, including relative cerebral blood volume (rCBV), relative cerebral blood flow (rCBF), transfer coefficient (ktrans) and leakage (ve), were calculated and their degree of correlation with immunohistologically obtained microvessel density (MVD) and vascular endothelial growth factor (VEGF) determined. The rCBV was corrected for the leakage effect. Discriminant analysis for rCBV, rCBF, ktrans and ve was performed to predict the group membership of each case and post hoc analysis was performed to look for group differences.
The rCBV, rCBF, ktrans, ve, MVD and VEGF were significantly different (P<0.001) between the three groups. Discriminant analysis showed that rCBV predicted 73.1% of the infective lesions, 84.6% of the HGG and 72.0% of the LGG. The rCBF classified 86.5% of the HGG, 80.0% of the LGG and 65.4% of the infective lesions. The ktrans discriminated 98.1% of the HGG, 76.0% of the LGG and 88.5% of the infective lesions correctly. The ve classified 98.1% of the HGG, 76.0% of the LGG and 84.6% the infective lesions. The rCBV was correlated significantly with MVD and VEGF, while the correlation between ktrans and MVD was not significant.
Physiological perfusion indices such as ktrans and ve appear to be useful in differentiating infective from neoplastic brain lesions. Adding these indices to the current imaging protocol is likely to improve tissue characterization of these focal brain mass lesions.
KeywordsDCE-MRI Brain tumor Blood–brain permeability Brain abscess Brain tuberculoma
This work was funded by the Department of Science and Technology, New Delhi (grant no. SP/SO/HS-50/2002). Mohammad Haris received financial assistance from the University Grant Commission, New Delhi. Anup Singh received financial assistance from the Council of Scientific and Industrial Research, New Delhi.
Conflict of interest statement
We declare that we have no conflict of interest.
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