European Radiology

, Volume 29, Issue 10, pp 5539–5548 | Cite as

Permeability measurement using dynamic susceptibility contrast magnetic resonance imaging enhances differential diagnosis of primary central nervous system lymphoma from glioblastoma

  • Ji Ye Lee
  • Atle Bjørnerud
  • Ji Eun ParkEmail author
  • Bo Eun Lee
  • Joo Hyun Kim
  • Ho Sung Kim



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.

Key Points

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.


Glioblastoma Lymphoma Perfusion magnetic resonance imaging Magnetic resonance imaging Permeability 



Area under the receiver operating characteristics curve


Dynamic contrast-enhanced


Dynamic susceptibility contrast


Extraction fraction


Relative permeability constant


Apparent permeability


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.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.


• retrospective

• cross-sectional study

• performed at one institution

Supplementary material

330_2019_6097_MOESM1_ESM.docx (20 kb)
ESM 1 (DOCX 19 kb)


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.Department of RadiologyEulji Medical CenterSeoulRepublic of Korea
  2. 2.Department of Diagnostic Physics, Division of Radiology and Nuclear MedicineOslo University HospitalOsloNorway
  3. 3.Department of PhysicsUniversity of OsloOsloNorway
  4. 4.Department of Radiology and Research Institute of Radiology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
  5. 5.Department of Radiology, Boramae Medical CenterSeoul Metropolitan Government -Seoul National UniversitySeoulRepublic of Korea
  6. 6.NordicNeuroLab, LLCSeoulRepublic of Korea

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