Abstract
Objectives
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.
Results
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.
Conclusions
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.
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Abbreviations
- AUC:
-
Area under the receiver operating characteristics curve
- DCE:
-
Dynamic contrast-enhanced
- DSC:
-
Dynamic susceptibility contrast
- E x :
-
Extraction fraction
- K 2 :
-
Relative permeability constant
- K a :
-
Apparent permeability
- K trans :
-
Contrast agent transfer constant
- nCBFres :
-
Leakage-corrected normalized cerebral blood flow from a tissue residue function-based method
- nCBV:
-
Normalized cerebral blood volume from a Weisskoff-Boxerman method
- nCBVres :
-
Leakage-corrected normalized cerebral blood volume from a tissue residue function-based method
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Funding
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).
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The scientific guarantor of this publication is Ho Sung Kim.
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Lee, J.Y., Bjørnerud, A., Park, J.E. et al. Permeability measurement using dynamic susceptibility contrast magnetic resonance imaging enhances differential diagnosis of primary central nervous system lymphoma from glioblastoma. Eur Radiol 29, 5539–5548 (2019). https://doi.org/10.1007/s00330-019-06097-9
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DOI: https://doi.org/10.1007/s00330-019-06097-9