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European Radiology
Published in: European Radiology 9/2018

01-09-2018 | Neuro

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

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

Published in: European Radiology | Issue 9/2018

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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.
Appendix
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Metadata
Title
Differentiation between primary CNS lymphoma and glioblastoma: qualitative and quantitative analysis using arterial spin labeling MR imaging
Authors
Sung-Hye You
Tae Jin Yun
Hye Jeong Choi
Roh-Eul Yoo
Koung Mi Kang
Seung Hong Choi
Ji-hoon Kim
Chul-Ho Sohn
Publication date
01-09-2018
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 9/2018
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-018-5359-5

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