Perfusion and diffusion MR imaging in enhancing malignant cerebral tumors

Area of Science:

• Neuroradiology
• Oncology
• Medical Imaging

Background:

• Contrast-enhancing malignant brain tumors like glioblastoma multiforme (GBM), anaplastic astrocytomas (AA), metastases, and lymphomas often present with similar conventional MRI findings.
• Accurate differentiation is crucial for appropriate treatment planning and patient management.

Purpose of the Study:

• To evaluate the effectiveness of perfusion MR imaging (PWI) and diffusion-weighted imaging (DWI) in differentiating common contrast-enhancing malignant cerebral tumors.
• To assess the diagnostic utility of minimum apparent diffusion coefficient (ADCmin) and maximum relative cerebral blood volume (rCBVmax) values.

Main Methods:

• Forty-eight patients with histologically proven contrast-enhancing brain tumors underwent routine MRI including DWI and PWI.
• ADCmin values were calculated from ADC maps, and rCBVmax ratios were determined using dynamic susceptibility contrast technique.
• Statistical analysis, including one-way ANOVA and Bonferroni test, was used to compare values between tumor types.

Main Results:

• Lymphomas showed significantly lower ADCmin values compared to GBMs and AAs (P<0.05, P<0.03).
• No significant differences in ADCmin were found between lymphomas and metastases, or among GBMs, AAs, and metastases.
• GBMs exhibited significantly higher rCBVmax ratios than AAs and lymphomas (P<0.001, P<0.0001).

Conclusions:

• The combination of DWI and PWI, utilizing ADCmin and rCBVmax calculations, shows promise in differentiating common cerebral contrast-enhancing malignant tumors.
• These advanced MRI techniques can augment routine imaging for improved diagnostic accuracy.