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Perfusion and diffusion MR imaging in enhancing malignant cerebral tumors
Cem Calli1, Omer Kitis, Nilgun Yunten
1Department of Radiology, Ege University Medical School, 35100 Bornova, Izmir, Turkey. cemcalli@superonline.com
Objective:
Common contrast-enhancing malignant tumors of the brain are glioblastoma multiforme (GBMs), anaplastic astrocytomas (AAs), metastases, and lymphomas, all of which have sometimes similar conventional MRI findings. Our aim was to evaluate the role of perfusion MR imaging (PWI) and diffusion-weighted imaging (DWI) in the differentiation of these contrast-enhancing malignant cerebral tumors.
Materials And Methods:
Forty-eight patients with contrast-enhancing and histologically proven brain tumors, 14 AAs, 17 GBMs, nine metastases, and eight lymphomas, were included in the study. All patients have undergone routine MR examination where DWI and PWI were performed in the same session. DWI was performed with b values of 0, 500, and 1000 mm(2)/s. Minimum ADC values (ADC(min)) of each tumor was later calculated from ADC map images. PWI was applied using dynamic susceptibility contrast technique and maximum relative cerebral blood volume (rCBV(max)) was calculated from each tumor, given in ratio with contralateral normal white matter. Comparisons of ADC(min) and rCBV(max) values with the histological types of the enhancing tumors were made with a one-way analysis of variance and Bonferroni test. A P value less than 0.05 indicated a statistically significant difference.
Results:
The ADC(min) values (mean+/-S.D.) in GBMs, AAs, lymphomas, and metastases were 0.79+/-0.21 (x10(-3)mm(2)/s), 0.75+/-0.21 (x10(-3)mm(2)/s), 0.51+/-0.09 (x10(-3)mm(2)/s), and 0.68+/-0.11 (x10(-3)mm(2)/s), respectively. The difference in ADC(min) values were statistically significant between lymphomas and GBMs (P<0.05). It was also statistically significant between lymphomas and AAs (P<0.03). However, there were no differences between lymphomas and metastasis, and between GBMs, AAs, and metastasis. The rCBV(max) ratio (mean+/-S.D.) in GBMs were 6.33+/-2.03, whereas it was 3.66+/-1.79 in AAs, 2.33+/-0.68 in lymphomas, and 4.45+/-1.87 in metastases. These values were statistically different between GBMs and AAs (P<0.001), GBMs and lymphoma (P<0.0001). Although there seemed to be difference between GBMs and metastases, it was not statistically significant (P<0.083).
Conclusion:
Combination of DWI and PWI, with ADC(min) and rCBV(max) calculations, may aid routine MR imaging in the differentiation of common cerebral contrast-enhancing malignant tumors.
Insights
Perfusion MR imaging (PWI) and diffusion-weighted imaging (DWI) can help differentiate common brain tumors. Calculating minimum ADC values and maximum rCBV ratios aids in distinguishing between glioblastoma multiforme, anaplastic astrocytomas, lymphomas, and metastases.
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.
