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Assessing Cortical Cerebral Microinfarcts on High Resolution MR Images
Published on: November 20, 2015
Evaluation of different cerebral mass lesions by perfusion-weighted MR imaging
Bahattin Hakyemez1, Cuneyt Erdogan, Naile Bolca
1Department of Radiology, Uludag University Medical School, and Bursa State Hospital, Bursa, Turkey. bhakyemez@uludag.edu.tr
Purpose:
To investigate the contribution of perfusion-weighted MR imaging (PWI) by using the relative cerebral blood volume (rCBV) ratio in the differential diagnosis of various intracranial space-occupying lesions.
Materials And Methods:
This study involved 105 patients with lesions (high-grade glioma (N=26), low-grade glioma (N=11), meningioma (N=23), metastasis (N=25), hemangioblastoma (N=6), pyogenic abscess (N=4), schwannoma (N=5), and lymphoma (N=5)). The patients were examined with a T2*-weighted (T2*W) gradient-echo single-shot EPI sequence. The rCBV ratios of the lesions were obtained by dividing the values obtained from the normal white matter. Statistical analysis was performed with the Mann-Whitney U-test. A P-value less than 0.05 was considered statistically significant.
Results:
The rCBV ratio was 5.76+/-3.35 in high-grade gliomas, 1.69+/-0.51 in low-grade gliomas, 8.02+/-3.89 in meningiomas, 5.27+/-3.22 in metastases, 11.36+/-4.41 in hemangioblastomas, 0.76+/-0.12 in abscesses, 1.10+/-0.32 in lymphomas, and 3.23+/-0.81 in schwannomas. The rCBV ratios were used to discriminate between 1) high- and low-grade gliomas (P<0.001), 2) hemangioblastomas and metastases (P<0.05), 3) abscesses from high-grade gliomas and metastases (P<0.001), 4) schwannomas and meningiomas (P<0.001), 5) lymphomas from high-grade gliomas and metastases (P<0.001), and 6) typical meningiomas and atypical meningiomas (P<0.01).
Conclusion:
rCBV ratios can help discriminate intracranial space-occupying lesions by demonstrating lesion vascularity. It is possible to discriminate between 1) high- and low-grade gliomas, 2) hemangioblastomas and other intracranial posterior fossa masses, 3) abscesses from high-grade gliomas and metastases, 4) schwannomas and meningiomas, 5) lymphomas and high-grade gliomas and metastases, and 6) typical and atypical meningiomas.
Insights
Relative cerebral blood volume (rCBV) ratios effectively differentiate various intracranial tumors and lesions. This perfusion-weighted MRI technique aids in distinguishing between high- and low-grade gliomas, meningiomas, metastases, and other space-occupying masses.
Area of Science:
- Neuroradiology
- Neuro-oncology
- Medical Imaging
Background:
- Intracranial space-occupying lesions require accurate differential diagnosis for effective treatment.
- Perfusion-weighted MRI (PWI) offers insights into lesion vascularity.
- The relative cerebral blood volume (rCBV) ratio is a key PWI metric.
Purpose of the Study:
- To evaluate the utility of the relative cerebral blood volume (rCBV) ratio in differentiating diverse intracranial space-occupying lesions.
- To assess the diagnostic performance of PWI in classifying various brain tumors and non-tumoral lesions.
Main Methods:
- A cohort of 105 patients with histopathologically confirmed lesions underwent T2*-weighted gradient-echo PWI.
- Lesion rCBV ratios were calculated by normalizing to normal white matter values.
- Statistical analysis, including the Mann-Whitney U-test, was employed to compare rCBV ratios between lesion types.
Main Results:
- Significant differences in rCBV ratios were observed across various lesion types, including high-grade gliomas, low-grade gliomas, meningiomas, metastases, hemangioblastomas, abscesses, schwannomas, and lymphomas.
- The rCBV ratio successfully discriminated between several specific lesion pairs, such as high- vs. low-grade gliomas and abscesses vs. high-grade gliomas/metastases.
- Specific P-values highlight the statistical significance of these differentiations (e.g., P<0.001 for multiple comparisons).
Conclusions:
- rCBV ratio derived from PWI is a valuable tool for the differential diagnosis of intracranial space-occupying lesions.
- This quantitative imaging biomarker aids in distinguishing between neoplastic and non-neoplastic lesions, as well as among different tumor grades and types.
- The findings support the integration of rCBV assessment into routine neuroimaging protocols for improved diagnostic accuracy.
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