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Diagnostic value of peritumoral minimum apparent diffusion coefficient for differentiation of glioblastoma multiforme
Eun Ja Lee1, Karel terBrugge, David Mikulis
1Department of Radiology, Kwandong University, College of Medicine, Myongji Hospital, Koyang City, Gyunggi-Do, South Korea.
Objective:
In glioblastoma multiforme, the peritumoral region may be infiltrated with malignant cells in addition to vasogenic edema, whereas in a metastatic deposit, the peritumoral areas comprise predominantly vasogenic edema. The purpose of this study was to determine whether the minimum apparent diffusion coefficient (ADC) can be used to differentiate glioblastoma from solitary metastasis on the basis of cellularity levels in the enhancing tumor and in the peritumoral region.
Materials And Methods:
Seventy-three patients underwent conventional MRI and diffusion-weighted imaging (DWI) before undergoing treatment. The minimum ADC was measured in the enhancing tumor, peritumoral region, and contralateral normal white matter. To determine whether there was a statistical difference between metastasis and glioblastoma, we analyzed patient age and sex, minimum ADC value, and ADC ratio of the two groups. A receiver operating characteristic (ROC) curve analysis was used to determine the cutoff value of the minimum ADC that had the best combination of sensitivity and specificity for distinguishing between glioblastoma and metastasis.
Results:
The mean minimum ADC values and mean ADC ratios in the peritumoral regions of glioblastomas were significantly higher than those in metastases. However, the mean minimum ADC values and mean ADC ratios in enhancing tumors showed no statistically significant difference between the two groups. According to ROC curve analysis, a cutoff value of 1.302 × 10(-3) mm(2)/s for the minimum peritumoral ADC value generated the best combination of sensitivity (82.9%) and specificity (78.9%) for distinguishing between glioblastoma and metastasis.
Conclusion:
Although the characteristics of solitary metastasis and glioblastoma multiforme may be similar on conventional MRI, DWI can offer diagnostic information to distinguish between the tumors.
Insights
Apparent diffusion coefficient (ADC) measurements in the peritumoral region can help differentiate glioblastoma from metastasis. Minimum ADC values in glioblastomas were higher, aiding diagnosis when conventional MRI is inconclusive.
Area of Science:
- Neuro-oncology
- Radiology
- Medical Imaging
Background:
- Glioblastoma multiforme and solitary metastasis share similar conventional MRI characteristics.
- Peritumoral regions in glioblastoma may contain malignant cells, while metastases primarily show vasogenic edema.
Purpose of the Study:
- To evaluate the utility of minimum apparent diffusion coefficient (ADC) in differentiating glioblastoma from solitary metastasis.
- To assess ADC values in both the enhancing tumor and peritumoral regions based on cellularity.
Main Methods:
- Conventional MRI and diffusion-weighted imaging (DWI) were performed on 73 patients.
- Minimum ADC values and ADC ratios were measured in the enhancing tumor and peritumoral regions.
- Receiver operating characteristic (ROC) curve analysis determined diagnostic cutoff values.
Main Results:
- Mean minimum ADC values and ADC ratios in the peritumoral region were significantly higher in glioblastomas than in metastases.
- No significant difference in ADC values was observed in the enhancing tumor regions.
- A minimum peritumoral ADC cutoff of 1.302 × 10(-3) mm(2)/s achieved 82.9% sensitivity and 78.9% specificity.
Conclusions:
- Diffusion-weighted imaging (DWI) provides valuable information for distinguishing glioblastoma from metastasis.
- Minimum ADC in the peritumoral region is a key differentiator, especially when conventional MRI findings are ambiguous.
