title: Differentiation between glioblastomas, solitary brain metastases, and primary cerebral lymphomas using diffusion tensor and dynamic susceptibility contrast-enhanced MR imaging.
abstract: OBJECTIVE
  Glioblastomas, brain metastases, and PCLs may have similar enhancement patterns on MR imaging, making the differential diagnosis difficult or even impossible. The purpose of this study was to determine whether a combination of DTI and DSC can assist in the differentiation of glioblastomas, solitary brain metastases, and PCLs.
  
  
  METHODS
  Twenty-six glioblastomas, 25 brain metastases, and 16 PCLs were retrospectively identified. DTI metrics, including FA, ADC, CL, CP, CS, and rCBV were measured from the enhancing, immediate peritumoral and distant peritumoral regions. A 2-level decision tree was designed, and a multivariate logistic regression analysis was used at each level to determine the best model for classification.
  
  
  RESULTS
  From the enhancing region, significantly elevated FA, CL, and CP and decreased CS values were observed in glioblastomas compared with brain metastases and PCLs (P < .001), whereas ADC, rCBV, and rCBV(max) values of glioblastomas were significantly higher than those of PCLs (P < .01). The best model to distinguish glioblastomas from nonglioblastomas consisted of ADC, CS (or FA) from the enhancing region, and rCBV from the immediate peritumoral region, resulting in AUC = 0.938. The best predictor to differentiate PCLs from brain metastases comprised ADC from the enhancing region and CP from the immediate peritumoral region with AUC = 0.909.
  
  
  CONCLUSIONS
  The combination of DTI metrics and rCBV measurement can help in the differentiation of glioblastomas from brain metastases and PCLs.
authors.affiliation: Department of Radiology, Division of Neuroradiology, Hospital of the University of Pennsylvania, Philadelphia, 19104, USA. Sumei.Wang@uphs.upenn.edu
authors.forename: S
authors.initials: S
authors.lastname: Wang
authors.forename: S
authors.initials: S
authors.lastname: Kim
authors.forename: S
authors.initials: S
authors.lastname: Chawla
authors.forename: R L
authors.initials: RL
authors.lastname: Wolf
authors.forename: D E
authors.initials: DE
authors.lastname: Knipp
authors.forename: A
authors.initials: A
authors.lastname: Vossough
authors.forename: D M
authors.initials: DM
authors.lastname: O'Rourke
authors.forename: K D
authors.initials: KD
authors.lastname: Judy
authors.forename: H
authors.initials: H
authors.lastname: Poptani
authors.forename: E R
authors.initials: ER
authors.lastname: Melhem
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000556:secondary*; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D019786:Gadolinium DTPA; D005909:Glioblastoma / Q000175:diagnosis* / Q000556:secondary*; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008223:Lymphoma / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D003287:Contrast Media; C064925:gadodiamide; D019786:Gadolinium DTPA