title: Non-invasive assessment of intratumoral vascularity using arterial spin labeling: A comparison to susceptibility-weighted imaging for the differentiation of primary cerebral lymphoma and glioblastoma.
abstract: Using conventional MRI methods, the differentiation of primary cerebral lymphomas (PCNSL) and other primary brain tumors, such as glioblastomas, is difficult due to overlapping imaging characteristics. This study was designed to discriminate tumor entities using normalized vascular intratumoral signal intensity values (nVITS) obtained from pulsed arterial spin labeling (PASL), combined with intratumoral susceptibility signals (ITSS) from susceptibility-weighted imaging (SWI). Thirty consecutive patients with glioblastoma (n=22) and PCNSL (n=8), histologically classified according to the WHO brain tumor classification, were included. MRIs were acquired on a 3T scanner, and included PASL and SWI sequences. nVITS was defined by the signal intensity ratio between the tumor and the contralateral normal brain tissue, as obtained by PASL images. ITSS was determined as intratumoral low signal intensity structures detected on SWI sequences and were divided into four different grades. Potential differences in the nVITS and ITSS between glioblastomas and PCNSLs were revealed using statistical testing. To determine sensitivity, specificity, and diagnostic accuracy, as well as an optimum cut-off value for the differentiation of PCNSL and glioblastoma, a receiver operating characteristic analysis was used. We found that nVITS (p=0.011) and ITSS (p=0.001) values were significantly higher in glioblastoma than in PCNSL. The optimal cut-off value for nVITS was 1.41 and 1.5 for ITSS, with a sensitivity, specificity, and accuracy of more than 95%. These findings indicate that nVITS values have a comparable diagnostic accuracy to ITSS values in differentiating glioblastoma and PCNSL, offering a completely non-invasive and fast assessment of tumoral vascularity in a clinical setting.
authors.affiliation: Department of Biomedical Imaging und Image-guided Therapy, Medical University of Vienna, Austria; Comprehensive Cancer Center-Central Nervous System Tumors Unit (CCC-CNS), Medical University of Vienna, Austria. Electronic address: julia.furtner@meduniwien.ac.at.
authors.forename: J
authors.initials: J
authors.lastname: Furtner
authors.affiliation: Department of Biomedical Imaging und Image-guided Therapy, Medical University of Vienna, Austria. Electronic address: veronika.schoepf@meduniwien.ac.at.
authors.forename: V
authors.initials: V
authors.lastname: Schöpf
authors.affiliation: Department of Medicine I, Division of Oncology, Medical University of Vienna, Austria; Comprehensive Cancer Center-Central Nervous System Tumors Unit (CCC-CNS), Medical University of Vienna, Austria. Electronic address: matthias.preusser@meduniwien.ac.at.
authors.forename: M
authors.initials: M
authors.lastname: Preusser
authors.affiliation: Department of Biomedical Imaging und Image-guided Therapy, Medical University of Vienna, Austria. Electronic address: ulrika.asenbaum@meduniwien.ac.at.
authors.forename: U
authors.initials: U
authors.lastname: Asenbaum
authors.affiliation: Department of Biomedical Imaging und Image-guided Therapy, Medical University of Vienna, Austria. Electronic address: ramona.woitek@meduniwien.ac.at.
authors.forename: R
authors.initials: R
authors.lastname: Woitek
authors.affiliation: Institute of Neurology, Medical University of Vienna, Austria; Comprehensive Cancer Center-Central Nervous System Tumors Unit (CCC-CNS), Medical University of Vienna, Austria. Electronic address: adelheid.woehrer@meduniwien.ac.at.
authors.forename: A
authors.initials: A
authors.lastname: Wöhrer
authors.affiliation: Institute of Neurology, Medical University of Vienna, Austria; Comprehensive Cancer Center-Central Nervous System Tumors Unit (CCC-CNS), Medical University of Vienna, Austria. Electronic address: johannes.hainfellner@meduniwien.ac.at.
authors.forename: J A
authors.initials: JA
authors.lastname: Hainfellner
authors.affiliation: Department of Neurosurgery, Medical University of Vienna, Austria; Comprehensive Cancer Center-Central Nervous System Tumors Unit (CCC-CNS), Medical University of Vienna, Austria. Electronic address: stefan.wolfsberger@meduniwien.ac.at.
authors.forename: S
authors.initials: S
authors.lastname: Wolfsberger
authors.affiliation: Department of Biomedical Imaging und Image-guided Therapy, Medical University of Vienna, Austria; Comprehensive Cancer Center-Central Nervous System Tumors Unit (CCC-CNS), Medical University of Vienna, Austria. Electronic address: daniela.prayer@meduniwien.ac.at.
authors.forename: D
authors.initials: D
authors.lastname: Prayer
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000098:blood supply / Q000150:complications / Q000473:pathology*; D003937:Diagnosis, Differential; D005260:Female; D005909:Glioblastoma / Q000098:blood supply / Q000150:complications / Q000473:pathology*; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008223:Lymphoma / Q000150:complications / Q000473:pathology*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000150:complications / Q000473:pathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013113:Spin Labels; D055815:Young Adult
chemical_list: D013113:Spin Labels
keywords: Arterial spin labeling; Glioblastoma; Intratumoural susceptibility signals; Primary CNS lymphoma; Susceptibility-weighted imaging