Evaluation of microvascular permeability with dynamic contrast-enhanced MRI for the differentiation of primary CNS lymphoma and glioblastoma: radiologic-pathologic correlation.
OBJECTIVE
Dynamic contrast-enhanced MR imaging can provide in vivo assessment of the microvasculature in intracranial tumors. The aim of the present study was to evaluate the diagnostic performance of dynamic contrast-enhanced MR imaging derived vascular permeability parameters, including the volume transfer constant, the volume of extravascular extracellular space, and the flux rate constant between the extravascular extracellular space and plasma, for the differentiation of primary CNS lymphoma and glioblastoma.


METHODS
Sixty glioblastomas and 11 primary central nervous system lymphomas were included. Pretreatment T1-weighted dynamic contrast-enhanced MR imaging with a 3D T1-weighted spoiled gradient-echo sequence was performed on a 3T MR imaging scanner. Perfusion parameters (volume transfer constant, the volume of extravascular extracellular space, and the flux rate constant) were measured on the basis of the Tofts-Kernmode model. The Mann-Whitney U test and receiver operating characteristic analysis were used to compare those parameters between primary central nervous system lymphoma and glioblastoma. Histopathologic correlation of dynamic contrast-enhanced MR imaging findings was performed by using reticulin staining and CD31 immunohistochemistry.


RESULTS
Median volume transfer constant and flux rate constant values were significantly higher in primary central nervous system lymphoma (0.145 ± 0.057 and 0.396 ± 0.088) than in glioblastoma (0.064 ± 0.021 and 0.230 ± 0.058) (P < .001, respectively). Median volume of extravascular extracellular space values did not differ significantly between primary central nervous system lymphoma (0.434 ± 0.165) and glioblastoma (0.319 ± 0.107). On receiver operating characteristic analysis, volume transfer constant had the best discriminative value for differentiating primary central nervous system lymphoma and glioblastoma (threshold, 0.093; sensitivity, 90.9%; specificity, 95.0%). Histopathologic evaluation revealed intact vascular integrity in glioblastoma despite endothelial proliferation, whereas primary central nervous system lymphoma demonstrated destroyed vessel architecture, thereby promoting vascular disintegrity.


CONCLUSIONS
Primary central nervous system lymphoma demonstrated significantly higher volume transfer constant and flux rate constant values compared with glioblastoma, implying a higher vascular permeability in primary central nervous system lymphoma. These findings confirm initial observations from perfusion CT and dynamic contrast-enhanced MR imaging studies, correlating with underlying histopathologic features, and may be useful in distinguishing primary central nervous system lymphoma from glioblastoma.
From the Departments of Neuroradiology (P.K., S.H., M.B., A.R.) philipp.kickingereder@med.uni-heidelberg.de.
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P
Kickingereder
Neuropathology (F.S., A.v.D.)German Cancer Consortium, Clinical Cooperation Unit Neuropathology (F.S., A.v.D.).
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F
Sahm
Neuro-oncology (B.W., W.W.), Neurology Clinic, University of Heidelberg Medical Center, Heidelberg, GermanyClinical Cooperation Unit Neuro-oncology (B.W., W.W.).
B
B
Wiestler
Department of Radiology (M.R., H.-P.S., A.R.), German Cancer Research Center, Heidelberg, Germany.
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M
Roethke
From the Departments of Neuroradiology (P.K., S.H., M.B., A.R.).
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S
Heiland
Department of Radiology (M.R., H.-P.S., A.R.), German Cancer Research Center, Heidelberg, Germany.
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HP
Schlemmer
Neuro-oncology (B.W., W.W.), Neurology Clinic, University of Heidelberg Medical Center, Heidelberg, GermanyClinical Cooperation Unit Neuro-oncology (B.W., W.W.).
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W
Wick
Neuropathology (F.S., A.v.D.)German Cancer Consortium, Clinical Cooperation Unit Neuropathology (F.S., A.v.D.).
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A
von Deimling
From the Departments of Neuroradiology (P.K., S.H., M.B., A.R.).
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M
Bendszus
From the Departments of Neuroradiology (P.K., S.H., M.B., A.R.)Department of Radiology (M.R., H.-P.S., A.R.), German Cancer Research Center, Heidelberg, Germany.
A
A
Radbruch
D001932:Brain Neoplasms / Q000175:diagnosis*; D002199:Capillary Permeability; D003287:Contrast Media; D003937:Diagnosis, Differential; D005909:Glioblastoma / Q000175:diagnosis*; D006801:Humans; D008223:Lymphoma / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D012372:ROC Curve; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric
D003287:Contrast Media