title: Gradient of apparent diffusion coefficient values in peritumoral edema helps in differentiation of glioblastoma from solitary metastatic lesions.
abstract: OBJECTIVE
  Glioblastoma and solitary metastatic lesions can be difficult to differentiate with conventional MRI. The use of diffusion-weighted MRI to better characterize peritumoral edema has been explored for this purpose, but the results have been conflicting. The purpose of this study was to test the hypothesis that the gradient of apparent diffusion coefficient (ADC) values in peritumoral edema--that is, the difference in ADC values from the region closest to the enhancing tumor and the one closest to the normal-appearing white matter--may be a marker for differentiating glioblastoma from a metastatic lesion.
  
  
  METHODS
  Forty patients, 20 with glioblastoma and 20 with a solitary metastatic lesion, underwent diffusion-weighted brain MRI before surgical resection. The ADC values were retrospectively collected in the peritumoral edema in three positions: near, an intermediate distance from, and far from the core enhancing tumor (G1, G2, and G3). The ADC gradient in the peritumoral edema was calculated as the subtractions ADCG3 - ADCG1, ADCG3 - ADCG2, and ADCG2 - ADCG1. The ADC values in the enhancing tumor, peritumoral edema, ipsilateral normal-appearing white matter, contralateral healthy white matter, and CSF were also collected.
  
  
  RESULTS
  A gradient of ADC values was found in the peritumoral edema of glioblastoma. The ADC values increased from the region close to the enhancing tumor (1.36 ± 0.24 × 10(-3) mm(2)/s) to the area near the normal-appearing white matter (1.57 ± 0.34 × 10(-3) mm(2)/s). In metastatic lesions, however, those values were nearly homogeneous (p = 0.04).
  
  
  CONCLUSIONS
  The ADC gradient in peritumoral edema appears to be a promising tool for differentiating glioblastoma from a metastatic lesion.
authors.affiliation: Department of Radiology, Hospital Universitario y Politécnico la Fe, Bulevar Sur, Valencia, Spain 46026.
authors.forename: Pierre
authors.initials: P
authors.lastname: Lemercier
authors.forename: Silvia
authors.initials: S
authors.lastname: Paz Maya
authors.forename: James T
authors.initials: JT
authors.lastname: Patrie
authors.forename: Lucía
authors.initials: L
authors.lastname: Flors
authors.forename: Carlos
authors.initials: C
authors.lastname: Leiva-Salinas
mesh_terms: D000368:Aged; D001929:Brain Edema / Q000175:diagnosis* / Q000473:pathology; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000556:secondary; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D005909:Glioblastoma / Q000175:diagnosis* / Q000556:secondary; D006801:Humans; D008297:Male; D012189:Retrospective Studies
keywords: MRI; apparent diffusion coefficient; brain; glioblastoma; metastasis