title: Differentiation of solitary brain metastasis from glioblastoma multiforme: a predictive multiparametric approach using combined MR diffusion and perfusion.
abstract: BACKGROUND
  Solitary brain metastasis (MET) and glioblastoma multiforme (GBM) can appear similar on conventional MRI. The purpose of this study was to identify magnetic resonance (MR) perfusion and diffusion-weighted biomarkers that can differentiate MET from GBM.
  
  
  METHODS
  In this retrospective study, patients were included if they met the following criteria: underwent resection of a solitary enhancing brain tumor and had preoperative 3.0 T MRI encompassing diffusion tensor imaging (DTI), dynamic contrast-enhanced (DCE), and dynamic susceptibility contrast (DSC) perfusion. Using co-registered images, voxel-based fractional anisotropy (FA), mean diffusivity (MD), K(trans), and relative cerebral blood volume (rCBV) values were obtained in the enhancing tumor and non-enhancing peritumoral T2 hyperintense region (NET2). Data were analyzed by logistic regression and analysis of variance. Receiver operating characteristic (ROC) analysis was performed to determine the optimal parameter/s and threshold for predicting of GBM vs. MET.
  
  
  RESULTS
  Twenty-three patients (14 M, age 32-78 years old) met our inclusion criteria. Pathology revealed 13 GBMs and 10 METs. In the enhancing tumor, rCBV, K(trans), and FA were higher in GBM, whereas MD was lower, neither without statistical significance. In the NET2, rCBV was significantly higher (p = 0.05) in GBM, but MD was significantly lower (p < 0.01) in GBM. FA and K(trans) were higher in GBM, though not reaching significance. The best discriminative power was obtained in NET2 from a combination of rCBV, FA, and MD, resulting in an area under the curve (AUC) of 0.98.
  
  
  CONCLUSIONS
  The combination of MR diffusion and perfusion matrices in NET2 can help differentiate GBM over solitary MET with diagnostic accuracy of 98%.
authors.affiliation: Department of Medical Imaging, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Taper Bldg., Suite M335, Los Angeles, CA, 90048, USA, adam.herman.bauer@gmail.com.
authors.forename: Adam Herman
authors.initials: AH
authors.lastname: Bauer
authors.forename: William
authors.initials: W
authors.lastname: Erly
authors.forename: Franklin G
authors.initials: FG
authors.lastname: Moser
authors.forename: Marcel
authors.initials: M
authors.lastname: Maya
authors.forename: Kambiz
authors.initials: K
authors.lastname: Nael
mesh_terms: D000328:Adult; D000368:Aged; D016880:Anisotropy; D001932:Brain Neoplasms / Q000473:pathology* / Q000556:secondary*; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging; D056324:Diffusion Tensor Imaging; D005260:Female; D005909:Glioblastoma / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies
references.citation: NMR Biomed. 2014 Sep;27(9):1103-11
references.pmid: 25066520
references.citation: AJNR Am J Neuroradiol. 2011 Jan;32(1):67-73
references.pmid: 21051512
references.citation: J Neuroradiol. 2012 Dec;39(5):301-7
references.pmid: 22197404
references.citation: J Neurosurg. 2005 Feb;102(2):336-41
references.pmid: 15739563
references.citation: AJNR Am J Neuroradiol. 2003 May;24(5):937-41
references.pmid: 12748097
references.citation: Magn Reson Med. 1998 Jun;39(6):928-34
references.pmid: 9621916
references.citation: Magn Reson Imaging. 2013 Nov;31(9):1567-77
references.pmid: 23906533
references.citation: J Cereb Blood Flow Metab. 1985 Dec;5(4):584-90
references.pmid: 4055928
references.citation: Korean J Radiol. 2002 Jul-Sep;3(3):171-9
references.pmid: 12271162
references.citation: J Magn Reson Imaging. 1999 Sep;10(3):223-32
references.pmid: 10508281
references.citation: Magn Reson Med. 2002 Jun;47(6):1202-10
references.pmid: 12111967
references.citation: Neuroradiology. 2011 May;53(5):319-30
references.pmid: 20625709
references.citation: J Cancer Res Clin Oncol. 2001 Apr;127(4):217-25
references.pmid: 11315255
references.citation: Magn Reson Med. 2000 Dec;44(6):825-32
references.pmid: 11108618
references.citation: Cancer Res. 2002 Sep 15;62(18):5381-5
references.pmid: 12235011
references.citation: J Neuroradiol. 2002 Jun;29(2):105-13
references.pmid: 12297732
references.citation: AJNR Am J Neuroradiol. 2007 Jun-Jul;28(6):1078-84
references.pmid: 17569962
references.citation: AJNR Am J Neuroradiol. 2014 May;35(5):928-34
references.pmid: 24503556
references.citation: J Neurosurg. 1979 Jul;51(1):53-8
references.pmid: 448419
references.citation: Neurology. 2004 May 25;62(10):1788-93
references.pmid: 15159479
references.citation: Magn Reson Med. 2006 Mar;55(3):566-74
references.pmid: 16450365
references.citation: J Neurooncol. 2008 Sep;89(3):259-69
references.pmid: 18712280
references.citation: Med Image Comput Comput Assist Interv. 2005;8(Pt 1):506-14
references.pmid: 16685884
references.citation: Radiology. 2002 Mar;222(3):715-21
references.pmid: 11867790
references.citation: Cancer Imaging. 2012 Oct 26;12:423-36
references.pmid: 23108208
references.citation: Neuroimage. 2008 Oct 15;43(1):29-35
references.pmid: 18672074
references.citation: Radiographics. 1996 Nov;16(6):1413-38; quiz 1462-3
references.pmid: 8946545
references.citation: Radiology. 2004 Jul;232(1):221-8
references.pmid: 15220505
references.citation: AJNR Am J Neuroradiol. 2004 May;25(5):746-55
references.pmid: 15140713
references.citation: Radiology. 2008 Nov;249(2):601-13
references.pmid: 18780827
references.citation: Neurotherapeutics. 2009 Jul;6(3):598-603
references.pmid: 19560748
references.citation: NMR Biomed. 2002 Nov-Dec;15(7-8):435-55
references.pmid: 12489094
references.citation: AJNR Am J Neuroradiol. 2011 Mar;32(3):507-14
references.pmid: 21330399
references.citation: Radiology. 2005 Jun;235(3):985-91
references.pmid: 15833979
references.citation: Magn Reson Med. 2003 Jul;50(1):164-74
references.pmid: 12815691
references.citation: Br J Radiol. 2005 Jun;78(930):533-7
references.pmid: 15900059
references.citation: Neuroimage. 2009 Feb 1;44(3):653-60
references.pmid: 18951985