Performance of Apparent Diffusion Coefficient Values and Conventional MRI Features in Differentiating Tumefactive Demyelinating Lesions From Primary Brain Neoplasms.
OBJECTIVE
Tumefactive demyelinating lesions (TDLs) remain one of the most common brain lesions to mimic a brain tumor, particularly primary CNS lymphoma (PCNSL) and high-grade gliomas. The purpose of our study was to evaluate the ability of apparent diffusion coefficient (ADC) values and conventional MRI features to differentiate TDLs from PCNSLs and high-grade gliomas.


METHODS
Seventy-five patients (24 patients with TDLs, 28 with PCNSLs, and 23 with high-grade gliomas) with 168 brain lesions (70 TDLs, 68 PCNSLs, and 30 high-grade gliomas) who underwent DWI before surgery or therapy were included in the study. Minimum ADC (ADC(min)) and average ADC (ADC(avg)) values were calculated for each lesion. ANOVA and ROC analyses were performed. ROC analyses were also performed for the presence of incomplete rim enhancement and for the number of lesions. Multiple-variable logistic regression with ROC analysis was then performed to evaluate performance in multiple-variable models.


RESULTS
ADC(min) was statistically significantly higher (p < 0.01) in TDLs (mean, 0.886; 95% CI, 0.802-0.931) than in PCNSLs (0.547; 95% CI, 0.496-0.598) and high-grade gliomas (0.470; 95% CI, 0.385-0.555). (All ADC values in this article are reported in units of × 10(-3) mm(2)/s.) ADC(avg) was statistically significantly higher (p < 0.01) in TDLs (mean, 1.362; 95% CI, 1.268-1.456) than in PCNSLs (0.990; 95% CI, 0.919-1.061) but not in high-grade gliomas (1.216; 95% CI, 1.074-1.356). Multiple-variable models showed statistically significant individual effects and superior diagnostic performance on ROC analysis.


CONCLUSIONS
TDLs can be diagnosed on preoperative MRI with a high degree of specificity; MRI features of incomplete rim enhancement, high ADC values, and a large number of lesions individually increase the probability and diagnostic confidence that a lesion is a TDL.
1 Department of Radiology and Biomedical Imaging, University of California at San Francisco, 350 Parnassus Ave, Box 0336, Ste 307H, San Francisco, CA 94143-0628.
Marc C
MC
Mabray
1 Department of Radiology and Biomedical Imaging, University of California at San Francisco, 350 Parnassus Ave, Box 0336, Ste 307H, San Francisco, CA 94143-0628.
Benjamin A
BA
Cohen
1 Department of Radiology and Biomedical Imaging, University of California at San Francisco, 350 Parnassus Ave, Box 0336, Ste 307H, San Francisco, CA 94143-0628.
Javier E
JE
Villanueva-Meyer
1 Department of Radiology and Biomedical Imaging, University of California at San Francisco, 350 Parnassus Ave, Box 0336, Ste 307H, San Francisco, CA 94143-0628.
Francisco E
FE
Valles
1 Department of Radiology and Biomedical Imaging, University of California at San Francisco, 350 Parnassus Ave, Box 0336, Ste 307H, San Francisco, CA 94143-0628.
Ramon F
RF
Barajas
2 Department of Medicine, Division of Hematology/Oncology, University of California at San Francisco, San Francisco, CA.
James L
JL
Rubenstein
1 Department of Radiology and Biomedical Imaging, University of California at San Francisco, 350 Parnassus Ave, Box 0336, Ste 307H, San Francisco, CA 94143-0628.
Soonmee
S
Cha
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000473:pathology; D003287:Contrast Media; D003711:Demyelinating Diseases / Q000175:diagnosis* / Q000473:pathology; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D005910:Glioma / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
D003287:Contrast Media
apparent diffusion coefficient (ADC); diffusion; primary CNS lymphoma (PCNSL); tumefactive demyelinating lesion (TDL); tumefactive demyelination