title: The role of cerebral blood flow gradient in peritumoral edema for differentiation of glioblastomas from solitary metastatic lesions.
abstract: OBJECTIVE
  Differentiation of glioblastomas from solitary brain metastases using conventional MRI remains an important unsolved problem. In this study, we introduced the conception of the cerebral blood flow (CBF) gradient in peritumoral edema-the difference in CBF values from the proximity of the enhancing tumor to the normal-appearing white matter, and investigated the contribution of perfusion metrics on the discrimination of glioblastoma from a metastatic lesion.
  
  
  METHODS
  Fifty-two consecutive patients with glioblastoma or a solitary metastatic lesion underwent three-dimensional arterial spin labeling (3D-ASL) before surgical resection. The CBF values were measured in the peritumoral edema (near: G1; Intermediate: G2; Far: G3). The CBF gradient was calculated as the subtractions CBFG1 -CBFG3, CBFG1 - CBFG2 and CBFG2 - CBFG3. A receiver operating characteristic (ROC) curve analysis was used to seek for the best cutoff value permitting discrimination between these two tumors.
  
  
  RESULTS
  The absolute/related CBF values and the CBF gradient in the peritumoral regions of glioblastomas were significantly higher than those in metastases(P < 0.038). ROC curve analysis reveals, a cutoff value of 1.92 ml/100g for the CBF gradient of CBFG1 -CBFG3 generated the best combination of sensitivity (92.86%) and specificity (100.00%) for distinguishing between a glioblastoma and metastasis.
  
  
  CONCLUSIONS
  The CBF gradient in peritumoral edema appears to be a more promising ASL perfusion metrics in differentiating high grade glioma from a solitary metastasis.
authors.affiliation: Department of Radiology, Union Hospital of Fujian Medical University, Fuzhou, Fujian, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Lin
authors.affiliation: Department of Radiology, Union Hospital of Fujian Medical University, Fuzhou, Fujian, China.
authors.forename: Yunjing
authors.initials: Y
authors.lastname: Xue
authors.affiliation: Department of Radiology, Union Hospital of Fujian Medical University, Fuzhou, Fujian, China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Duan
authors.affiliation: Department of Radiology, Union Hospital of Fujian Medical University, Fuzhou, Fujian, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Sun
authors.affiliation: Department of Radiology, Union Hospital of Fujian Medical University, Fuzhou, Fujian, China.
authors.forename: Hailong
authors.initials: H
authors.lastname: Lin
authors.affiliation: Department of Radiology, Union Hospital of Fujian Medical University, Fuzhou, Fujian, China.
authors.forename: Xinming
authors.initials: X
authors.lastname: Huang
authors.affiliation: Department of Radiology, Fujian Provincial Cancer Hospital, Fuzhou, Fujian, China.
authors.forename: Xiaodan
authors.initials: X
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000098:blood supply / Q000473:pathology*; D002454:Cell Differentiation; D002560:Cerebrovascular Circulation; D004487:Edema / Q000150:complications*; D005260:Female; D005909:Glioblastoma / Q000098:blood supply / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D010477:Perfusion; D012372:ROC Curve; D013113:Spin Labels
chemical_list: D013113:Spin Labels
keywords: cerebral blood flow; glioblastoma; metastasis; perfusion; three-dimensional arterial spin labeling