title: Differentiation between Glioblastoma Multiforme and Primary Cerebral Lymphoma: Additional Benefits of Quantitative Diffusion-Weighted MR Imaging.
abstract: The differentiation between glioblastoma multiforme (GBM) and primary cerebral lymphoma (PCL) is important because the treatments are substantially different. The purpose of this article is to describe the MR imaging characteristics of GBM and PCL with emphasis on the quantitative ADC analysis in the tumor necrosis, the most strongly-enhanced tumor area, and the peritumoral edema. This retrospective cohort study collected 104 GBM (WHO grade IV) patients and 22 immune-competent PCL (diffuse large B cell lymphoma) patients. All these patients had pretreatment brain MR DWI and ADC imaging. Analysis of conventional MR imaging and quantitative ADC measurement including the tumor necrosis (ADCn), the most strongly-enhanced tumor area (ADCt), and the peritumoral edema (ADCe) were done. ROC analysis with optimal cut-off values and area-under-the ROC curve (AUC) was performed. For conventional MR imaging, there are statistical differences in tumor size, tumor location, tumor margin, and the presence of tumor necrosis between GBM and PCL. Quantitative ADC analysis shows that GBM tended to have significantly (P<0.05) higher ADC in the most strongly-enhanced area (ADCt) and lower ADC in the peritumoral edema (ADCe) as compared with PCL. Excellent AUC (0.94) with optimal sensitivity of 90% and specificity of 86% for differentiating between GBM and PCL was obtained by combination of ADC in the tumor necrosis (ADCn), the most strongly-enhanced tumor area (ADCt), and the peritumoral edema (ADCe). Besides, there are positive ADC gradients in the peritumoral edema in a subset of GBMs but not in the PCLs. Quantitative ADC analysis in these three areas can thus be implemented to improve diagnostic accuracy for these two brain tumor types. The histological correlation of the ADC difference deserves further investigation.
authors.affiliation: Department of Medical Imaging, Chi Mei Medical Center, Tainan, Taiwan.|Institute of Biomedical Science, National Sun Yat-Sen University, Kaohsiung, Taiwan.
authors.forename: Ching Chung
authors.initials: CC
authors.lastname: Ko
authors.affiliation: Institute of Biomedical Science, National Sun Yat-Sen University, Kaohsiung, Taiwan.
authors.forename: Ming Hong
authors.initials: MH
authors.lastname: Tai
authors.affiliation: Department of Pathology, Chi Mei Medical Center, Tainan, Taiwan.
authors.forename: Chien Feng
authors.initials: CF
authors.lastname: Li
authors.affiliation: Department of Medical Imaging, Chi Mei Medical Center, Tainan, Taiwan.|Graduate Institute of Medical Sciences, Chang Jung Christian University, Tainan, Taiwan.
authors.forename: Tai Yuan
authors.initials: TY
authors.lastname: Chen
authors.affiliation: Department of Radiology, E-DA Hospital, I-Shou University, Kaohsiung, Taiwan.
authors.forename: Jeon Hor
authors.initials: JH
authors.lastname: Chen
authors.affiliation: Department of Medical Imaging, Chi Mei Medical Center, Tainan, Taiwan.
authors.forename: Ginger
authors.initials: G
authors.lastname: Shu
authors.affiliation: Department of Medical Imaging, Chi Mei Medical Center, Tainan, Taiwan.
authors.forename: Yu Ting
authors.initials: YT
authors.lastname: Kuo
authors.affiliation: Department of Radiology, E-DA Hospital, I-Shou University, Kaohsiung, Taiwan.
authors.forename: Yu Chang
authors.initials: YC
authors.lastname: Lee
mesh_terms: D000368:Aged; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D005909:Glioblastoma / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D008223:Lymphoma / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies