title: Differentiation of Glioblastoma from Brain Metastasis: Qualitative and Quantitative Analysis Using Arterial Spin Labeling MR Imaging.
abstract: OBJECTIVE
  To evaluate the diagnostic performance of cerebral blood flow (CBF) by using arterial spin labeling (ASL) perfusion magnetic resonance (MR) imaging to differentiate glioblastoma (GBM) from brain metastasis.
  
  
  METHODS
  The institutional review board of our hospital approved this retrospective study. The study population consisted of 128 consecutive patients who underwent surgical resection and were diagnosed as either GBM (n = 89) or brain metastasis (n = 39). All participants underwent preoperative MR imaging including ASL. For qualitative analysis, the tumors were visually graded into five categories based on ASL-CBF maps by two blinded reviewers. For quantitative analysis, the reviewers drew regions of interest (ROIs) on ASL-CBF maps upon the most hyperperfused portion within the tumor and upon peritumoral T2 hyperintensity area. Signal intensities of intratumoral and peritumoral ROIs for each subject were normalized by dividing the values by those of contralateral normal gray matter (nCBFintratumoral and nCBFperitumoral, respectively). Visual grading scales and quantitative parameters between GBM and brain metastasis were compared. In addition, the area under the receiver-operating characteristic curve was used to evaluate the diagnostic performance of ASL-driven CBF to differentiate GBM from brain metastasis.
  
  
  RESULTS
  For qualitative analysis, GBM group showed significantly higher grade compared to metastasis group (p = 0.001). For quantitative analysis, both nCBFintratumoral and nCBFperitumoral in GBM were significantly higher than those in metastasis (both p < 0.001). The areas under the curve were 0.677, 0.714, and 0.835 for visual grading, nCBFintratumoral, and nCBFperitumoral, respectively (all p < 0.001).
  
  
  CONCLUSIONS
  ASL perfusion MR imaging can aid in the differentiation of GBM from brain metastasis.
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.|Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Leonard
authors.initials: L
authors.lastname: Sunwoo
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.|Department of Radiology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Tae Jin
authors.identifier: http://orcid.org/0000-0001-8441-4574
authors.initials: TJ
authors.lastname: Yun
authors.affiliation: Department of Radiology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Sung-Hye
authors.initials: SH
authors.lastname: You
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.|Department of Radiology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Roh-Eul
authors.initials: RE
authors.lastname: Yoo
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.|Department of Radiology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Koung Mi
authors.initials: KM
authors.lastname: Kang
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.|Department of Radiology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Seung Hong
authors.initials: SH
authors.lastname: Choi
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.|Department of Radiology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Ji-Hoon
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.|Department of Radiology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Chul-Ho
authors.initials: CH
authors.lastname: Sohn
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.|Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: Sun-Won
authors.initials: SW
authors.lastname: Park
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.|Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Cheolkyu
authors.initials: C
authors.lastname: Jung
authors.affiliation: Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
authors.forename: Chul-Kee
authors.initials: CK
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary*; D003937:Diagnosis, Differential; D005260:Female; D005909:Glioblastoma / Q000000981:diagnostic imaging*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012189:Retrospective Studies