Advantage of High b Value Diffusion-Weighted Imaging for Differentiation of Hemangioblastoma from Brain Metastases in Posterior Fossa.
OBJECTIVE
It is sometimes difficult to make a differential diagnosis between brain metastases and hemangioblastomas in the posterior fossa. We assessed whether high b value diffusion-weighted image (DWI) at b = 4000 could differentiate these tumors.


METHODS
We acquired DWI at 3-T magnetic resonance imaging with b = 1000 and b = 4000 seconds/mm2in histologically confirmed 12 patients of hemangioblastoma without von Hippel-Lindau disease and 16 patients with brain metastases originating at the posterior fossa. Apparent diffusion coefficient (ADC) values were measured by manually placing regions of interest on ADC maps at the site of enhanced tumor confirmed on contrast-enhanced T1- weighed image. ADC was expressed as the minimum (ADCMIN), mean (ADCMEAN), and maximum (ADCMAX) values.


RESULTS
All the ADC values of hemangioblastomas were statistically higher than those of metastatic tumor in both b = 1000 and b = 4000 (P < 0.0001 in ADCMIN, ADCMEAN, and ADCMAX; Mann-Whitney U test). With the cutoff value at 0.6 × 10-3mm2/second, the positive predictive value of ADCMINat b = 4000 was higher than that of ADCMINat b = 1000 (100% vs. 89.3%, logistic analysis) to differentiate hemangioblastomas from brain metastases. Moreover, we studied the pathologic subtype of hemangioblastoma and confirmed that ADCs (b = 4000MIN) of cellular subtype were statistically lower than those of reticular subtype (P = 0.03; Mann-Whitney U test).


CONCLUSIONS
High b value DWI reflects diffusion more accurately than does regular b value. Our results showed that ADC calculation by high b value (b = 4000) DWI at 3-T magnetic resonance imaging is clinically useful for differentiating hemangioblastomas from brain metastases.
Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Minami-ku, Hiroshima-city, Hiroshima, Japan.
Shumpei
S
Onishi
Department of Diagnostic Pathology, Kobe University Hospital, Chuo-ku, Kobe City, Hyogo, Japan.
Takanori
T
Hirose
Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Minami-ku, Hiroshima-city, Hiroshima, Japan.
Takeshi
T
Takayasu
Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Minami-ku, Hiroshima-city, Hiroshima, Japan.
Ryo
R
Nosaka
Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Minami-ku, Hiroshima-city, Hiroshima, Japan.
Manish
M
Kolakshyapati
Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Minami-ku, Hiroshima-city, Hiroshima, Japan.
Taiichi
T
Saito
Department of Clinical Radiology, Hiroshima University Hospital, Minami-ku, Hiroshima-city, Hiroshima, Japan.
Yuji
Y
Akiyama
Department of Clinical Oncology and Neuro-oncology Program, Hiroshima University Hospital, Minami-ku, Hiroshima-city, Hiroshima, Japan.
Kazuhiko
K
Sugiyama
Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Minami-ku, Hiroshima-city, Hiroshima, Japan.
Kaoru
K
Kurisu
Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Minami-ku, Hiroshima-city, Hiroshima, Japan. Electronic address: fyama@hiroshima-u.ac.jp.
Fumiyuki
F
Yamasaki
D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D002528:Cerebellar Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods* / Q000592:standards; D005260:Female; D018325:Hemangioblastoma / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D015192:Infratentorial Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
Apparent diffusion coefficient; Brain metastases; Diffusion-weighted image; Hemangioblastoma; High b value