title: Combining Diffusion Tensor Metrics and DSC Perfusion Imaging: Can It Improve the Diagnostic Accuracy in Differentiating Tumefactive Demyelination from High-Grade Glioma?
abstract: Tumefactive demyelinating lesions with atypical features can mimic high-grade gliomas on conventional imaging sequences. The aim of this study was to assess the role of conventional imaging, DTI metrics (p:qtensor decomposition), and DSC perfusion in differentiating tumefactive demyelinating lesions and high-grade gliomas.
  
  
  
  Fourteen patients with tumefactive demyelinating lesions and 21 patients with high-grade gliomas underwent brain MR imaging with conventional, DTI, and DSC perfusion imaging. Imaging sequences were assessed for differentiation of the lesions. DTI metrics in the enhancing areas and perilesional hyperintensity were obtained by ROI analysis, and the relative CBV values in enhancing areas were calculated on DSC perfusion imaging.
  
  
  
  Conventional imaging sequences had a sensitivity of 80.9% and specificity of 57.1% in differentiating high-grade gliomas (P= .049) from tumefactive demyelinating lesions. DTI metrics (p:qtensor decomposition) and DSC perfusion demonstrated a statistically significant difference in the mean values of ADC, the isotropic component of the diffusion tensor, the anisotropic component of the diffusion tensor, the total magnitude of the diffusion tensor, and rCBV among enhancing portions in tumefactive demyelinating lesions and high-grade gliomas (P≤ .02), with the highest specificity for ADC, the anisotropic component of the diffusion tensor, and relative CBV (92.9%). Mean fractional anisotropy values showed no significant statistical difference between tumefactive demyelinating lesions and high-grade gliomas. The combination of DTI and DSC parameters improved the diagnostic accuracy (area under the curve = 0.901). Addition of a heterogeneous enhancement pattern to DTI and DSC parameters improved it further (area under the curve = 0.966). The sensitivity increased from 71.4% to 85.7% after the addition of the enhancement pattern.
  
  
  
  DTI and DSC perfusion add profoundly to conventional imaging in differentiating tumefactive demyelinating lesions and high-grade gliomas. The combination of DTI metrics and DSC perfusion markedly improved diagnostic accuracy.
authors.affiliation: From the Departments of Imaging Sciences and Interventional Radiology (S.B.H., A.M., S.K., C.N., C.K., T.R.K., B.T.).
authors.forename: S B
authors.identifier: 0000-0003-4600-6662
authors.initials: SB
authors.lastname: Hiremath
authors.affiliation: From the Departments of Imaging Sciences and Interventional Radiology (S.B.H., A.M., S.K., C.N., C.K., T.R.K., B.T.).
authors.forename: A
authors.identifier: 0000-0002-1924-8247
authors.initials: A
authors.lastname: Muraleedharan
authors.affiliation: From the Departments of Imaging Sciences and Interventional Radiology (S.B.H., A.M., S.K., C.N., C.K., T.R.K., B.T.).
authors.forename: S
authors.identifier: 0000-0003-0554-144X
authors.initials: S
authors.lastname: Kumar
authors.affiliation: From the Departments of Imaging Sciences and Interventional Radiology (S.B.H., A.M., S.K., C.N., C.K., T.R.K., B.T.).
authors.forename: C
authors.identifier: 0000-0001-9074-8490
authors.initials: C
authors.lastname: Nagesh
authors.affiliation: From the Departments of Imaging Sciences and Interventional Radiology (S.B.H., A.M., S.K., C.N., C.K., T.R.K., B.T.).
authors.forename: C
authors.identifier: 0000-0003-4914-8666
authors.initials: C
authors.lastname: Kesavadas
authors.affiliation: Neurosurgery (M.A.), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
authors.forename: M
authors.identifier: 0000-0001-6467-3456
authors.initials: M
authors.lastname: Abraham
authors.affiliation: From the Departments of Imaging Sciences and Interventional Radiology (S.B.H., A.M., S.K., C.N., C.K., T.R.K., B.T.).
authors.forename: T R
authors.identifier: 0000-0003-1837-5030
authors.initials: TR
authors.lastname: Kapilamoorthy
authors.affiliation: From the Departments of Imaging Sciences and Interventional Radiology (S.B.H., A.M., S.K., C.N., C.K., T.R.K., B.T.) bejoy@sctimst.ac.in.
authors.forename: B
authors.identifier: 0000-0003-0355-3375
authors.initials: B
authors.lastname: Thomas
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000000981:diagnostic imaging*; D003711:Demyelinating Diseases / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D056324:Diffusion Tensor Imaging / Q000379:methods*; D005260:Female; D005910:Glioma / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging / Q000379:methods; D055420:Perfusion Imaging / Q000379:methods*; D012680:Sensitivity and Specificity