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Muroya Y, Suzuki K, Nagasaka S, Nakano Y, Yamamoto J. Primary central nervous system lymphoma of the third ventricle with intra-tumoral hemorrhage: A case report and literature review. Oncol Lett 2022; 25:47. [PMID: 36644156 PMCID: PMC9811644 DOI: 10.3892/ol.2022.13633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 12/02/2022] [Indexed: 12/16/2022] Open
Abstract
Primary central nervous system lymphoma (PCNSL) is a rare brain tumor that most commonly arises in the cerebral white matter, basal ganglia, peri-ventricle or corpus callosum. Confinement of PCNSL to the third ventricle is extremely rare, and seldom presents with intratumoral hemorrhage (ITH). The present study described the case of a 75-year-old woman who presented with obstructive hydrocephalus due to third-ventricle PCNSL. On magnetic resonance imaging (MRI), the tumor presented ITH on T2*-weighted images and a highly elevated regional cerebral blood volume on dynamic susceptibility contrast-enhanced MRI (DSC-MRI). Due to the high elevation of the regional cerebral blood volume, high-grade glioma was suspected as a preoperative diagnosis. The patient underwent endoscopic tumor biopsy and third ventricle PCNSL was successfully diagnosed. The patient achieved good prognosis at an early stage after the start of treatment initiation. There are many differential considerations for a third-ventricle tumor, and DSC-MRI can help the differential diagnosis of these tumors. Furthermore, the presence of ITH can lead to the inaccurate estimation of regional cerebral blood volume values. Overall, silent or microhemorrhage in PCNSL may be underestimated, and clinicians should therefore carefully evaluate tumor vascularity by MRI.
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Affiliation(s)
- Yu Muroya
- Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Fukuoka 807-8555, Japan
| | - Kohei Suzuki
- Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Fukuoka 807-8555, Japan,Correspondence to: Dr Kohei Suzuki, Department of Neurosurgery, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka 807-8555, Japan, E-mail:
| | - Shohei Nagasaka
- Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Fukuoka 807-8555, Japan
| | - Yoshiteru Nakano
- Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Fukuoka 807-8555, Japan
| | - Junkoh Yamamoto
- Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Fukuoka 807-8555, Japan
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Cao L, Zhang M, Zhang Y, Ji B, Wang X, Wang X. Progress of radiological‑pathological workflows in the differential diagnosis between primary central nervous system lymphoma and high‑grade glioma (Review). Oncol Rep 2022; 49:20. [PMID: 36484403 PMCID: PMC9773014 DOI: 10.3892/or.2022.8457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 11/03/2022] [Indexed: 12/13/2022] Open
Abstract
Primary central nervous system lymphoma (PCNSL) and high‑grade glioma (HGG) are distinct entities of the CNS with completely distinct treatments. The treatment of PCNSL is chemotherapy‑based, while surgery is the first choice for HGG. However, the clinical features of the two entities often overlap, and a clear pathological diagnosis is important for subsequent management, especially for the management of PCNSL. Stereotactic biopsy is recognized as one of the minimally invasive alternatives for evaluating the involvement of the CNS. However, in the case of limited tissue materials, the differential diagnosis between the two entities is still difficult. In addition, some patients are too ill to tolerate a needle biopsy. Therefore, combining imaging, histopathology and laboratory examinations is essential in order to make a clear diagnosis as soon as possible. The present study reviews the progress of comparative research on both imaging and laboratory tests based on the pathophysiological changes of the two entities, and proposes an integrative and optimized diagnostic process, with the purpose of building a better understanding for neurologists, hematologists, radiologists and pathologists.
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Affiliation(s)
- Luming Cao
- Department of Pathology, China-Japan Union Hospital, Jilin University, Changchun, Jilin 130033, P.R. China
| | - Mengchao Zhang
- Department of Radiology, China-Japan Union Hospital, Jilin University, Changchun, Jilin 130033, P.R. China
| | - Ying Zhang
- Department of Pathology, China-Japan Union Hospital, Jilin University, Changchun, Jilin 130033, P.R. China
| | - Bin Ji
- Department of Nuclear Medicine, China-Japan Union Hospital, Jilin University, Changchun, Jilin 130033, P.R. China
| | - Xuemei Wang
- Department of Pathology, China-Japan Union Hospital, Jilin University, Changchun, Jilin 130033, P.R. China
| | - Xueju Wang
- Department of Pathology, China-Japan Union Hospital, Jilin University, Changchun, Jilin 130033, P.R. China,Correspondence to: Dr Xueju Wang, Department of Pathology, China-Japan Union Hospital, Jilin University, 126 Xiantai Street, Changchun, Jilin 130033, P.R. China, E-mail:
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Du X, He Y, Lin W. Diagnostic Accuracy of the Diffusion-Weighted Imaging Method Used in Association With the Apparent Diffusion Coefficient for Differentiating Between Primary Central Nervous System Lymphoma and High-Grade Glioma: Systematic Review and Meta-Analysis. Front Neurol 2022; 13:882334. [PMID: 35812103 PMCID: PMC9263097 DOI: 10.3389/fneur.2022.882334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/27/2022] [Indexed: 12/30/2022] Open
Abstract
Background It is difficult to differentiate between a few primary central nervous system lymphoma (PCNSL) and high-grade glioma (HGG) using conventional magnetic resonance imaging techniques. The purpose of this study is to explore whether diffusion-weighted imaging (DWI) can be effectively used to differentiate between these two types of tumors by analyzing the apparent diffusion coefficient (ADC). Research Design and Methods Data presented in Pubmed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, and China Science and Technology Journal Database (CQVIP) were analyzed. High-quality literature was included, and the quality was evaluated using the quality assessment of diagnostic accuracy studies-2 (QUADAS-2) tool, and the studies were based on the inclusion and exclusion rules. The pooled sensitivity, pooled specificity, pooled positive likelihood ratio (PLR), pooled negative likelihood ratio (NLR), pooled diagnostic odds ratio (DOR), area under the curve (AUC) of the summary operating characteristic curve (SROC), and corresponding 95% confidence interval (CI) were calculated using the bivariate mixed effect model. Meta-regression analysis and subgroup analysis were used to explore the sources of heterogeneity. The publication bias was evaluated by conducting Deek's test. Results In total, eighteen high-quality studies were included. The pooled sensitivity was 0.82 (95% CI: 0.75–0.88), the pooled specificity was 0.87 (95% CI: 0.84–0.90), the pooled positive likelihood ratio was 6.49 (95% CI: 5.06–8.32), the pooled NLR was 0.21 (95% CI: 0.14–0.30), the pooled DOR was 31.31 (95% CI: 18.55–52.86), and the pooled AUC was 0.90 (95% CI: 0.87–0.92). Sample size, language and country of publication, magnetic field strength, region of interest (ROI), and cut-off values of different types of ADC can potentially be the sources of heterogeneity. There was no publication bias in this meta-analysis. Conclusions The results obtained from the meta-analysis suggest that DWI is characterized by high diagnostic accuracy and thus can be effectively used for differentiating between PCNSL and HGG.
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Affiliation(s)
- Xiaoli Du
- Department of Radiology, Chengdu First People's Hospital, Chengdu, China
| | - Yue He
- Department of Orthopedics, Chengdu First People's Hospital, Chengdu, China
| | - Wei Lin
- Department of Radiology, Chengdu First People's Hospital, Chengdu, China
- *Correspondence: Wei Lin
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Hemodynamic Imaging in Cerebral Diffuse Glioma-Part A: Concept, Differential Diagnosis and Tumor Grading. Cancers (Basel) 2022; 14:cancers14061432. [PMID: 35326580 PMCID: PMC8946242 DOI: 10.3390/cancers14061432] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/01/2022] [Accepted: 03/08/2022] [Indexed: 11/17/2022] Open
Abstract
Diffuse gliomas are the most common primary malignant intracranial neoplasms. Aside from the challenges pertaining to their treatment-glioblastomas, in particular, have a dismal prognosis and are currently incurable-their pre-operative assessment using standard neuroimaging has several drawbacks, including broad differentials diagnosis, imprecise characterization of tumor subtype and definition of its infiltration in the surrounding brain parenchyma for accurate resection planning. As the pathophysiological alterations of tumor tissue are tightly linked to an aberrant vascularization, advanced hemodynamic imaging, in addition to other innovative approaches, has attracted considerable interest as a means to improve diffuse glioma characterization. In the present part A of our two-review series, the fundamental concepts, techniques and parameters of hemodynamic imaging are discussed in conjunction with their potential role in the differential diagnosis and grading of diffuse gliomas. In particular, recent evidence on dynamic susceptibility contrast, dynamic contrast-enhanced and arterial spin labeling magnetic resonance imaging are reviewed together with perfusion-computed tomography. While these techniques have provided encouraging results in terms of their sensitivity and specificity, the limitations deriving from a lack of standardized acquisition and processing have prevented their widespread clinical adoption, with current efforts aimed at overcoming the existing barriers.
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Hsu SPC, Hsiao TY, Pai LC, Sun CW. Differentiation of primary central nervous system lymphoma from glioblastoma using optical coherence tomography based on attention ResNet. NEUROPHOTONICS 2022; 9:015005. [PMID: 35345493 PMCID: PMC8940883 DOI: 10.1117/1.nph.9.1.015005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 02/04/2022] [Indexed: 06/14/2023]
Abstract
Significance: Differentiation of primary central nervous system lymphoma from glioblastoma is clinically crucial to minimize the risk of treatments, but current imaging modalities often misclassify glioblastoma and lymphoma. Therefore, there is a need for methods to achieve high differentiation power intraoperatively. Aim: The aim is to develop and corroborate a method of classifying normal brain tissue, glioblastoma, and lymphoma using optical coherence tomography with deep learning algorithm in an ex vivo experimental design. Approach: We collected tumor specimens from ordinal surgical operations and measured them with optical coherence tomography. An attention ResNet deep learning model was utilized to differentiate glioblastoma and lymphoma from normal brain tissues. Results: Our model demonstrated a robust classification power of detecting tumoral tissues from normal tissues and moderate discrimination between lymphoma and glioblastoma. Moreover, our results showed good consistency with the previous histological findings in the pathological manifestation of lymphoma, and this could be important from the aspect of future clinical practice. Conclusion: We proposed and demonstrated a quantitative approach to distinguish different brain tumor types. Using our method, both neoplasms can be identified and classified with high accuracy. Hopefully, the proposed method can finally assist surgeons with decision-making intraoperatively.
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Affiliation(s)
- Sanford P. C. Hsu
- Taipei Veterans General Hospital, Neurological Institute, Department of Neurosurgery, Taipei, Taiwan
| | - Tien-Yu Hsiao
- National Yang Ming Chiao Tung University, Department of Photonics, College of Electrical and Computer Engineering, Hsinchu, Taiwan
| | - Li-Chieh Pai
- National Yang Ming Chiao Tung University, Department of Photonics, College of Electrical and Computer Engineering, Hsinchu, Taiwan
| | - Chia-Wei Sun
- National Yang Ming Chiao Tung University, Department of Photonics, College of Electrical and Computer Engineering, Hsinchu, Taiwan
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Albano D, Bruno F, Agostini A, Angileri SA, Benenati M, Bicchierai G, Cellina M, Chianca V, Cozzi D, Danti G, De Muzio F, Di Meglio L, Gentili F, Giacobbe G, Grazzini G, Grazzini I, Guerriero P, Messina C, Micci G, Palumbo P, Rocco MP, Grassi R, Miele V, Barile A. Dynamic contrast-enhanced (DCE) imaging: state of the art and applications in whole-body imaging. Jpn J Radiol 2021; 40:341-366. [PMID: 34951000 DOI: 10.1007/s11604-021-01223-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/17/2021] [Indexed: 12/18/2022]
Abstract
Dynamic contrast-enhanced (DCE) imaging is a non-invasive technique used for the evaluation of tissue vascularity features through imaging series acquisition after contrast medium administration. Over the years, the study technique and protocols have evolved, seeing a growing application of this method across different imaging modalities for the study of almost all body districts. The main and most consolidated current applications concern MRI imaging for the study of tumors, but an increasing number of studies are evaluating the use of this technique also for inflammatory pathologies and functional studies. Furthermore, the recent advent of artificial intelligence techniques is opening up a vast scenario for the analysis of quantitative information deriving from DCE. The purpose of this article is to provide a comprehensive update on the techniques, protocols, and clinical applications - both established and emerging - of DCE in whole-body imaging.
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Affiliation(s)
- Domenico Albano
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Dipartimento Di Biomedicina, Neuroscienze E Diagnostica Avanzata, Sezione Di Scienze Radiologiche, Università Degli Studi Di Palermo, via Vetoio 1L'Aquila, 67100, Palermo, Italy
| | - Federico Bruno
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy.
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Andrea Agostini
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Department of Clinical, Special and Dental Sciences, Department of Radiology, University Politecnica delle Marche, University Hospital "Ospedali Riuniti Umberto I - G.M. Lancisi - G. Salesi", Ancona, Italy
| | - Salvatore Alessio Angileri
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Radiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimo Benenati
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Dipartimento di Diagnostica per Immagini, Fondazione Policlinico Universitario A. Gemelli IRCCS, Oncologia ed Ematologia, RadioterapiaRome, Italy
| | - Giulia Bicchierai
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Michaela Cellina
- Department of Radiology, ASST Fatebenefratelli Sacco, Ospedale Fatebenefratelli, Milan, Italy
| | - Vito Chianca
- Ospedale Evangelico Betania, Naples, Italy
- Clinica Di Radiologia, Istituto Imaging Della Svizzera Italiana - Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Diletta Cozzi
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
| | - Ginevra Danti
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
| | - Federica De Muzio
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Letizia Di Meglio
- Postgraduation School in Radiodiagnostics, University of Milan, Milan, Italy
| | - Francesco Gentili
- Unit of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Giuliana Giacobbe
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Giulia Grazzini
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Irene Grazzini
- Department of Radiology, Section of Neuroradiology, San Donato Hospital, Arezzo, Italy
| | - Pasquale Guerriero
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | | | - Giuseppe Micci
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Dipartimento Di Biomedicina, Neuroscienze E Diagnostica Avanzata, Sezione Di Scienze Radiologiche, Università Degli Studi Di Palermo, via Vetoio 1L'Aquila, 67100, Palermo, Italy
| | - Pierpaolo Palumbo
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Abruzzo Health Unit 1, Department of diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, L'Aquila, Italy
| | - Maria Paola Rocco
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Roberto Grassi
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Vittorio Miele
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Antonio Barile
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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Abstract
The central role of MRI in neuro-oncology is undisputed. The technique is used, both in clinical practice and in clinical trials, to diagnose and monitor disease activity, support treatment decision-making, guide the use of focused treatments and determine response to treatment. Despite recent substantial advances in imaging technology and image analysis techniques, clinical MRI is still primarily used for the qualitative subjective interpretation of macrostructural features, as opposed to quantitative analyses that take into consideration multiple pathophysiological features. However, the field of quantitative imaging and imaging biomarker development is maturing. The European Imaging Biomarkers Alliance (EIBALL) and Quantitative Imaging Biomarkers Alliance (QIBA) are setting standards for biomarker development, validation and implementation, as well as promoting the use of quantitative imaging and imaging biomarkers by demonstrating their clinical value. In parallel, advanced imaging techniques are reaching the clinical arena, providing quantitative, commonly physiological imaging parameters that are driving the discovery, validation and implementation of quantitative imaging and imaging biomarkers in the clinical routine. Additionally, computational analysis techniques are increasingly being used in the research setting to convert medical images into objective high-dimensional data and define radiomic signatures of disease states. Here, I review the definition and current state of MRI biomarkers in neuro-oncology, and discuss the clinical potential of quantitative image analysis techniques.
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Classification of glioblastoma versus primary central nervous system lymphoma using convolutional neural networks. Sci Rep 2021; 11:15219. [PMID: 34312463 PMCID: PMC8313677 DOI: 10.1038/s41598-021-94733-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 06/21/2021] [Indexed: 12/15/2022] Open
Abstract
A subset of primary central nervous system lymphomas (PCNSL) are difficult to distinguish from glioblastoma multiforme (GBM) on magnetic resonance imaging (MRI). We developed a convolutional neural network (CNN) to distinguish these tumors on contrast-enhanced T1-weighted images. Preoperative brain tumor MRIs were retrospectively collected among 320 patients with either GBM (n = 160) and PCNSL (n = 160) from two academic institutions. The individual images from these MRIs consisted of a training set (n = 1894 GBM and 1245 PCNSL), a validation set (n = 339 GBM; 202 PCNSL), and a testing set (99 GBM and 108 PCNSL). Three CNNs using the EfficientNetB4 architecture were evaluated. To increase the size of the training set and minimize overfitting, random flips and changes to color were performed on the training set. Our transfer learning approach (with image augmentation and 292 epochs) yielded an AUC of 0.94 (95% CI: 0.91–0.97) for GBM and an AUC of 0.95 (95% CI: 0.92–0.98) for PCNL. In the second case (not augmented and 137 epochs), the images were augmented prior to training. The area under the curve for GBM was 0.92 (95% CI: 0.88–0.96) for GBM and an AUC of 0.94 (95% CI: 0.91–0.97) for PCNSL. For the last case (augmented, Gaussian noise and 238 epochs) the AUC for GBM was 0.93 (95% CI: 0.89–0.96) and an AUC 0.93 (95% CI = 0.89–0.96) for PCNSL. Even with a relatively small dataset, our transfer learning approach demonstrated CNNs may provide accurate diagnostic information to assist radiologists in distinguishing PCNSL and GBM.
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Krebs S, Barasch JG, Young RJ, Grommes C, Schöder H. Positron emission tomography and magnetic resonance imaging in primary central nervous system lymphoma-a narrative review. ANNALS OF LYMPHOMA 2021; 5. [PMID: 34223561 PMCID: PMC8248935 DOI: 10.21037/aol-20-52] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This review addresses the challenges of primary central nervous system (CNS) lymphoma diagnosis, assessment of treatment response, and detection of recurrence. Primary CNS lymphoma is a rare form of extra-nodal non-Hodgkin lymphoma that can involve brain, spinal cord, leptomeninges, and eyes. Primary CNS lymphoma lesions are most commonly confined to the white matter or deep cerebral structures such as basal ganglia and deep periventricular regions. Contrast-enhanced magnetic resonance imaging (MRI) is the standard diagnostic modality employed by neuro-oncologists. MRI often shows common morphological features such as a single or multiple uniformly well-enhancing lesions without necrosis but with moderate surrounding edema. Other brain tumors or inflammatory processes can show similar radiological patterns, making differential diagnosis difficult. [18F]-fluorodeoxyglucose (FDG) positron emission tomography (PET) has selected utility in cerebral lymphoma, especially in diagnosis. Primary CNS lymphoma can sometimes present with atypical findings on MRI and FDG PET, such as disseminated disease, non-enhancing or ring-like enhancing lesions. The complementary strengths of PET and MRI have led to the development of combined PET-MR systems, which in some cases may improve lesion characterization and detection. By highlighting active developments in this field, including advanced MRI sequences, novel radiotracers, and potential imaging biomarkers, we aim to spur interest in sophisticated imaging approaches.
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Affiliation(s)
- Simone Krebs
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Julia G Barasch
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Robert J Young
- Neuroradiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christian Grommes
- Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Heiko Schöder
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Chaganti J, Taylor M, Woodford H, Steel T. Differentiation of Primary Central Nervous System Lymphoma and High-Grade Glioma with Dynamic Susceptibility Contrast-Derived Metrics: Pilot Study. World Neurosurg 2021; 151:e979-e987. [PMID: 34020062 DOI: 10.1016/j.wneu.2021.05.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 05/09/2021] [Accepted: 05/10/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Preoperative differentiation of lymphoma from other aggressive intracranial neoplasms is important as the surgical and adjuvant therapy may be fundamentally different between the 2 types of tumors. The purpose of this study was to assess the ability of the dynamic susceptibility contrast-derived metrics, percentage signal recovery (PSR) ratio, and relative cerebral blood volume (rCBV) to distinguish between primary central nervous system lymphoma (PCNSL) and high-grade glioma (HGG). METHODS Twenty-six patients (15 with HGG and 11 with PCNSL) with histologically confirmed diagnoses were retrospectively analyzed. Mean PSR and rCBV were calculated from dynamic susceptibility contrast imaging. The 2 groups were compared using an independent samples t-test. Receiver operating characteristic analyses were performed to determine the area under the curve and identify threshold values to differentiate PCNSL from GBM. RESULTS Both rCBV and PSR values were significantly different, at both the group level and subject level, between the PCNSL and HGG patients. The mean rCBV was significantly lower in PCNSL (1.38 ± 0.64) compared with HGG (5.19 ± 2.21, df = 11.24, P < 0.001). The mean PSR ratio was significantly higher in PCNSL (1.04 ± 0.11) compared with HGG (0.72 ± 0.16, df = 17.23, P < 0.001). An rCBV threshold value of 2.67 provided a 100% sensitivity and 100% specificity (area under the curve 1.0) for differentiating PCNSL from HGG. A PSR ratio threshold value of 0.9 was 100% sensitive and 90.91% specific for differentiating PCNSL from HGG. CONCLUSIONS The findings of our study show that rCBV and PSR ratio are different in HGG and PCNSL at both the group level and subject level. Incorporation of perfusion in routine magnetic resonance imaging of contrast-enhancing lesions can have a significant impact on patient management.
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Affiliation(s)
- Joga Chaganti
- Department of Radiology and Imaging, St. Vincent's Hospital, Sydney, Australia.
| | - Michael Taylor
- Department of Neurosurgery, John Hunter Hospital, Newcastle, Australia
| | - Hannah Woodford
- Department of Radiology, John Hunter Hospital, Newcastle, Australia
| | - Timothy Steel
- Department of Neurosurgery, St. Vincent's Hospital, Sydney, Australia
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11
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Kang KM, Choi SH, Chul-Kee P, Kim TM, Park SH, Lee JH, Lee ST, Hwang I, Yoo RE, Yun TJ, Kim JH, Sohn CH. Differentiation between glioblastoma and primary CNS lymphoma: application of DCE-MRI parameters based on arterial input function obtained from DSC-MRI. Eur Radiol 2021; 31:9098-9109. [PMID: 34003350 DOI: 10.1007/s00330-021-08044-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 04/06/2021] [Accepted: 05/04/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This study aimed to evaluate whether arterial input functions (AIFs) obtained from dynamic susceptibility contrast (DSC)-MRI (AIFDSC) improve the reliability and diagnostic accuracy of dynamic contrast-enhanced (DCE)-derived pharmacokinetic (PK) parameters for differentiating glioblastoma from primary CNS lymphoma (PCNSL) compared with AIFs derived from DCE-MRI (AIFDCE). METHODS This retrospective study included 172 patients with glioblastoma (n = 147) and PCNSL (n = 25). All patients had undergone preoperative DSC- and DCE-MRI. The volume transfer constant (Ktrans), volume of the vascular plasma space (vp), and volume of the extravascular extracellular space (ve) were acquired using AIFDSC and AIFDCE. The relative cerebral blood volume (rCBV) was obtained from DSC-MRI. Intraclass correlation coefficients (ICC) and ROC curves were used to assess the reliability and diagnostic accuracy of individual parameters. RESULTS The mean Ktrans, vp, and ve values revealed better ICCs with AIFDSC than with AIFDCE (Ktrans, 0.911 vs 0.355; vp, 0.766 vs 0.503; ve, 0.758 vs 0.657, respectively). For differentiating all glioblastomas from PCNSL, the mean rCBV (AUC = 0.856) was more accurate than the AIFDSC-driven mean Ktrans, which had the largest AUC (0.711) among the DCE-derived parameters (p = 0.02). However, for glioblastomas with low rCBV (≤ 75th percentile of PCNSL; n = 30), the AIFDSC-driven mean Ktrans and vp were more accurate than rCBV (AUC: Ktrans, 0.807 vs rCBV, 0.515, p = 0.004; vp, 0.715 vs rCBV, p = 0.045). CONCLUSION DCE-derived PK parameters using the AIFDSC showed improved reliability and diagnostic accuracy for differentiating glioblastoma with low rCBV from PCNSL. KEY POINTS • An accurate differential diagnosis of glioblastoma and PCNSL is crucial because of different therapeutic strategies. • In contrast to the rCBV from DSC-MRI, another perfusion imaging technique, the DCE parameters for the differential diagnosis have been limited because of the low reliability of AIFs from DCE-MRI. • When we analyzed DCE-MRI data using AIFs from DSC-MRI (AIFDSC), AIFDSC-driven DCE parameters showed improved reliability and better diagnostic accuracy than rCBV for differentiating glioblastoma with low rCBV from PCNSL.
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Affiliation(s)
- Koung Mi Kang
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Seung Hong Choi
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea. .,Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, 110-744, Republic of Korea. .,Center for Nanoparticle Research, Institute for Basic Science, and School of Chemical and Biological Engineering, Seoul National University, Seoul, Republic of Korea.
| | - Park Chul-Kee
- Department of Neurosurgery and Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Tae Min Kim
- Department of Internal Medicine and Cancer Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sung-Hye Park
- Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Joo Ho Lee
- Department of Radiation Oncology and Cancer Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soon-Tae Lee
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Inpyeong Hwang
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Roh-Eul Yoo
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Tae Jin Yun
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Ji-Hoon Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Chul-Ho Sohn
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, 110-744, Republic of Korea
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12
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Park JE, Kim HS, Lee J, Cheong EN, Shin I, Ahn SS, Shim WH. Deep-learned time-signal intensity pattern analysis using an autoencoder captures magnetic resonance perfusion heterogeneity for brain tumor differentiation. Sci Rep 2020; 10:21485. [PMID: 33293590 PMCID: PMC7723041 DOI: 10.1038/s41598-020-78485-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 11/11/2020] [Indexed: 01/10/2023] Open
Abstract
Current image processing methods for dynamic susceptibility contrast (DSC) magnetic resonance imaging (MRI) do not capture complex dynamic information of time-signal intensity curves. We investigated whether an autoencoder-based pattern analysis of DSC MRI captured representative temporal features that improves tissue characterization and tumor diagnosis in a multicenter setting. The autoencoder was applied to the time-signal intensity curves to obtain representative temporal patterns, which were subsequently learned by a convolutional neural network. This network was trained with 216 preoperative DSC MRI acquisitions and validated using external data (n = 43) collected with different DSC acquisition protocols. The autoencoder applied to time-signal intensity curves and clustering obtained nine representative clusters of temporal patterns, which accurately identified tumor and non-tumoral tissues. The dominant clusters of temporal patterns distinguished primary central nervous system lymphoma (PCNSL) from glioblastoma (AUC 0.89) and metastasis from glioblastoma (AUC 0.95). The autoencoder captured DSC time-signal intensity patterns that improved identification of tumoral tissues and differentiation of tumor type and was generalizable across centers.
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Affiliation(s)
- Ji Eun Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 43 Olympic-ro 88, Songpa-Gu, Seoul, 05505, Korea
| | - Ho Sung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 43 Olympic-ro 88, Songpa-Gu, Seoul, 05505, Korea.
| | - Junkyu Lee
- Department of Medical Science and Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, 43 Olympic-ro 88, Songpa-Gu, Seoul, Korea
| | - E-Nae Cheong
- Department of Medical Science and Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, 43 Olympic-ro 88, Songpa-Gu, Seoul, Korea
| | - Ilah Shin
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Soo Ahn
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Korea
| | - Woo Hyun Shim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 43 Olympic-ro 88, Songpa-Gu, Seoul, 05505, Korea.,Department of Medical Science and Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, 43 Olympic-ro 88, Songpa-Gu, Seoul, Korea
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13
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Eisenhut F, Schmidt MA, Putz F, Lettmaier S, Fröhlich K, Arinrad S, Coras R, Luecking H, Lang S, Fietkau R, Doerfler A. Classification of Primary Cerebral Lymphoma and Glioblastoma Featuring Dynamic Susceptibility Contrast and Apparent Diffusion Coefficient. Brain Sci 2020; 10:brainsci10110886. [PMID: 33233698 PMCID: PMC7699775 DOI: 10.3390/brainsci10110886] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 11/09/2020] [Accepted: 11/19/2020] [Indexed: 12/14/2022] Open
Abstract
This study aimed to differentiate primary central nervous system lymphoma (PCNSL) and glioblastoma (GBM) via multimodal MRI featuring radiomic analysis. MRI data sets of patients with histological proven PCNSL and GBM were analyzed retrospectively. Diffusion-weighted imaging (DWI) and dynamic susceptibility contrast (DSC) perfusion imaging were evaluated to differentiate contrast enhancing intracerebral lesions. Selective (contrast enhanced tumor area with the highest mean cerebral blood volume (CBV) value) and unselective (contouring whole contrast enhanced lesion) Apparent diffusion coefficient (ADC) measurement was performed. By multivariate logistic regression, a multiparametric model was compiled and tested for its diagnostic strength. A total of 74 patients were included in our study. Selective and unselective mean and maximum ADC values, mean and maximum CBV and ratioCBV as quotient of tumor CBV and CBV in contralateral healthy white matter were significantly larger in patients with GBM than PCNSL; minimum CBV was significantly lower in GBM than in PCNSL. The highest AUC for discrimination of PCNSL and GBM was obtained for selective mean and maximum ADC, mean and maximum CBV and ratioCBV. By integrating these five in a multiparametric model 100% of the patients were classified correctly. The combination of perfusion imaging (CBV) and tumor hot-spot selective ADC measurement yields reliable radiological discrimination of PCNSL from GBM with highest accuracy and is readily available in clinical routine.
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Affiliation(s)
- Felix Eisenhut
- Department of Neuroradiology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany; (M.A.S.); (H.L.); (S.L.); (A.D.)
- Correspondence: ; Tel.: +49-9131-853-9388
| | - Manuel A. Schmidt
- Department of Neuroradiology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany; (M.A.S.); (H.L.); (S.L.); (A.D.)
| | - Florian Putz
- Department of Radiation Oncology, University of Erlangen-Nuremberg, Universitaetsstrasse 27, 91054 Erlangen, Germany; (F.P.); (S.L.); (R.F.)
| | - Sebastian Lettmaier
- Department of Radiation Oncology, University of Erlangen-Nuremberg, Universitaetsstrasse 27, 91054 Erlangen, Germany; (F.P.); (S.L.); (R.F.)
| | - Kilian Fröhlich
- Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany;
| | - Soheil Arinrad
- Department of Neurosurgery, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany;
| | - Roland Coras
- Department of Neuropathology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany;
| | - Hannes Luecking
- Department of Neuroradiology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany; (M.A.S.); (H.L.); (S.L.); (A.D.)
| | - Stefan Lang
- Department of Neuroradiology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany; (M.A.S.); (H.L.); (S.L.); (A.D.)
| | - Rainer Fietkau
- Department of Radiation Oncology, University of Erlangen-Nuremberg, Universitaetsstrasse 27, 91054 Erlangen, Germany; (F.P.); (S.L.); (R.F.)
| | - Arnd Doerfler
- Department of Neuroradiology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany; (M.A.S.); (H.L.); (S.L.); (A.D.)
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14
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Alkanhal H, Das K, Rathi N, Syed K, Poptani H. Differentiating Nonenhancing Grade II Gliomas from Grade III Gliomas Using Diffusion Tensor Imaging and Dynamic Susceptibility Contrast MRI. World Neurosurg 2020; 146:e555-e564. [PMID: 33152494 DOI: 10.1016/j.wneu.2020.10.144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/25/2020] [Accepted: 10/26/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Contrast enhancement in a brain tumor on magnetic resonance imaging is typically indicative of a high-grade glioma. However, a significant proportion of nonenhancing gliomas can be either grade II or III. While gross total resection remains the primary goal, imaging biomarkers may guide management when surgery is not possible, especially for nonenhancing gliomas. The utility of diffusion tensor imaging and dynamic susceptibility contrast magnetic resonance imaging was evaluated in differentiating nonenhancing gliomas. METHODS Retrospective analysis was performed on imaging data from 72 nonenhancing gliomas, including grade II (n = 49) and III (n = 23) gliomas. Diffusion tensor imaging and dynamic susceptibility contrast data were used to generate fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity as well as cerebral blood volume, cerebral blood flow, and mean transit time maps. Univariate and multivariate logistic regression and area under the curve analyses were used to measure sensitivity and specificity of imaging parameters. A subanalysis was performed to evaluate the utility of imaging parameters in differentiating between different histologic groups. RESULTS Logistic regression analysis indicated that tumor volume and relative mean transit time could differentiate between grade II and III nonenhancing gliomas. At a cutoff value of 0.33, this combination provided an area under the curve of 0.71, 70.6% sensitivity, and 64.3% specificity. Logistic regression analyses demonstrated much higher sensitivity and specificity in the differentiation of astrocytomas from oligodendrogliomas or identification of grades within these histologic subtypes. CONCLUSIONS Diffusion tensor imaging and dynamic susceptibility contrast imaging can aid in differentiation of nonenhancing grade II and III gliomas and between histologic subtypes.
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Affiliation(s)
- Hatham Alkanhal
- Centre for Preclinical Imaging, University of Liverpool, Liverpool, United Kingdom
| | - Kumar Das
- Department of Neuroradiology, Walton Centre NHS Trust, Liverpool, United Kingdom
| | - Nitika Rathi
- Department of Pathology, Walton Centre NHS Trust, Liverpool, United Kingdom
| | - Khaja Syed
- Department of Pathology, Walton Centre NHS Trust, Liverpool, United Kingdom
| | - Harish Poptani
- Centre for Preclinical Imaging, University of Liverpool, Liverpool, United Kingdom.
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15
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Pons-Escoda A, Garcia-Ruiz A, Naval-Baudin P, Cos M, Vidal N, Plans G, Bruna J, Perez-Lopez R, Majos C. Presurgical Identification of Primary Central Nervous System Lymphoma with Normalized Time-Intensity Curve: A Pilot Study of a New Method to Analyze DSC-PWI. AJNR Am J Neuroradiol 2020; 41:1816-1824. [PMID: 32943424 DOI: 10.3174/ajnr.a6761] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/03/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE DSC-PWI has demonstrated promising results in the presurgical diagnosis of brain tumors. While most studies analyze specific parameters derived from time-intensity curves, very few have directly analyzed the whole curves. The aims of this study were the following: 1) to design a new method of postprocessing time-intensity curves, which renders normalized curves, and 2) to test its feasibility and performance on the diagnosis of primary central nervous system lymphoma. MATERIALS AND METHODS Diagnostic MR imaging of patients with histologically confirmed primary central nervous system lymphoma were retrospectively reviewed. Correlative cases of glioblastoma, anaplastic astrocytoma, metastasis, and meningioma, matched by date and number, were retrieved for comparison. Time-intensity curves of enhancing tumor and normal-appearing white matter were obtained for each case. Enhancing tumor curves were normalized relative to normal-appearing white matter. We performed pair-wise comparisons for primary central nervous system lymphoma against the other tumor type. The best discriminatory time points of the curves were obtained through a stepwise selection. Logistic binary regression was applied to obtain prediction models. The generated algorithms were applied in a test subset. RESULTS A total of 233 patients were included in the study: 47 primary central nervous system lymphomas, 48 glioblastomas, 39 anaplastic astrocytomas, 49 metastases, and 50 meningiomas. The classifiers satisfactorily performed all bilateral comparisons in the test subset (primary central nervous system lymphoma versus glioblastoma, area under the curve = 0.96 and accuracy = 93%; versus anaplastic astrocytoma, 0.83 and 71%; versus metastases, 0.95 and 93%; versus meningioma, 0.93 and 96%). CONCLUSIONS The proposed method for DSC-PWI time-intensity curve normalization renders comparable curves beyond technical and patient variability. Normalized time-intensity curves performed satisfactorily for the presurgical identification of primary central nervous system lymphoma.
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Affiliation(s)
- A Pons-Escoda
- Radiology Department (A.P.-E., P.N.-B., M.C., C.M.), Institut de Diagnòstic per la Imatge, Hospital Universitari de Bellvitge. L'Hospitalet de Llobregat, Barcelona, Spain .,Neurooncology Unit (A.P.-E., N.V., G.P., J.B., C.M.), Insitut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - A Garcia-Ruiz
- Radiomics Group (A.G.-R., R.P.-L.), Vall d'Hebron Institut d'Oncologia, Barcelona, Spain
| | - P Naval-Baudin
- Radiology Department (A.P.-E., P.N.-B., M.C., C.M.), Institut de Diagnòstic per la Imatge, Hospital Universitari de Bellvitge. L'Hospitalet de Llobregat, Barcelona, Spain
| | - M Cos
- Radiology Department (A.P.-E., P.N.-B., M.C., C.M.), Institut de Diagnòstic per la Imatge, Hospital Universitari de Bellvitge. L'Hospitalet de Llobregat, Barcelona, Spain
| | - N Vidal
- Pathology Department (N.V.), Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.,Neurooncology Unit (A.P.-E., N.V., G.P., J.B., C.M.), Insitut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - G Plans
- Neurosurgery Department (G.P.), Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.,Neurooncology Unit (A.P.-E., N.V., G.P., J.B., C.M.), Insitut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - J Bruna
- Neurology Department (J.B.), Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.,Neurooncology Unit (A.P.-E., N.V., G.P., J.B., C.M.), Insitut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - R Perez-Lopez
- Radiomics Group (A.G.-R., R.P.-L.), Vall d'Hebron Institut d'Oncologia, Barcelona, Spain
| | - C Majos
- Radiology Department (A.P.-E., P.N.-B., M.C., C.M.), Institut de Diagnòstic per la Imatge, Hospital Universitari de Bellvitge. L'Hospitalet de Llobregat, Barcelona, Spain.,Neurooncology Unit (A.P.-E., N.V., G.P., J.B., C.M.), Insitut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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16
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Diffusion- and Perfusion-Weighted Magnetic Resonance Imaging Methods in Nonenhancing Gliomas. World Neurosurg 2020; 141:123-130. [DOI: 10.1016/j.wneu.2020.05.278] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/29/2020] [Accepted: 05/30/2020] [Indexed: 12/21/2022]
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17
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Park JE, Kim HS. [Current Applications and Future Perspectives of Brain Tumor Imaging]. TAEHAN YONGSANG UIHAKHOE CHI 2020; 81:467-487. [PMID: 36238631 PMCID: PMC9431910 DOI: 10.3348/jksr.2020.81.3.467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/04/2020] [Accepted: 05/07/2020] [Indexed: 11/29/2022]
Abstract
뇌종양의 진단 및 치료 반응 평가의 기본이 되는 영상기법은 해부학적 영상이다. 현재 임상에서 사용 가능한 영상기법들 중 확산 강조 영상 및 관류 영상이 추가적인 정보를 제공하고 있다. 최근에는 종양의 유전체 변이와 이질성 평가가 중요해지면서 라디오믹스와 딥러닝을 이용한 영상분석기법의 임상 응용이 기대되고 있다. 본 종설에서는 뇌종양 영상 임상 적용에서 여전히 중요한 해부학적 영상을 중심으로 한 자기공명영상 촬영 권고안, 최신 영상기법 중 확산 강조 영상 및 관류 영상의 기본 원리, 병태생리학적 배경 및 임상응용, 마지막으로 최근 컴퓨터 기술의 발전으로 많이 연구되고 있는 라디오믹스와 딥러닝의 뇌종양에서의 향후 활용가치에 대해 기술하고자 한다.
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Gupta M, Gupta T, Purandare N, Rangarajan V, Puranik A, Moiyadi A, Shetty P, Epari S, Sahay A, Mahajan A, Janu A, Bagal B, Menon H, Kannan S, Krishnatry R, Sastri GJ, Jalali R. Utility of flouro-deoxy-glucose positron emission tomography/computed tomography in the diagnostic and staging evaluation of patients with primary CNS lymphoma. CNS Oncol 2019; 8:CNS46. [PMID: 31779471 PMCID: PMC6912853 DOI: 10.2217/cns-2019-0016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Aim: To prospectively assess the clinical utility of pretreatment flouro-deoxy-glucose positron emission tomography/computed tomography (18F-FDG-PET/CT) in patients with primary central nervous system (CNS) lymphoma (PCNSL). Materials & methods: Patients with suspected/proven PCNSL underwent baseline whole-body 18F-FDG-PET/CT. Maximum standardized uptake value and tumor/normal tissue ratios were compared between CNS lymphoma and other histological diagnoses. Results: The mean maximum standardized uptake value (27.5 vs 18.2; p = 0.001) and mean tumor/normal tissue ratio (2.34 vs 1.53; p < 0.001) of CNS lymphoma was significantly higher than other histologic diagnoses. Five of 50 (10%) patients with biopsy-proven CNS lymphomas had pathologically increased FDG-uptake at extraneuraxial sites uncovering systemic lymphoma. Conclusion: Pretreatment whole-body 18F-FDG-PET/CT provides valuable complementary information in the diagnostic and staging evaluation of patients with PCNSL to guide therapeutic decision-making.
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Affiliation(s)
- Meetakshi Gupta
- Department of Radiation Oncology, TMH/ACTREC, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai 400012, India
| | - Tejpal Gupta
- Department of Radiation Oncology, TMH/ACTREC, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai 400012, India
| | - Nilendu Purandare
- Department of Nuclear Medicine & Molecular Imaging, TMH/ACTREC, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai 400012, India
| | - Venkatesh Rangarajan
- Department of Nuclear Medicine & Molecular Imaging, TMH/ACTREC, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai 400012, India
| | - Ameya Puranik
- Department of Nuclear Medicine & Molecular Imaging, TMH/ACTREC, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai 400012, India
| | - Aliasgar Moiyadi
- Department of Neuro-surgery, TMH/ACTREC, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai 400012, India
| | - Prakash Shetty
- Department of Neuro-surgery, TMH/ACTREC, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai 400012, India
| | - Sridhar Epari
- Department of Pathology, TMH/ACTREC, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai 400012, India
| | - Ayushi Sahay
- Department of Pathology, TMH/ACTREC, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai 400012, India
| | - Abhishek Mahajan
- Department of Radio-diagnosis, TMH/ACTREC, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai 400012, India
| | - Amit Janu
- Department of Radio-diagnosis, TMH/ACTREC, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai 400012, India
| | - Bhausaheb Bagal
- Department of Medical Oncology, TMH/ACTREC, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai 400012, India
| | - Hari Menon
- Department of Medical Oncology, TMH/ACTREC, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai 400012, India
| | - Sadhana Kannan
- Department of Clinical Research Secretariat, TMH/ACTREC, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai 400012, India
| | - Rahul Krishnatry
- Department of Radiation Oncology, TMH/ACTREC, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai 400012, India
| | - Goda Jayant Sastri
- Department of Radiation Oncology, TMH/ACTREC, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai 400012, India
| | - Rakesh Jalali
- Department of Radiation Oncology, TMH/ACTREC, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai 400012, India
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19
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Kang D, Park JE, Kim YH, Kim JH, Oh JY, Kim J, Kim Y, Kim ST, Kim HS. Diffusion radiomics as a diagnostic model for atypical manifestation of primary central nervous system lymphoma: development and multicenter external validation. Neuro Oncol 2019; 20:1251-1261. [PMID: 29438500 DOI: 10.1093/neuonc/noy021] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Radiomics is a rapidly growing field in neuro-oncology, but studies have been limited to conventional MRI, and external validation is critically lacking. We evaluated technical feasibility, diagnostic performance, and generalizability of a diffusion radiomics model for identifying atypical primary central nervous system lymphoma (PCNSL) mimicking glioblastoma. Methods A total of 1618 radiomics features were extracted from diffusion and conventional MRI from 112 patients (training set, 70 glioblastomas and 42 PCNSLs). Feature selection and classification were optimized using a machine-learning algorithm. The diagnostic performance was tested in 42 patients of internal and external validation sets. The performance was compared with that of human readers (2 neuroimaging experts), cerebral blood volume (90% histogram cutoff, CBV90), and apparent diffusion coefficient (10% histogram, ADC10) using the area under the receiver operating characteristic curve (AUC). Results The diffusion radiomics was optimized with the combination of recursive feature elimination and a random forest classifier (AUC 0.983, stability 2.52%). In internal validation, the diffusion model (AUC 0.984) showed similar performance with conventional (AUC 0.968) or combined diffusion and conventional radiomics (AUC 0.984) and better than human readers (AUC 0.825-0.908), CBV90 (AUC 0.905), or ADC10 (AUC 0.787) in atypical PCNSL diagnosis. In external validation, the diffusion radiomics showed robustness (AUC 0.944) and performed better than conventional radiomics (AUC 0.819) and similar to combined radiomics (AUC 0.946) or human readers (AUC 0.896-0.930). Conclusion The diffusion radiomics model had good generalizability and yielded a better diagnostic performance than conventional radiomics or single advanced MRI in identifying atypical PCNSL mimicking glioblastoma.
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Affiliation(s)
- Daesung Kang
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ji Eun Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Young-Hoon Kim
- Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jeong Hoon Kim
- Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Joo Young Oh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jungyoun Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Yikyung Kim
- Department of Radiology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Sung Tae Kim
- Department of Radiology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Ho Sung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Okuchi S, Rojas-Garcia A, Ulyte A, Lopez I, Ušinskienė J, Lewis M, Hassanein SM, Sanverdi E, Golay X, Thust S, Panovska-Griffiths J, Bisdas S. Diagnostic accuracy of dynamic contrast-enhanced perfusion MRI in stratifying gliomas: A systematic review and meta-analysis. Cancer Med 2019; 8:5564-5573. [PMID: 31389669 PMCID: PMC6745862 DOI: 10.1002/cam4.2369] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 05/19/2019] [Accepted: 06/10/2019] [Indexed: 02/06/2023] Open
Abstract
Background T1‐weighted dynamic contrast‐enhanced (DCE) perfusion magnetic resonance imaging (MRI) has been broadly utilized in the evaluation of brain tumors. We aimed at assessing the diagnostic accuracy of DCE‐MRI in discriminating between low‐grade gliomas (LGGs) and high‐grade gliomas (HGGs), between tumor recurrence and treatment‐related changes, and between primary central nervous system lymphomas (PCNSLs) and HGGs. Methods We performed this study based on the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis of Diagnostic Test Accuracy Studies criteria. We systematically surveyed studies evaluating the diagnostic accuracy of DCE‐MRI for the aforementioned entities. Meta‐analysis was conducted with the use of a random effects model. Results Twenty‐seven studies were included after screening of 2945 possible entries. We categorized the eligible studies into three groups: those utilizing DCE‐MRI to differentiate between HGGs and LGGs (14 studies, 546 patients), between recurrence and treatment‐related changes (9 studies, 298 patients) and between PCNSLs and HGGs (5 studies, 224 patients). The pooled sensitivity, specificity, and area under the curve for differentiating HGGs from LGGs were 0.93, 0.90, and 0.96, for differentiating tumor relapse from treatment‐related changes were 0.88, 0.86, and 0.89, and for differentiating PCNSLs from HGGs were 0.78, 0.81, and 0.86, respectively. Conclusions Dynamic contrast‐enhanced‐Magnetic resonance imaging is a promising noninvasive imaging method that has moderate or high accuracy in stratifying gliomas. DCE‐MRI shows high diagnostic accuracy in discriminating between HGGs and their low‐grade counterparts, and moderate diagnostic accuracy in discriminating recurrent lesions and treatment‐related changes as well as PCNSLs and HGGs.
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Affiliation(s)
- Sachi Okuchi
- Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, UK
| | | | - Agne Ulyte
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Ingeborg Lopez
- Neuroradiology, Institute of Neurosurgery Dr. A. Asenjo, Santiago, Chile
| | - Jurgita Ušinskienė
- Diagnostic and Interventional Radiology Department, Faculty of Medicine, National Cancer Institute, Vilnius University, Vilnius, Lithuania
| | - Martin Lewis
- Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, UK
| | - Sara M Hassanein
- Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, UK.,Diagnostic Radiology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Eser Sanverdi
- Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, UK
| | - Xavier Golay
- Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, UK
| | - Stefanie Thust
- Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, UK.,Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
| | | | - Sotirios Bisdas
- Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, UK.,Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
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21
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Yamanaka T, Kanai H, Aihara N, Ohno T, Mase M. A Case of Sarcoidosis-lymphoma Syndrome: Importance of Brain Biopsy. NMC Case Rep J 2019; 6:61-64. [PMID: 31016103 PMCID: PMC6476816 DOI: 10.2176/nmccrj.cr.2018-0223] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 12/10/2018] [Indexed: 11/21/2022] Open
Abstract
Sarcoidosis is occasionally associated with malignant lymphoma. Cases of sarcoidosis associated with malignant lymphoma are called sarcoidosis-lymphoma syndrome. We report a 63-year-old man with sarcoidosis associated with primary central nervous system lymphoma (PCNSL). Definitive diagnosis by clinical and radiological findings was difficult. Finally, brain biopsy could produce the correct diagnosis. We could provide appropriate treatment for PCNSL and the patient has survived over 2 years. Thus, it is very important to make an early definitive diagnosis by biopsy for intracranial lesion, because it can prolong survival in patients with sarcoidosis.
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Affiliation(s)
- Tomoyasu Yamanaka
- Department of Neurosurgery, Nagoya City University, Nagoya, Aichi, Japan.,Department of Neurosurgery, Nagoya City East Medical Center, Nagoya, Aichi, Japan
| | - Hideki Kanai
- Department of Neurosurgery, Nagoya City East Medical Center, Nagoya, Aichi, Japan
| | - Noritaka Aihara
- Department of Neurosurgery, Nagoya City University, Nagoya, Aichi, Japan
| | - Takayuki Ohno
- Department of Neurosurgery, Nagoya City East Medical Center, Nagoya, Aichi, Japan
| | - Mitsuhito Mase
- Department of Neurosurgery, Nagoya City University, Nagoya, Aichi, Japan
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Permeability measurement using dynamic susceptibility contrast magnetic resonance imaging enhances differential diagnosis of primary central nervous system lymphoma from glioblastoma. Eur Radiol 2019; 29:5539-5548. [DOI: 10.1007/s00330-019-06097-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 01/10/2019] [Accepted: 02/11/2019] [Indexed: 11/25/2022]
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Diagnostic performance of DWI for differentiating primary central nervous system lymphoma from glioblastoma: a systematic review and meta-analysis. Neurol Sci 2019; 40:947-956. [PMID: 30706241 DOI: 10.1007/s10072-019-03732-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 01/18/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The purpose of this meta-analysis was to evaluate the diagnostic performance of diffusion-weighted imaging (DWI) for differentiating primary central nervous system lymphoma (PCNSL) from glioblastoma (GBM). MATERIALS AND METHODS A thorough search of the databases including PubMed, EMBASE, and Cochrane Library was carried out and the data acquired were up to November 1, 2017. The quality of the studies involved was evaluated using QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies, revised version). Multiple analytic values including sensitivity (SEN), specificity (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and the summary receiver operating characteristic (SROC) curve were calculated and pooled for the statistical analysis. The subgroup analysis was also performed to explore the heterogeneity. RESULTS Eight retrospective studies (461 patients with 461 lesions) were included. The pooled SEN, SPE, PLR, NLR, and DOR with 95% confidence interval (CI) were 0.82 [95% CI 0.70-0.90], 0.84 [95% CI 0.75-0.90], 4.96 [95% CI 3.20-7.69], 0.22 [95% CI 0.13-0.37], and 22.85 [95% CI 10.42-50.11], respectively. The area under the curve (AUC) given by SROC curve was 0.90 [95% CI 0.87-0.92]. The subgroup analysis indicated the slice thickness of the images (> 3 mm versus ≤ 3 mm) was a significant factor affecting the heterogeneity. No existence of significant publication bias was confirmed with Deeks' test. CONCLUSIONS DWI showed moderate diagnostic performance for differentiating primary central nervous system lymphoma (PCNSL) from glioblastoma (GBM). Moreover, it is of clinical significance using DWI combined with conventional MRI to differentiate PCNSL from GBM.
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Suh CH, Kim HS, Jung SC, Park JE, Choi CG, Kim SJ. MRI as a diagnostic biomarker for differentiating primary central nervous system lymphoma from glioblastoma: A systematic review and meta-analysis. J Magn Reson Imaging 2019; 50:560-572. [PMID: 30637843 DOI: 10.1002/jmri.26602] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 11/28/2018] [Accepted: 11/28/2018] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Accurate preoperative differentiation of primary central nervous system lymphoma (PCNSL) and glioblastoma is clinically crucial because the treatment strategies differ substantially. PURPOSE To evaluate the diagnostic performance of MRI for differentiating PCNSL from glioblastoma. STUDY TYPE Systematic review and meta-analysis. SUBJECTS Ovid-MEDLINE and EMBASE databases were searched to find relevant original articles up to November 25, 2018. The search term combined synonyms for "lymphoma," "glioblastoma," and "MRI." FIELD STRENGTH/SEQUENCE Patients underwent at least one MRI sequence including diffusion-weighted imaging (DWI), dynamic susceptibility-weighted contrast-enhanced imaging (DSC), dynamic contrast-enhanced imaging (DCE), arterial spin labeling (ASL), susceptibility-weighted imaging (SWI), intravoxel incoherent motion (IVIM), and magnetic resonance spectroscopy (MRS) using 1.5 or 3 T. ASSESSMENT Quality assessment was performed according to the Quality Assessment of Diagnostic Accuracy Studies-2 tool. STATISTICAL TESTS Hierarchical logistic regression modeling was used to obtain pooled sensitivity and specificity. Meta-regression was performed. RESULTS Twenty-two studies with 1182 patients were included. MRI sequences demonstrated high overall diagnostic performance with pooled sensitivity of 91% (95% confidence interval [CI], 87-93%) and specificity of 89% (95% CI, 85-93%). The area under the hierarchical summary receiver operating characteristic curve was 0.92 (95% CI, 0.90-0.94). Studies using DSC or ASL showed high diagnostic performance (sensitivity of 93% [95% CI, 89-97%] and specificity of 91% [95% CI, 86-96%]). Heterogeneity was only detected in specificity (I2 = 66.84%) and magnetic field strength was revealed to be a significant factor affecting study heterogeneity. DATA CONCLUSION MRI showed overall high diagnostic performance for differentiating PCNSL from glioblastoma, with studies using DSC or ASL showing high diagnostic performance. Therefore, MRI sequences including DSC or ASL is a potential diagnostic tool for differentiating PCNSL from glioblastoma. LEVEL OF EVIDENCE 3 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2019;50:560-572.
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Affiliation(s)
- Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Ho Sung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Seung Chai Jung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Ji Eun Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Choong Gon Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Sang Joon Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Abdel Razek AAK, El-Serougy L, Abdelsalam M, Gaballa G, Talaat M. Differentiation of Primary Central Nervous System Lymphoma From Glioblastoma: Quantitative Analysis Using Arterial Spin Labeling and Diffusion Tensor Imaging. World Neurosurg 2018; 123:e303-e309. [PMID: 30502475 DOI: 10.1016/j.wneu.2018.11.155] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/16/2018] [Accepted: 11/18/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Differentiation of primary central nervous system lymphoma (PCNSL) from glioblastoma using arterial spin labeling perfusion and diffusion tensor imaging (DTI). METHODS We performed a prospective study of 31 patients with a provisional diagnosis of PCNSL and glioblastoma who underwent conventional magnetic resonance imaging, DTI, and arterial spin labeling of the brain. The tumor blood flow (TBF), mean diffusivity (MD) plus fractional anisotropy (FA) of the mass were measured. The final diagnosis was confirmed by pathological examination. RESULTS The TBF of PCNSL (26.41 ± 4.03 mL/100 g/minute) was significantly lower than that of glioblastoma (51.08 ± 3.9 mL/100 g/minute; P = 0.001). The TBF cutoff (35.73 mL/100 g/minute) used for differentiation showed area under the curve (AUC) of 0.93, accuracy of 95.2%, sensitivity of 91.7%, and specificity of 100%. The MD of PCNSL (0.87 ± 0.2X 10-3 mm2/second) was significantly lower than that of glioblastoma (0.87 ± 0.2 × 10-3 mm2/second; P = 0.01). The MD cutoff (0.935 × 10-3 mm2/second) used for differentiation showed an AUC of 0.73 and accuracy of 66.7% and a sensitivity of 75% and specificity of 55.6%. The FA of PCNSL (0.253 ± 0.05) was significantly greater than that of glioblastoma (0.135 ± 0.06; P = 0.001). The FA cutoff (0.185) used for differentiation revealed an AUC of 0.944 and accuracy of 85.7% and a sensitivity of 83.3% and specificity of 88.9%. The combined TBF, MD, and FA cutoffs revealed an AUC of 0.96 and accuracy of 95.5% and a sensitivity of 83.3% and specificity of 100%. CONCLUSION The noninvasive imaging parameters using TBF and DTI might help in differentiating PCNSL from glioblastoma.
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Affiliation(s)
| | - Lamiaa El-Serougy
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura, Egypt
| | | | - Gada Gaballa
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Mona Talaat
- Department of Diagnostic Radiology, Kafr Elsheak Faculty of Medicine, Kafr Elsheak, Egypt
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Specific Features of Primary Central Nervous System Lymphoma in Comparison with Glioblastoma on Conventional MRI. IRANIAN JOURNAL OF RADIOLOGY 2018. [DOI: 10.5812/iranjradiol78868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Clinical utility of arterial spin labeling for preoperative grading of glioma. Biosci Rep 2018; 38:BSR20180507. [PMID: 29769414 PMCID: PMC6117615 DOI: 10.1042/bsr20180507] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/09/2018] [Accepted: 05/15/2018] [Indexed: 12/30/2022] Open
Abstract
There were obvious differences in biological behavior and prognosis between low- and high-grade gliomas, it is of great importance for clinicians to make a right judgement for preoperative grading. We conducted a comprehensive meta-analysis to evaluate the clinical utility of arterial spin labeling for preoperative grading. We searched the PubMed, Embase, China National Knowledge Infrastructure, and Weipu electronic databases for articles published through 10 November 2017 and used ‘arterial spin-labeling’ or ‘ASL perfusion, grading’ or ‘differentiation, glioma’ or ‘glial tumor, diagnostic test’ as the search terms. A manual search of relevant original and review articles was performed to identify additional studies. The meta-analysis included nine studies. No obvious heterogeneity was found in the data in a fixed-effect model. The pooled sensitivity and specificity were 90% (95% confidence interval (CI): 0.84–0.94) and 91% (95% CI: 0.83–0.96), respectively, and the pooled positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 10.40 (95% CI: 2.21–20.77) and 0.11 (95% CI: 0.07–0.18). The diagnostic odds ratio (DOR) was 92.47 (95% CI: 39.61–215.92). The diagnostic score was 4.53 (95% CI: 3.68–5.38). The area under the curve (AUC) was 0.94 (95% CI: 0.91–0.96). Subgroup analyses did not change the pooled results. No publication bias was found (P=0.102). The normalized maximal tumor blood flow/normal white matter ratio obtained with the arterial spin labeling technique was relatively accurate for distinguishing high/low-grade glioma. As a non-invasive procedure with favorable repeatability, this index may be useful for clinical diagnostics.
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Lee B, Park JE, Bjørnerud A, Kim JH, Lee JY, Kim HS. Clinical Value of Vascular Permeability Estimates Using Dynamic Susceptibility Contrast MRI: Improved Diagnostic Performance in Distinguishing Hypervascular Primary CNS Lymphoma from Glioblastoma. AJNR Am J Neuroradiol 2018; 39:1415-1422. [PMID: 30026384 DOI: 10.3174/ajnr.a5732] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 05/01/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE A small subset of primary central nervous system lymphomas exhibits high cerebral blood volume, which is indistinguishable from that in glioblastoma on dynamic susceptibility contrast MR imaging. Our study aimed to test whether estimates of combined perfusion and vascular permeability metrics derived from DSC-MR imaging can improve the diagnostic performance in differentiating hypervascular primary central nervous system lymphoma from glioblastoma. MATERIALS AND METHODS A total of 119 patients (with 30 primary central nervous system lymphomas and 89 glioblastomas) exhibited hypervascular foci using the reference method of leakage-corrected CBV (reference-normalized CBV). An alternative postprocessing method used the tissue residue function to calculate vascular permeability (extraction fraction), leakage-corrected CBV, cerebral blood flow, and mean transit time. Parameters were compared using Mann-Whitney U tests, and the diagnostic performance to distinguish primary central nervous system lymphoma from glioblastoma was calculated using the area under the curve from the receiver operating characteristic curve and was cross-validated with bootstrapping. RESULTS Hypervascular primary central nervous system lymphoma showed similar leakage-corrected normalized CBV and leakage-corrected CBV compared with glioblastoma (P > .05); however, primary central nervous system lymphoma exhibited a significantly higher extraction fraction (P < .001) and CBF (P = .01) and shorter MTT (P < .001) than glioblastoma. The extraction fraction showed the highest diagnostic performance (the area under the receiver operating characteristic curve [AUC], 0.78; 95% confidence interval, 0.69-0.85) for distinguishing hypervascular primary central nervous system lymphoma from glioblastoma, with a significantly higher performance than both CBV (AUC, 0.53-0.59, largest P = .02) and CBF (AUC, 0.72) and MTT (AUC, 0.71). CONCLUSIONS Estimation of vascular permeability with DSC-MR imaging further characterizes hypervascular primary central nervous system lymphoma and improves diagnostic performance in glioblastoma differentiation.
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Affiliation(s)
- B Lee
- From the Department of Radiology (B.L.), Seoul Metropolitan Government-Seoul National University, Boramae Medical Center, Seoul, Korea
| | - J E Park
- Department of Radiology and Research Institute of Radiology (J.E.P., H.S.K.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - A Bjørnerud
- Department of Diagnostic Physics (A.B.), Rikshopitalet University Hospital, Oslo, Norway
| | - J H Kim
- NordicNeuroLab (J.H.K.), Seoul, Korea
| | - J Y Lee
- Department of Radiology (J.Y.L.), Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - H S Kim
- Department of Radiology and Research Institute of Radiology (J.E.P., H.S.K.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Is deep brain involvement in intracranial primary central nervous system lymphoma of importance for penetration of chemotherapeutic agents? Neuroradiology 2018; 60:703-713. [DOI: 10.1007/s00234-018-2038-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 05/16/2018] [Indexed: 12/14/2022]
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Luna A, Martín Noguerol T, Mata LA. Bases de la imagen funcional II: técnicas emergentes de resonancia magnética y nuevos métodos de análisis. RADIOLOGIA 2018. [DOI: 10.1016/j.rx.2018.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Wu Y, Den Z, Lin Y. Accuracy of Susceptibility-Weighted Imaging and Dynamic Susceptibility Contrast Magnetic Resonance Imaging for Differentiating High-Grade Glioma from Primary Central Nervous System Lymphomas: Meta-Analysis. World Neurosurg 2018; 112:e617-e623. [PMID: 29371168 DOI: 10.1016/j.wneu.2018.01.098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 01/14/2018] [Accepted: 01/15/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE It is always a great challenge to distinguish high-grade glioma (HGG) from primary central nervous system lymphoma (PCNSL). We conducted a meta-analysis to assess the performance of dynamic susceptibility contrast (DSC) and susceptibility-weighted imaging (SWI) in differentiating HGGs from PCNSLs. METHODS Heterogeneity and threshold effect were evaluated, and sensitivity, specificity (SPE), and areas under the summary receiver operating characteristic curve (SROC) were calculated. RESULTS Thirteen studies with a total of 704 participants were included in this meta-analysis. For the dynamic susceptibility contrast (DSC) technique, the pooled sensitivity and SPE were 0.94 and 0.84, respectively. The area under the curve (AUC) under the SROC was 0.9595, and the diagnostic odds ratio was 81.880. For the susceptibility weighted imaging (SWI) technique, the pooled sensitivity and SPE were 0.92 and 0.87, respectively. The AUC under the SROC was 0.9608, and the diagnostic odds ratio was 89.774. A Z test showed that no significant difference in AUC values between DSC and SWI (P = 0.97) was observed. In addition, no obvious public bias was observed in both the DSC (P = 0.69) and SWI (P = 0.32) groups. CONCLUSIONS This meta-analysis indicated that both DSC-MRI and SWI have a high and similar level of diagnostic accuracy for differentiating HGGs from PCNSLs.
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Affiliation(s)
- Yangzong Wu
- Department of Neurosurgery, Longyan Second Hospital of Fujian Province, Longyan, China
| | - Zhihong Den
- Department of Neurosurgery, Longyan Second Hospital of Fujian Province, Longyan, China
| | - Yuanxiang Lin
- Department of Neurosurgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
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