J Korean Soc Magn Reson Med.  2012 Dec;16(3):226-235. 10.13104/jksmrm.2012.16.3.226.

Differentitation between Primary Central Nervous System Lymphoma and Glioblastoma: Added Value of Quantitative Analysis of CT Attenuation and Apparent Diffusion Coefficient

• Lee SC
• Moon WJ
• Choi JW
• Roh HG
• Bak SH
• Yi JG
• Yim YJ
• Chung EC

• KMID: 2099858
• DOI: http://doi.org/10.13104/jksmrm.2012.16.3.226

Abstract

PURPOSE
Purpose of this study was to determine if quantitative measures of CT attenuation and ADC values in combination with conventional imaging features can differentiate primary central nervous system lymphoma (PCNSL) and glioblastoma (GBM).
MATERIALS AND METHODS
Twenty-six patients with histologically-proven GBM (14 men and 12 women; median age, 50 years; age range, 22 - 73 years) and 14 patients with PCNSL (11 men and 3 women; median age, 61 years; age range, 41 - 74 years) were enrolled. Maximum CT attenuation, minimum ADC, and lesion to normal parenchyma minimum ADC ratios were measured in solid tumor regions. Conventional imaging features were evaluated for the following: ill-defined margin, homogeneous enhancement pattern, degree of necrosis, extent of tumor involvement and multiplicity. The Mann-Whitney test was used to compare maximum CT attenuation and minimum ADC values for PCNSL and GBM. Fisher's exact test was used to evaluate relationships between pathologic diagnoses and imaging features.
RESULTS
The CT attenuations were similar for PCNSL and GBM (37.84 +/- 6.90 HU versus 37.00 +/- 5.54 HU, p = 0.68), but minimum ADC and minimum ADC ratio were significant lower in PCNSL than in GBM (595.01 +/- 228.28 10(-6) mm2/s versus 736.52 +/- 162.05 10(-6) mm2/s; p = 0.028, 0.87 +/- 0.26 versus 1.14 +/- 0.29; p = 0.007). PCNSL showed greater homogeneous enhancement and smaller necrotic areas than GBM (p = 0.003 and p < 0.001, respectively) and was more likely to have multiple tumors than GBM (p = 0.039). When necrotic PCNSL (n = 4) and necrotic GBM (n = 24) were compared, minimum ADC and minimum ADC ratios were also significantly lower in PCNSL, but CT attenuation were not.
CONCLUSION
Although CT attenuation does not provide valuable information, minimum ADC and minimum ADC ratio and some imaging features can aid the differentiation of PCNSL and GBM.

Keyword

Central Nervous System; Lymphoma; Glioblastoma; Computed tomography (CT); Diffusion weighted imaging (DWI)

MeSH Terms

Central Nervous System
Diffusion
Glioblastoma
Humans
Lymphoma
Male
Necrosis

Figure

• 

  Fig. 1 Boxplot of the CT attenuations of PCNSL and GBM lesions in a subset of necrotic tumors. The line across the box represents the median value. PCNSL and GBM values were not significantly different (p = 0.126). The box ends represent the first and third quartiles, and the end points of each graph represent smallest and largest values.

• 

  Fig. 2 Boxplot of the minimum ADC ratios of PCNSL and GBM lesions in a subset of necrotic tumors (p = 0.004). The line across the box represents the median value. The box ends represent the first and third quartiles, and the end points of each graph represent smallest and largest values.

• 

  Fig. 3 Minimum ADC and minimum ADC ratios and the differentiation of PCNSL and GBM by receiver operating characteristic curve analysis (For minimum ADC ratios, AUC = 0.766 [95% confidence interval; 0.610-0.923] and p = 0.006, for minimum ADC, AUC = 0.681 [95% confidence interval; 0.491-0.872] and p = 0.061).

• 

  Fig. 4 MR and CT images of 49-year-old man with glioblastoma (GBM). a. Axial DWI image, b. ADC map, c. axial post-contrast T1WI image, d. axial non-contrast CT. The necrotic enhancing tumor (arrows) is iso-attenuated versus adjacent gray matter on the CT image (maximum CT density; 31.4 HU), hyperintense on the DWI image, and heterogeneously low on the ADC map (minimum ADC; 840×10-6 mm2/s).

• 

  Fig. 5 MR and CT images in 66-year-old man with PCNSL. a. Axial DWI image, b. ADC map, c. axial post-contrast T1WI image, d. axial non-contrast CT image. This well enhancing tumor with a small region of central necrosis (arrows) was hyper-attenuated versus contralateral gray matter on CT images (maximum CT density; 42.3 HU), hyperintense on DWI images, and definitely lower on the ADC map than contralateral normal brain parenchyma (minimum ADC; 377.2×10-6 mm2/s). A small enhancing mass is also shown (arrowhead).

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