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Current Medical Imaging


ISSN (Print): 1573-4056
ISSN (Online): 1875-6603

Research Article

The Potential Role of Peritumoral Apparent Diffusion Coefficient Evaluation in Differentiating Glioblastoma and Solitary Metastatic Lesions of the Brain

Author(s): Murat Tepe*, Suzan Saylisoy, Ugur Toprak and Ibrahim Inan

Volume 17, Issue 10, 2021

Published on: 16 March, 2021

Page: [1200 - 1208] Pages: 9

DOI: 10.2174/1573405617666210316120314


Objective: Differentiating glioblastoma (GBM) and solitary metastasis is not always possible using conventional magnetic resonance imaging (MRI) techniques. In conventional brain MRI, GBM and brain metastases are lesions with mostly similar imaging findings. In this study, we investigated whether apparent diffusion coefficient (ADC) ratios, ADC gradients, and minimum ADC values in the peritumoral edema tissue can be used to discriminate between these two tumors.

Methods: This retrospective study was approved by the local institutional review board with a waiver of written informed consent. Prior to surgical and medical treatment, conventional brain MRI and diffusion-weighted MRI (b = 0 and b = 1000) images were taken from 43 patients (12 GBM and 31 solitary metastasis cases). Quantitative ADC measurements were performed on the peritumoral tissue from the nearest segment to the tumor (ADC1), the middle segment (ADC2), and the most distant segment (ADC3). The ratios of these three values were determined proportionally to calculate the peritumoral ADC ratios. In addition, these three values were subtracted from each other to obtain the peritumoral ADC gradients. Lastly, the minimum peritumoral and tumoral ADC values, and the quantitative ADC values from the normal-appearing ipsilateral white matter, contralateral white matter, and ADC values from cerebrospinal fluid (CSF) were recorded.

Results: For the differentiation of GBM and solitary metastasis, ADC3 / ADC1 was the most powerful parameter with a sensitivity of 91.7% and specificity of 87.1% at the cut-off value of 1.105 (p < 0.001), followed by ADC3 / ADC2 with a cut-off value of 1.025 (p = 0.001), sensitivity of 91.7%, and specificity of 74.2%. The cut-off, sensitivity and specificity of ADC2 / ADC1 were 1.055 (p = 0.002), 83.3%, and 67.7%, respectively. For ADC3 – ADC1, the cut-off value, sensitivity, and specificity were calculated as 150 (p < 0.001), 91.7%, and 83.9%, respectively. ADC3 – ADC2 had a cutoff value of 55 (p = 0.001), sensitivity of 91.7%, and specificity of 77.4, whereas ADC2 – ADC1 had a cut-off value of 75 (p = 0.003), sensitivity of 91.7%, and specificity of 61.3%. Among the remaining parameters, only the ADC3 value successfully differentiated between GBM and metastasis (GBM 1802.50 ± 189.74 vs. metastasis 1634.52 ± 212.65, p = 0.022).

Conclusion: The integration of the evaluation of peritumoral ADC ratio and ADC gradient into conventional MR imaging may provide valuable information for differentiating GBM from solitary metastatic lesions.

Keywords: Glioblastoma, brain metastasis, apparent diffusion coefficient (ADC), peritumoral edema, GBM, diffusion MRI.

Graphical Abstract
Omuro A, DeAngelis LM. Glioblastoma and other malignant gliomas: a clinical review. JAMA 2013; 310(17): 1842-50.
[] [PMID: 24193082]
Tang YM, Ngai S, Stuckey S. The solitary enhancing cerebral lesion: can FLAIR aid the differentiation between glioma and metastasis? AJNR Am J Neuroradiol 2006; 27(3): 609-11.
[PMID: 16552003]
Lee EJ, Ahn KJ, Lee EK, Lee YS, Kim DB. Potential role of advanced MRI techniques for the peritumoural region in differentiating glioblastoma multiforme and solitary metastatic lesions. Clin Radiol 2013; 68(12): e689-97.
[] [PMID: 23969153]
Andersen C, Jensen FT. Differences in blood-tumour-barrier leakage of human intracranial tumours: quantitative monitoring of vasogenic oedema and its response to glucocorticoid treatment. Acta Neurochir (Wien) 1998; 140(9): 919-24.
[] [PMID: 9842429]
Pekmezci M, Perry A. Neuropathology of brain metastases. Surg Neurol Int 2013; 4(Suppl. 4): S245-55.
[] [PMID: 23717796]
Claes A, Idema AJ, Wesseling P. Diffuse glioma growth: a guerilla war. Acta Neuropathol 2007; 114(5): 443-58.
[] [PMID: 17805551]
Caravan I, Ciortea CA, Contis A, Lebovici A. Diagnostic value of apparent diffusion coefficient in differentiating between high- grade gliomas and brain metastases. Acta Radiol 2018; 59(5): 599-605.
[] [PMID: 28835111]
Lin L, Xue Y, Duan Q, et al. The role of cerebral blood flow gradient in peritumoral edema for differentiation of glioblastomas from solitary metastatic lesions. Oncotarget 2016; 7(42): 69051-9.
[] [PMID: 27655705]
Lu S, Gao Q, Yu J, et al. Utility of dynamic contrast-enhanced magnetic resonance imaging for differentiating glioblastoma, primary central nervous system lymphoma and brain metastatic tumor. Eur J Radiol 2016; 85(10): 1722-7.
[] [PMID: 27666608]
Papageorgiou TS, Chourmouzi D, Drevelengas A, Kouskouras K, Siountas A. Diffusion Tensor Imaging in brain tumors: A study on gliomas and metastases. Phys Med 2015; 31(7): 767-73.
[] [PMID: 25866320]
Sunwoo L, Yun TJ, You SH, et al. Differentiation of glioblastoma from brain metastasis: Qualitative and quantitative analysis using arterial spin labeling MR imaging. PLoS One 2016; 11(11): e0166662.
[] [PMID: 27861605]
Bulakbasi N, Kocaoglu M, Ors F, Tayfun C, Uçöz T. Combination of single-voxel proton MR spectroscopy and apparent diffusion coefficient calculation in the evaluation of common brain tumors. AJNR Am J Neuroradiol 2003; 24(2): 225-33.
[PMID: 12591638]
Lee EJ, terBrugge K, Mikulis D, et al. Diagnostic value of peritumoral minimum apparent diffusion coefficient for differentiation of glioblastoma multiforme from solitary metastatic lesions. AJR Am J Roentgenol 2011; 196(1): 71-6.
[] [PMID: 21178049]
Yamasaki F, Kurisu K, Satoh K, et al. Apparent diffusion coefficient of human brain tumors at MR imaging. Radiology 2005; 235(3): 985-91.
[] [PMID: 15833979]
Lemercier P, Paz Maya S, Patrie JT, Flors L, Leiva-Salinas C. Gradient of apparent diffusion coefficient values in peritumoral edema helps in differentiation of glioblastoma from solitary metastatic lesions. AJR Am J Roentgenol 2014; 203(1): 163-9.
[] [PMID: 24951211]
Schaefer PW, Grant PE, Gonzalez RG. Diffusion-weighted MR imaging of the brain. Radiology 2000; 217(2): 331-45.
[] [PMID: 11058626]
Chen XZ, Yin XM, Ai L, Chen Q, Li SW, Dai JP. Differentiation between brain glioblastoma multiforme and solitary metastasis: qualitative and quantitative analysis based on routine MR imaging. AJNR Am J Neuroradiol 2012; 33(10): 1907-12.
[] [PMID: 22743640]
Maurer MH, Synowitz M, Badakshi H, et al. Glioblastoma multiforme versus solitary supratentorial brain metastasis: differentiation based on morphology and magnetic resonance signal characteristics. RoFo Fortschr Geb Rontgenstr Nuklearmed 2013; 185(3): 235-40.
[PMID: 23196836]
Halshtok Neiman O, Sadetzki S, Chetrit A, Raskin S, Yaniv G, Hoffmann C. Perfusion-weighted imaging of peritumoral edema can aid in the differential diagnosis of glioblastoma mulltiforme versus brain metastasis. Isr Med Assoc J 2013; 15(2): 103-5.
[PMID: 23516772]
Min ZG, Niu C, Rana N, Ji HM, Zhang M. Differentiation of pure vasogenic edema and tumor-infiltrated edema in patients with peritumoral edema by analyzing the relationship of axial and radial diffusivities on 3.0T MRI. Clin Neurol Neurosurg 2013; 115(8): 1366-70.
[] [PMID: 23351840]
Server A, Orheim TE, Graff BA, Josefsen R, Kumar T, Nakstad PH. Diagnostic examination performance by using microvascular leakage, cerebral blood volume, and blood flow derived from 3-T dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging in the differentiation of glioblastoma multiforme and brain metastasis. Neuroradiology 2011; 53(5): 319-30.
[] [PMID: 20625709]
Tsougos I, Svolos P, Kousi E, et al. Differentiation of glioblastoma multiforme from metastatic brain tumor using proton magnetic resonance spectroscopy, diffusion and perfusion metrics at 3 T. Cancer Imaging 2012; 12: 423-36.
[] [PMID: 23108208]
Kıvrak AS, Paksoy Y, Erol C, Koplay M, Özbek S, Kara F. Comparison of apparent diffusion coefficient values among different MRI platforms: a multicenter phantom study. Diagn Interv Radiol 2013; 19(6): 433-7.
[] [PMID: 24004973]
Server A, Kulle B, Maehlen J, et al. Quantitative apparent diffusion coefficients in the characterization of brain tumors and associated peritumoral edema. Acta Radiol 2009; 50(6): 682-9.
[] [PMID: 19449234]
Cuddapah VA, Robel S, Watkins S, Sontheimer H. A neurocentric perspective on glioma invasion. Nat Rev Neurosci 2014; 15(7): 455-65.
[] [PMID: 24946761]
Pauleit D, Langen KJ, Floeth F, et al. Can the apparent diffusion coefficient be used as a noninvasive parameter to distinguish tumor tissue from peritumoral tissue in cerebral gliomas? J Magn Reson Imaging 2004; 20(5): 758-64.
[] [PMID: 15503327]
Blasel S, Jurcoane A, Franz K, Morawe G, Pellikan S, Hattingen E. Elevated peritumoural rCBV values as a mean to differentiate metastases from high-grade gliomas. Acta Neurochir (Wien) 2010; 152(11): 1893-9.
[] [PMID: 20799046]
Chiang IC, Kuo YT, Lu CY, et al. Distinction between high-grade gliomas and solitary metastases using peritumoral 3-T magnetic resonance spectroscopy, diffusion, and perfusion imagings. Neuroradiology 2004; 46(8): 619-27.
[] [PMID: 15243726]
Wang W, Steward CE, Desmond PM. Diffusion tensor imaging in glioblastoma multiforme and brain metastases: the role of p, q, L, and fractional anisotropy. AJNR Am J Neuroradiol 2009; 30(1): 203-8.
[] [PMID: 18842762]

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