Differentiation of Glioblastoma from Brain Metastasis: Qualitative and Quantitative Analysis using Pseudo-continuous Arterial Spin Labeling MR Imaging
Leonard Sunwoo1,2, Tae Jin Yun2,3, Roh-Eul Yoo2,3, Soo Chin Kim2,4, and Hye Young Sun2,4

1Radiology, Seoul National University Bundang Hospital, Seongnam, Korea, Republic of, 2Seoul National University College of Medicine, Seoul, Korea, Republic of, 3Radiology, Seoul National University Hospital, Seoul, Korea, Republic of, 4Radiology, Seoul National University Healthcare System Gangnam Center, Seoul, Korea, Republic of

Synopsis

Arterial spin labeling (ASL) magnetic resonance (MR) imaging could be used to assess the tumor blood flow (TBF). To distinguish glioblastoma (GBM) from brain metastasis, we compared TBF between the two groups by using visual grading and quantitative analyses. Both intratumoral and peritumoral blood flow were significantly higher in GBM than in brain metastasis. We propose that ASL-TBF can aid in differentiating GBM from brain metastasis either by qualitative or by quantitative methods.

Purpose

The aim of this study is to compare ASL-TBF in GBM with that in brain metastasis by using qualitative and quantitative analysis.

Methods

The study was approved by the institutional review board. The study population consisted of 128 consecutive patients who underwent surgical resection and were diagnosed either as GBM (n = 89) or as brain metastasis (n = 39). All participants underwent preoperative MR imaging including ASL.

Two reviewers blinded to patient history and pathologic data reviewed randomly-ordered MR image sets. For qualitative analysis, reviewers graded the lesions based on the degree of hyperintensity of ASL images using the following criteria: 1) no hyperintensity; 2) minimal hyperintensity; 3) mild hyperintensity; 4) moderate hyperintensity; and 5) strong hyperintensity.

For quantitative analysis, reviewers drew regions of interest (ROIs) on ASL images upon the most hyperintense portion within the tumor (intratumoral ROI) and upon the peritumoral T2 hyperintensity area (peritumoral ROI). Signal intensities of intratumoral and peritumoral ROIs for each subject were normalized by dividing the values by those of contralateral normal gray matter (nTBFmax and nTBFperi, respectively).1,2 We compared visual grading scales and quantitative parameters between GBM and brain metastasis.

Results

The overall agreements between the two reviewers were excellent. In terms of qualitative analysis, GBM group showed significantly higher grade compared to metastasis group (P = .001). With regard to quantitative analysis, both nTBFmax and nTBFperi were significantly higher in GBM than in metastasis (P < .001). The areas under the curve from receiver operating characteristics analysis were 0.677, 0.714, and 0.835 for visual grading, nTBFmax, and nTBFperi, respectively (all P < .001). Representative images are shown in Fig. 1.

Conclusion

Intratumoral or peritumoral blood flow on ASL can aid in differentiating GBM from brain metastasis.

Acknowledgements

No acknowledgement found.

References

1. Noguchi T, Yoshiura T, Hiwatashi A, et al. Perfusion imaging of brain tumors using arterial spin-labeling: correlation with histopathologic vascular density. AJNR Am J Neuroradiol. 2008;29(4):688-693.

2. Jarnum H, Steffensen EG, Knutsson L, et al. Perfusion MRI of brain tumours: a comparative study of pseudo-continuous arterial spin labelling and dynamic susceptibility contrast imaging. Neuroradiology. 2010;52(4):307-317.

Figures

(A-D) A 66-year-old male patient with glioblastoma. Arterial spin labeling (ASL) images reveal strong hyperintensity along the rim-enhancing tumor margin at the left frontal lobe (visual grading:5). (E-H) A 59-year-old male patient with metastatic lung cancer. No significant ASL hyperintensity is noted within the left temporal mass (visual grading:1).



Proc. Intl. Soc. Mag. Reson. Med. 24 (2016)
4355