The diagnostic value of dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) for distinguishing patients with glioblastoma from those with primary central nervous system lymphoma (PCNSL) was significantly enhanced by the addition of a permeability measurement to aid in the assessment of perfusion, according to researchers. These study findings were published online in European Radiology.

Previous studies have shown that neovascularization is more characteristic of glioblastoma than PCNSL. Currently, the use of DSC-MRI as a measure of cerebral blood flow/perfusion is the most established method for distinguishing between these 2 diagnoses. However, the evidence for the use of DSC-MRI to assess contrast agent extravasation (ie, leakage into the extravascular tissue) as a measure of microvascular permeability in this setting has been conflicting.

This retrospective study included 56 and 89 patients with pathologically confirmed diffuse large B-cell lymphoma and glioblastoma, respectively, who were included in the electronic databases of the Department of Radiology at participating institutions during the period between January 2013 and June 2017. All of these patients had previously undergone DSC-MRI of the brain. There were no differences between these 2 groups with respect to gender, age, or tumor volume.

Results from this study showed significantly higher permeability (ie, higher contrast-agent extraction fraction; P <.001) and lower perfusion (ie, leakage corrected normalized cerebral blood flow; P <.001) for PCNSL compared with glioblastoma. The combination of these 2 parameters showed significantly improved diagnostic value compared with either single perfusion (P <.001) or permeability (P <.001) alone. 

“The combined analysis of permeability metrics of contrast agent extraction fraction and perfusion of cerebral blood volume derived from a single DSC-MRI acquisition provided better diagnostic performance in the differentiation of PCNSL from glioblastoma than standard cerebral blood volume analysis,” the study authors noted. Furthermore, they wrote that “the combined analysis can be fully automated without the need for manual definition of an arterial input function or reference tissue and obtained with a single-dose of contrast agent usage, thereby making this approach feasible and attractive in a clinical setting.”

Reference

1. Lee JY, Bjørnerud A, Park JE, Lee BE, Kim JH, Kim HS. Permeability measurement using dynamic susceptibility contrast magnetic resonance imagingenhances differential diagnosis of primary central nervous system lymphoma from glioblastoma [published online March 15, 2019].Eur Radiol. doi: 10.1007/s00330-019-06097-9