Department of Radiology, Eulji Medical Center, Seoul, 01830, Republic of Korea.
Department of Diagnostic Physics, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.
Eur Radiol. 2019 Oct;29(10):5539-5548. doi: 10.1007/s00330-019-06097-9. Epub 2019 Mar 15.
To test if adding permeability measurement to perfusion obtained from dynamic susceptibility contrast MRI (DSC-MRI) improves diagnostic performance in the differentiation of primary central nervous system lymphoma (PCNSL) from glioblastoma.
DSC-MRI was acquired in 145 patients with pathologically proven glioblastoma (n = 89) or PCNSL (n = 56). The permeability metrics of contrast agent extraction fraction (E), apparent permeability (K), and leakage-corrected perfusion of normalized cerebral blood volume (nCBV) and cerebral blood flow (nCBF) were derived from a tissue residue function. For comparison purposes, the leakage-corrected normalized CBV (nCBV) and relative permeability constant (K) were also obtained using the established Weisskoff-Boxerman leakage correction method. The area under the receiver operating characteristics curve (AUC) and cross-validation were used to compare the diagnostic performance of the single DSC-MRI parameters with the performance obtained with the addition of permeability metrics.
PCNSL demonstrated significantly higher permeability (E, p < .001) and lower perfusion (nCBV, nCBF, and nCBV, all p < .001) than glioblastoma. The combination of E and nCBV showed the highest performance (AUC, 0.96; 95% confidence interval, 0.92-0.99) for differentiating PCNSL from glioblastoma, which was a significant improvement over the single perfusion (nCBV: AUC, 0.84; nCBV: AUC, 0.84; nCBF: AUC, 0.82; all p < .001) or E (AUC, 0.80; p < .001) parameters.
Analysis of the combined permeability and perfusion metrics obtained from a single DSC-MRI acquisition improves the diagnostic value for differentiating PCNSL from glioblastoma in comparison with single-parameter nCBV analysis.
• Permeability measurement can be calculated from DSC-MRI with a tissue residue function-based leakage correction. • Adding Eto CBV aids in the differentiation of PCNSL from glioblastoma. • CBV and Emeasurements from DSC-MRI were highly reproducible.
检验在动态磁敏感对比磁共振灌注成像（DSC-MRI）中增加通透性测量是否能提高原发性中枢神经系统淋巴瘤（PCNSL）与胶质母细胞瘤（GBM）鉴别诊断的性能。
共纳入 145 名经病理证实为 GBM（n=89）或 PCNSL（n=56）的患者，采集 DSC-MRI 数据。从组织残留函数中推导出对比剂提取分数（E）、表观通透性（K）和校正后标准化脑血容量（nCBV）和脑血流量（nCBF）的通透性参数。为了比较目的，还使用已建立的 Weisskoff-Boxerman 渗漏校正方法从校正后的标准化 CBV（nCBV）和相对通透性常数（K）中获得渗漏校正的参数。使用受试者工作特征曲线（ROC）下面积（AUC）和交叉验证来比较单 DSC-MRI 参数与添加通透性参数后的诊断性能。
PCNSL 的通透性（E，p<0.001）和灌注（nCBV、nCBF 和 nCBV，均 p<0.001）明显高于 GBM。E 和 nCBV 的组合在鉴别 PCNSL 与 GBM 方面表现出最高的性能（AUC，0.96；95%置信区间，0.92-0.99），这明显优于单一灌注（nCBV：AUC，0.84；nCBV：AUC，0.84；nCBF：AUC，0.82；均 p<0.001）或 E（AUC，0.80；p<0.001）参数。
与单参数 nCBV 分析相比，从单次 DSC-MRI 采集分析联合通透性和灌注参数可提高鉴别 PCNSL 与 GBM 的诊断价值。
可以使用基于组织残留函数的渗漏校正方法从 DSC-MRI 中计算通透性测量值。
将 E 加入 CBV 有助于鉴别 PCNSL 与 GBM。
DSC-MRI 的 CBV 和 E 测量值具有高度可重复性。
