Department of Radiology, Yantai Yuhuangding Hospital, Yantai, Shandong, PR China.
Department of Radiology, Gutian Hospital, Gutian, Fujian, PR China.
World Neurosurg. 2021 May;149:e696-e704. doi: 10.1016/j.wneu.2021.01.114. Epub 2021 Feb 3.
This study describes a distinct magnetic resonance imaging (MRI) feature, placing emphasis on fluid-attenuation inversion recovery (FLAIR) and contrast-enhanced T1-weighted (T1C) images for the preoperative differentiation of glioblastoma (GBM) from primary central nervous system lymphoma (PCNSL).
The preoperative MRI findings of 116 pathologically confirmed glioblastoma (n = 72) and PCNSL (n = 44) were retrospectively reviewed. Two neuroimaging specialists analyzed the MRIs, and image analysis was focused on the presence or absence of a shaping and nonenhancing peritumoral hyperintense gyral lesion on FLAIR imaging (SNEPGF, i.e., hyperintense lesion in a shaping and nonenhancing peritumoral gyral area on FLAIR imaging). The gyral area adjacent to and within 3 cm of the enhanced tumor was defined as the peritumoral gyrus region. The FLAIR hyperintensity lesion were termed as the signal intensity ratio ≥30% compared with contralateral normal gray matter. Then, the differential diagnostic efficacy of SNEFPG sign for GBM and PCNSL was analyzed.
The SNEPGF sign was found in 33 GBM cases (33 of 72, 45.8%), and the FLAIR signal intensity and apparent diffusion coefficient value of these area were lower than the peritumoral edema area (P < 0.0001). In 44 PCNSL cases, no SNEPGF sign was found. A slightly higher FLAIR signal intensity was seen in 9 PCNSLs, but uniform and marked enhancement was seen in these areas. The sensitivity, specificity, positive predictive value, and negative predictive value of the differential diagnosis of GBM and PCNSL with SNEPGF sign were 45.8%, 100%, 100%, and 53.0%, respectively.
The SNEPGF sign is effective in identifying GBM from PCNSL, especially with high specificity.
本研究描述了一种独特的磁共振成像（MRI）特征，重点关注液体衰减反转恢复（FLAIR）和对比增强 T1 加权（T1C）图像，用于术前鉴别胶质母细胞瘤（GBM）和原发性中枢神经系统淋巴瘤（PCNSL）。
回顾性分析了 116 例经病理证实的胶质母细胞瘤（n=72）和原发性中枢神经系统淋巴瘤（n=44）的术前 MRI 表现。两名神经影像学专家分析了 MRI，并重点分析 FLAIR 成像上是否存在形状不规则且无强化的瘤周高信号脑回病变（SNEPGF，即 FLAIR 成像上形状不规则且无强化的瘤周脑回区高信号病变）。与增强肿瘤相邻且在 3 厘米内的脑回区域定义为瘤周脑回区。FLAIR 高信号病变的信号强度与对侧正常灰质的比值≥30%。然后，分析 SNEFPG 征象对 GBM 和 PCNSL 的鉴别诊断效能。
33 例 GBM 病例（33/72，45.8%）存在 SNEPGF 征象，这些区域的 FLAIR 信号强度和表观扩散系数值均低于瘤周水肿区（P<0.0001）。44 例 PCNSL 病例中均未见 SNEPGF 征象。9 例 PCNSL 可见 FLAIR 信号稍高，但这些区域呈均匀明显强化。SNEPGF 征象对 GBM 和 PCNSL 的鉴别诊断的灵敏度、特异度、阳性预测值和阴性预测值分别为 45.8%、100%、100%和 53.0%。
SNEPGF 征象有助于识别 GBM 和 PCNSL，特异性高。
