Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, 110-744, Republic of Korea.
Eur Radiol. 2021 Dec;31(12):9098-9109. doi: 10.1007/s00330-021-08044-z. Epub 2021 May 18.
This study aimed to evaluate whether arterial input functions (AIFs) obtained from dynamic susceptibility contrast (DSC)-MRI (AIF) improve the reliability and diagnostic accuracy of dynamic contrast-enhanced (DCE)-derived pharmacokinetic (PK) parameters for differentiating glioblastoma from primary CNS lymphoma (PCNSL) compared with AIFs derived from DCE-MRI (AIF).
This retrospective study included 172 patients with glioblastoma (n = 147) and PCNSL (n = 25). All patients had undergone preoperative DSC- and DCE-MRI. The volume transfer constant (K), volume of the vascular plasma space (v), and volume of the extravascular extracellular space (v) were acquired using AIF and AIF. The relative cerebral blood volume (rCBV) was obtained from DSC-MRI. Intraclass correlation coefficients (ICC) and ROC curves were used to assess the reliability and diagnostic accuracy of individual parameters.
The mean K, v, and v values revealed better ICCs with AIF than with AIF (K, 0.911 vs 0.355; v, 0.766 vs 0.503; v, 0.758 vs 0.657, respectively). For differentiating all glioblastomas from PCNSL, the mean rCBV (AUC = 0.856) was more accurate than the AIF-driven mean K, which had the largest AUC (0.711) among the DCE-derived parameters (p = 0.02). However, for glioblastomas with low rCBV (≤ 75th percentile of PCNSL; n = 30), the AIF-driven mean K and v were more accurate than rCBV (AUC: K, 0.807 vs rCBV, 0.515, p = 0.004; v, 0.715 vs rCBV, p = 0.045).
DCE-derived PK parameters using the AIF showed improved reliability and diagnostic accuracy for differentiating glioblastoma with low rCBV from PCNSL.
• An accurate differential diagnosis of glioblastoma and PCNSL is crucial because of different therapeutic strategies. • In contrast to the rCBV from DSC-MRI, another perfusion imaging technique, the DCE parameters for the differential diagnosis have been limited because of the low reliability of AIFs from DCE-MRI. • When we analyzed DCE-MRI data using AIFs from DSC-MRI (AIF), AIF-driven DCE parameters showed improved reliability and better diagnostic accuracy than rCBV for differentiating glioblastoma with low rCBV from PCNSL.
本研究旨在评估与从动态对比增强（DCE）磁共振成像（MRI）获得的动脉输入函数（AIF）相比，从动态磁敏感对比（DSC）-MRI（AIF）获得的 AIF 是否能提高鉴别胶质母细胞瘤和原发性中枢神经系统淋巴瘤（PCNSL）的动态对比增强（DCE）衍生药代动力学（PK）参数的可靠性和诊断准确性。
这是一项回顾性研究，纳入了 172 名胶质母细胞瘤患者（n=147）和原发性中枢神经系统淋巴瘤患者（n=25）。所有患者均接受了术前 DSC 和 DCE-MRI 检查。使用 AIF 和 AIF 获得体积转移常数（K）、血管血浆容积（v）和血管外细胞外容积（v）。从 DSC-MRI 获得相对脑血容量（rCBV）。使用组内相关系数（ICC）和 ROC 曲线评估各参数的可靠性和诊断准确性。
与 AIF 相比，K、v 和 v 值的平均 ICC 更高（K，0.911 比 0.355；v，0.766 比 0.503；v，0.758 比 0.657）。对于所有胶质母细胞瘤与 PCNSL 的鉴别，平均 rCBV（AUC=0.856）比 DCE 衍生参数中 AUC 最大的平均 K（0.711）更准确（p=0.02）。然而，对于 rCBV 较低的胶质母细胞瘤（≤PCNSL 的 75%分位数；n=30），AIF 驱动的平均 K 和 v 比 rCBV 更准确（AUC：K，0.807 比 rCBV，0.515，p=0.004；v，0.715 比 rCBV，p=0.045）。
使用 AIF 的 DCE 衍生 PK 参数在鉴别低 rCBV 胶质母细胞瘤和 PCNSL 方面具有更好的可靠性和诊断准确性。
准确鉴别胶质母细胞瘤和 PCNSL 至关重要，因为它们的治疗策略不同。
与另一项灌注成像技术 DSC-MRI 的 rCBV 相比，DCE 参数的诊断准确性因 DCE-MRI 的 AIF 可靠性较低而受到限制。
当我们使用 DSC-MRI 的 AIF 分析 DCE-MRI 数据时，AIF 驱动的 DCE 参数在鉴别低 rCBV 的胶质母细胞瘤和 PCNSL 方面比 rCBV 具有更好的可靠性和诊断准确性。
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