Department of Radiology, University of Minnesota, Minneapolis, MN, 55455, USA.
Department of Radiology, University of Minnesota, Minneapolis, MN, 55455, USA.
Eur J Radiol. 2021 Aug;141:109784. doi: 10.1016/j.ejrad.2021.109784. Epub 2021 May 24.
We aimed to differentiate primary central nervous system lymphoma (PCNSL) from atypical glioblastoma (GB) and distinguish major genomic subtypes between these tumors using susceptibility-weighted imaging (SWI) along with diffusion-weighted imaging (DWI).
Thirty-one immuno-competent patients with PCNSL stratified by BCL2 and MYC rearrangement, and 57 patients with atypical GB (no visible necrosis) grouped according to isocitrate dehydrogenase-1 (IDH1) mutation status underwent 3.0-Tesla MRI before treatment in this retrospective study. Region of interest analysis with apparent diffusion coefficient (ADC) and SWI signal intensity values of the tumors were normalized by dividing those of contralateral white matter. The independent-samples t-test and Kruskal-Wallis test were utilized to compare parameters. The diagnostic ability of each parameter and their optimal combination was evaluated by logistic regression analysis and receiver operating characteristic.
PCNSL with rearrangement of both MYC and BCL2 (n = 7) [mean relative (r) ADCmean:0.87 ± 0.06, rADCmin:0.72 ± 0.08] demonstrated significantly lower rADCmean, and rADCmin compared to other PCNSLs (n = 24) (rADCmean:1.19 ± 0.18, rADCmin:1.03 ± 0.17;p < 0.001) and GBs (p < 0.001). GB without IDH1 mutation (n = 44) (mean rSWI value:0.95 ± 0.15) demonstrated significantly lower rSWI value compared to GB with IDH1 mutation (n = 13) (rSWI value:1.13 ± 0.09;p < 0.001) and PCNSL (p < 0.001). The incorporation of rADCmean and rSWI parameters distinguished GB with IDH1 mutation [Area under the curve (AUC):0.985] with sensitivity and specificity of 94.3 and 100 % respectively; and PCNSL with rearrangement of both MYC and BCL2 (AUC:0.982) with sensitivity and specificity of 100 % and 95.4 %, respectively. CONCLUSıONS: Combined analysis of SWI and DWI could differentiate atypical GB from PCNSL and distinguish major genomic subtypes between these tumors.
本研究旨在通过磁敏感加权成像（SWI）联合扩散加权成像（DWI），区分原发性中枢神经系统淋巴瘤（PCNSL）与非典型胶质母细胞瘤（GB），并鉴别这两种肿瘤的主要基因组亚型。
在这项回顾性研究中，我们对 31 例经 BCL2 和 MYC 重排分层的免疫功能正常的 PCNSL 患者和 57 例无可见坏死的 IDH1 突变型非典型 GB 患者进行了 3.0T MRI 检查。通过将肿瘤的表观扩散系数（ADC）和 SWI 信号强度值与对侧白质的比值进行归一化，对肿瘤的感兴趣区进行分析。采用独立样本 t 检验和 Kruskal-Wallis 检验比较参数。通过逻辑回归分析和受试者工作特征曲线评价每个参数及其最佳组合的诊断能力。
同时存在 MYC 和 BCL2 重排的 PCNSL（n=7）[平均相对 ADCmean：0.87±0.06，rADCmin：0.72±0.08]与其他 PCNSL（n=24）（rADCmean：1.19±0.18，rADCmin：1.03±0.17；p＜0.001）和 GB（p＜0.001）相比，rADCmean 和 rADCmin 显著降低。无 IDH1 突变的 GB（n=44）（平均 rSWI 值：0.95±0.15）与 IDH1 突变的 GB（n=13）（rSWI 值：1.13±0.09；p＜0.001）和 PCNSL（p＜0.001）相比，rSWI 值显著降低。rADCmean 和 rSWI 参数的联合分析可鉴别 IDH1 突变型 GB [曲线下面积（AUC）：0.985]，其灵敏度和特异性分别为 94.3%和 100%；以及同时存在 MYC 和 BCL2 重排的 PCNSL（AUC：0.982），其灵敏度和特异性分别为 100%和 95.4%。
SWI 和 DWI 的联合分析可区分非典型 GB 与 PCNSL，并鉴别这两种肿瘤的主要基因组亚型。
