Department of Radiology, The First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, Fujian, 350005, People's Republic of China.
Department of Radiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, People's Republic of China.
Eur Radiol. 2023 Dec;33(12):8800-8808. doi: 10.1007/s00330-023-09917-1. Epub 2023 Jul 13.
This study aimed to compare the accuracy of relative cerebral blood volume (rCBV) and percentage signal recovery (PSR) obtained from high flip-angle dynamic susceptibility contrast perfusion-weighted imaging (DSC-PWI) sequences with and without contrast agent (CA) preload for presurgical discrimination of brain glioblastoma and lymphoma.
Consecutive 336 patients (glioblastoma, 236; PCNSL, 100) were included. All the patients underwent DSC-PWI on 3.0-T magnetic resonance units before surgery. The rCBV and PSR with preloaded and non-preloaded CA were measured. The means of the continuous variables were compared using Welch's t-test. The diagnostic accuracies of the individual parameters were compared using the receiver operating characteristic curve analysis.
The rCBV was higher with preloaded CA than with non-preloaded CA (glioblastoma, 10.20 vs. 8.90, p = 0.020; PCNSL, 3.88 vs. 3.27, p = 0.020). The PSR was lower with preloaded CA than with non-preloaded CA (glioblastoma, 0.59 vs. 0.90; PCNSL, 0.70 vs. 1.63; all p < 0.001). Regarding the differentiation of glioblastoma and PCNSL, the AUC of rCBV with preloaded CA was indistinguishable from that of non-preloaded CA (0.940 vs. 0.949, p = 0.703), whereas the area under the curve of PSR with preloaded CA was lower than non-preloaded CA (0.529 vs. 0.884, p < 0.001).
With preloaded CA, diagnostic performance in differentiating glioblastoma and PCNSL did not improve for rCBV and it was decreased for PSR. Therefore, high flip-angle non-preload DSC-PWI sequences offer excellent accuracy and may be of choice sequence for presurgical discrimination of brain lymphoma and glioblastoma.
High flip-angle DSC-PWI using non-preloaded CA may be an excellent diagnostic method for distinguishing glioblastoma from PCNSL.
• Differentiating primary central nervous system lymphoma and glioblastoma accurately is critical for their management. • DSC-PWI sequences optimised for the most accurate CBV calculations may not be the optimal sequences for presurgical brain tumour diagnosis as they could be masquerading leakage phenomena that may provide interesting information in terms of differential diagnosis. • High flip-angle non-preloaded DSC-PWI sequences render the best accuracy in the presurgical differentiation of brain lymphoma and glioblastoma.
本研究旨在比较高翻转角动态磁敏感对比灌注加权成像（DSC-PWI）序列中带和不带对比剂（CA）预加载时获得的相对脑血容量（rCBV）和百分比信号恢复（PSR）在术前鉴别脑胶质母细胞瘤和淋巴瘤中的准确性。
连续纳入 336 例患者（胶质母细胞瘤 236 例，原发性中枢神经系统淋巴瘤 100 例）。所有患者均在术前于 3.0-T 磁共振设备上进行 DSC-PWI 检查。测量带和不带 CA 预加载的 rCBV 和 PSR。使用 Welch's t 检验比较连续变量的平均值。使用受试者工作特征曲线分析比较各参数的诊断准确性。
带 CA 预加载的 rCBV 高于不带 CA 预加载（胶质母细胞瘤，10.20 比 8.90，p=0.020；原发性中枢神经系统淋巴瘤，3.88 比 3.27，p=0.020）。带 CA 预加载的 PSR 低于不带 CA 预加载（胶质母细胞瘤，0.59 比 0.90；原发性中枢神经系统淋巴瘤，0.70 比 1.63；均 p<0.001）。在鉴别胶质母细胞瘤和原发性中枢神经系统淋巴瘤方面，带 CA 预加载的 rCBV 的 AUC 与不带 CA 预加载的 AUC 无显著差异（0.940 比 0.949，p=0.703），而带 CA 预加载的 PSR 的 AUC 低于不带 CA 预加载（0.529 比 0.884，p<0.001）。
带 CA 预加载时，rCBV 鉴别胶质母细胞瘤和原发性中枢神经系统淋巴瘤的诊断性能没有提高，而 PSR 则降低。因此，高翻转角不带 CA 预加载 DSC-PWI 序列提供了出色的准确性，可能是术前鉴别脑淋巴瘤和胶质母细胞瘤的首选序列。
使用不带 CA 预加载的高翻转角 DSC-PWI 可能是准确鉴别胶质母细胞瘤和原发性中枢神经系统淋巴瘤的一种极好的诊断方法。
• 准确区分原发性中枢神经系统淋巴瘤和胶质母细胞瘤对于其治疗至关重要。• 为获得最准确的 CBV 计算而优化的 DSC-PWI 序列可能不是术前脑肿瘤诊断的最佳序列，因为它们可能掩盖了漏出现象，这些现象在鉴别诊断方面可能提供有趣的信息。• 高翻转角不带 CA 预加载 DSC-PWI 序列在术前鉴别脑淋巴瘤和胶质母细胞瘤方面具有最佳的准确性。
