Müller Sebastian Johannes, Khadhraoui Eya, Henkes Hans, Ernst Marielle, Rohde Veit, Schatlo Bawarjan, Malinova Vesna
Institute of Neuroradiology, University Medical Center, Göttingen, Germany.
Clinic for Neuroradiology, Katharinen-Hospital Stuttgart, Stuttgart, Germany.
Discov Oncol. 2024 Sep 1;15(1):397. doi: 10.1007/s12672-024-01266-9.
Differentiating between glioblastoma (GB) with multiple foci (mGB) and multifocal central nervous system lymphoma (mCNSL) can be challenging because these cancers share several features at first appearance on magnetic resonance imaging (MRI). The aim of this study was to explore morphological differences in MRI findings for mGB versus mCNSL and to develop an interpretation algorithm with high diagnostic accuracy.
In this retrospective study, MRI characteristics were compared between 50 patients with mGB and 50 patients with mCNSL treated between 2015 and 2020. The following parameters were evaluated: size, morphology, lesion location and distribution, connections between the lesions on the fluid-attenuated inversion recovery sequence, patterns of contrast enhancement, and apparent diffusion coefficient (ADC) values within the tumor and the surrounding edema, as well as MR perfusion and susceptibility weighted imaging (SWI) whenever available.
A total of 187 mCNSL lesions and 181 mGB lesions were analyzed. The mCNSL lesions demonstrated frequently a solid morphology compared to mGB lesions, which showed more often a cystic, mixed cystic/solid morphology and a cortical infiltration. The mean measured diameter was significantly smaller for mCNSL than mGB lesions (p < 0.001). Tumor ADC ratios were significantly smaller in mCNSL than in mGB (0.89 ± 0.36 vs. 1.05 ± 0.35, p < 0.001). The ADC ratio of perilesional edema was significantly higher (p < 0.001) in mCNSL than in mGB. In SWI / T2*-weighted imaging, tumor-associated susceptibility artifacts were more often found in mCNSL than in mGB (p < 0.001).
The lesion size, ADC ratios of the lesions and the adjacent tissue as well as the vascularization of the lesions in the MR-perfusion were found to be significant distinctive patterns of mCNSL and mGB allowing a radiological differentiation of these two entities on initial MRI. A diagnostic algorithm based on these parameters merits a prospective validation.
鉴别具有多个病灶的胶质母细胞瘤（GB）与多灶性中枢神经系统淋巴瘤（mCNSL）具有挑战性，因为这些癌症在磁共振成像（MRI）初次表现时具有若干共同特征。本研究的目的是探讨mGB与mCNSL在MRI表现上的形态学差异，并开发一种具有高诊断准确性的解读算法。
在这项回顾性研究中，比较了2015年至2020年间接受治疗的50例mGB患者和50例mCNSL患者的MRI特征。评估了以下参数：大小、形态、病变位置和分布、液体衰减反转恢复序列上病变之间的连接、对比增强模式、肿瘤及周围水肿内的表观扩散系数（ADC）值，以及在可获得时的MR灌注和磁敏感加权成像（SWI）。
共分析了187个mCNSL病灶和181个mGB病灶。与mGB病灶相比，mCNSL病灶常表现为实性形态，mGB病灶更常表现为囊性、囊实性混合形态及皮质浸润。mCNSL的平均测量直径显著小于mGB病灶（p < 0.001）。mCNSL的肿瘤ADC比值显著低于mGB（0.89 ± 0.36 vs. 1.05 ± 0.35，p < 0.001）。mCNSL的瘤周水肿ADC比值显著高于mGB（p < 0.001）。在SWI/T2*加权成像中，mCNSL比mGB更常发现肿瘤相关的磁敏感伪影（p < 0.001）。
发现病变大小、病变及相邻组织的ADC比值以及MR灌注中病变的血管化是mCNSL和mGB的显著不同模式，可在初次MRI上对这两种实体进行影像学鉴别。基于这些参数的诊断算法值得进行前瞻性验证。
