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Improved performance of non-preloaded and high flip-angle dynamic susceptibility contrast perfusion-weighted imaging sequences in the presurgical differentiation of brain lymphoma and glioblastoma

  • Oncology
  • Published:
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Abstract

Objective

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.

Methods

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.

Results

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).

Conclusion

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.

Clinical relevance statement

High flip-angle DSC-PWI using non-preloaded CA may be an excellent diagnostic method for distinguishing glioblastoma from PCNSL.

Key Points

• 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.

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Abbreviations

AIF:

Artery inflow function

AUC:

Area under the curve

BBB:

Blood-brain barrier

CA:

Contrast agent

CE-T1WI:

Contrast-enhanced T1-weighted image

CNWM:

Contralateral normal-appearing white matter

DSC-PWI:

Dynamic susceptibility contrast perfusion-weighted imaging

FLAIR:

Fluid-attenuated inversion recovery

ICCs:

Intraclass correlation coefficient

PCNSL:

Primary central nervous system lymphoma

PSR:

Percentage signal recovery

rCBV:

Relative cerebral blood volume

ROC:

Receiver operating characteristics curve

ROI:

Region of interest

SI:

Signal intensity

TICs:

Time-intensity curves

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Acknowledgements

The authors thank Yang Song from Siemens Healthcare Shanghai and Xiance Zhao and Peng Wu from Philips Healthcare Shanghai for technical help with the MR.

Funding

This study has received funding from the National Natural Science Foundation of China (No.82071869), the Leading Project of the Department of Science and Technology of Fujian Province (No.2020Y0025), the Natural Science Foundation of Fujian Province (No.2021J01706), and the Joint Funds for the Innovation of Science and Technology, Fujian Province (No.2020Y9102).

Author information

Author notes

  1. Feng Wang and Xiaofang Zhou contributed equally to this study and are the co-first authors.

  2. Dairong Cao and Zhen Xing contributed equally to this study.

Authors and Affiliations

  1. Department of Radiology, The First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, Fujian, 350005, People’s Republic of China

    Feng Wang, Xiaofang Zhou, Ruiquan Chen, Jie Kang, Xinyi Yang, Jinzhu Lin, Dairong Cao & Zhen Xing

  2. Department of Radiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, People’s Republic of China

    Feng Wang, Xiaofang Zhou, Ruiquan Chen, Jie Kang, Xinyi Yang, Jinzhu Lin, Dairong Cao & Zhen Xing

  3. Department of Hyperbaric Oxygen, The First Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China

    Fang Liu

  4. Department of Radiology, Fujian Key Laboratory of Precision Medicine for Cancer, the First Affiliated Hospital, Fujian Medical University, Fuzhou, People’s Republic of China

    Dairong Cao

  5. Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, the First Affiliated Hospital, Fujian Medical University, Fuzhou, People’s Republic of China

    Dairong Cao

Authors
  1. Feng Wang
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Corresponding authors

Correspondence to Dairong Cao or Zhen Xing.

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Guarantor

The scientific guarantor of this publication is Prof. Dairong Cao, The First Affiliated Hospital of Fujian Medical University.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some patients in the present study cohort overlapped with one of our studies, in which we evaluated diffusion and perfusion MRI in primary CNS lymphomas of different locations (Xing Z, Kang N, Lin Y, Zhou X, Xiao Z, Cao D (2020) BMC Med Imaging. https://doi.org/10.1186/s12880-020-00462-7). As for the PCNSL part, 32 cases (32%) overlapped in these two studies. In that study, the research purpose and research method were far different from our present study.

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Wang, F., Zhou, X., Chen, R. et al. Improved performance of non-preloaded and high flip-angle dynamic susceptibility contrast perfusion-weighted imaging sequences in the presurgical differentiation of brain lymphoma and glioblastoma. Eur Radiol 33, 8800–8808 (2023). https://doi.org/10.1007/s00330-023-09917-1

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