PMID- 29184763
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220310
IS  - 2223-4292 (Print)
IS  - 2223-4306 (Electronic)
IS  - 2223-4306 (Linking)
VI  - 7
IP  - 5
DP  - 2017 Oct
TI  - Usefulness of enhancement-perfusion mismatch in differentiation of CNS lymphomas 
      from other enhancing malignant tumors of the brain.
PG  - 511-519
LID - 10.21037/qims.2017.09.03 [doi]
AB  - BACKGROUND: Surgical planning and treatment options for primary or secondary 
      central nervous system lymphomas (PCNSL or SCNSL) are different from other 
      enhancing malignant lesions such as glioblastoma multiforme (GBM), anaplastic 
      gliomas and metastases; so, it is critical to distinguish them preoperatively. We 
      hypothesized that enhancement-perfusion (E-P) mismatch on dynamic susceptibility 
      weighted magnetic resonance (DSC-MR) perfusion imaging which corresponds to low 
      mean relative cerebral blood volume (mean rCBV) in an enhancing portion of the 
      tumor should allow differentiation of CNS lymphomas from other enhancing 
      malignant lesions. METHODS: We retrospectively reviewed pre-treatment MRI exams, 
      including DSC-MR perfusion images of 15 lymphoma patients. As a control group, 
      pre-treatment DSC-MR perfusion images of biopsy proven 18 GBMs (group II), 13 
      metastases (group III), and 10 anaplastic enhancing gliomas (group IV) patients 
      were also reviewed. Region of interests (ROIs) were placed around the most 
      enhancing part of tumor on contrast-enhanced T1WI axial images and images were 
      transferred onto co-registered DSC perfusion maps to obtain CBV in all 4 groups. 
      The mean and maximum relative CBV values were obtained. Statistical analysis was 
      performed on SPSS software and significance of the results between the groups was 
      done with Mann-Whitney test, whereas optimal thresholds for tumor differentiation 
      were done by receiver operating characteristic (ROC) analysis. RESULTS: The 
      enhancing component of CNS lymphomas were found to have significantly lower mean 
      rCBV compared to enhancing component of GBM (1.2 versus 4.3; P<0.001), metastasis 
      (1.2 versus 2.7; P<0.001), and anaplastic enhancing gliomas (1.2 versus 2.4; 
      P<0.001). Maximum rCBV of enhancing component of lymphoma were significantly 
      lower than GBM (3.1 versus 6.5; P<0.001) and metastasis (3.1 versus 4.9; 
      P<0.013), and not significantly lower than anaplastic enhancing gliomas (3.9 
      versus 4.2; P<0.08). On the basis of ROC analysis, mean rCBV provided the best 
      threshold [area under the curve (AUC) =0.92] and had better accuracy in 
      differentiating malignant lesions. CONCLUSIONS: E-P mismatch in DSC perfusion MR, 
      i.e., low mean rCBV in an enhancing portion of the tumor is strongly suggestive 
      of lymphoma and should allow differentiation of CNS lymphoma from other enhancing 
      malignant lesions.
FAU - Goyal, Pradeep
AU  - Goyal P
AD  - Department of Radiology, St. Vincent's Medical Center, Bridgeport, Connecticut, 
      USA.
FAU - Kumar, Yogesh
AU  - Kumar Y
AD  - Department of Radiology, Columbia University at Bassett Healthcare, Cooperstown, 
      New York, USA.
FAU - Gupta, Nishant
AU  - Gupta N
AD  - Department of Radiology, Columbia University Medical Center, New York, NY, USA.
FAU - Malhotra, Ajay
AU  - Malhotra A
AD  - Department of Radiology and Biomedical Imaging, Yale School of Medicine, New 
      Haven, Connecticut, USA.
FAU - Gupta, Saurabh
AU  - Gupta S
AD  - Department of Radiology, SUNY Upstate Medical University, Syracuse, New York, 
      USA.
FAU - Gupta, Sonali
AU  - Gupta S
AD  - Department of Medicine, St. Vincent's Medical Center, Bridgeport, Connecticut, 
      USA.
FAU - Mangla, Manisha
AU  - Mangla M
AD  - Department of Radiology, SUNY Upstate Medical University, Syracuse, New York, 
      USA.
FAU - Mangla, Rajiv
AU  - Mangla R
AD  - Department of Radiology, University of Rochester Medical Center, Rochester, New 
      York, USA.
LA  - eng
PT  - Journal Article
PL  - China
TA  - Quant Imaging Med Surg
JT  - Quantitative imaging in medicine and surgery
JID - 101577942
PMC - PMC5682400
OTO - NOTNLM
OT  - CNS lymphoma
OT  - dynamic susceptibility weighted magnetic resonance perfusion imaging (DSC-MR 
      perfusion imaging)
OT  - enhancement-perfusion mismatch (E-P mismatch)
OT  - glioblastoma multiforme (GBM)
COIS- Conflicts of Interest: The authors have no conflicts of interest to declare.
EDAT- 2017/12/01 06:00
MHDA- 2017/12/01 06:01
PMCR- 2017/10/01
CRDT- 2017/11/30 06:00
PHST- 2017/11/30 06:00 [entrez]
PHST- 2017/12/01 06:00 [pubmed]
PHST- 2017/12/01 06:01 [medline]
PHST- 2017/10/01 00:00 [pmc-release]
AID - qims-07-05-511 [pii]
AID - 10.21037/qims.2017.09.03 [doi]
PST - ppublish
SO  - Quant Imaging Med Surg. 2017 Oct;7(5):511-519. doi: 10.21037/qims.2017.09.03.