EVALUATION STUDIES
JOURNAL ARTICLE
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Differentiation between primary CNS lymphoma and glioblastoma: qualitative and quantitative analysis using arterial spin labeling MR imaging.

European Radiology 2018 September
OBJECTIVES: To evaluate the diagnostic performance of arterial spin labelling perfusion weighted images (ASL-PWIs) to differentiate primary CNS lymphoma (PCNSL) from glioblastoma (GBM).

METHODS: ASL-PWIs of pathologically confirmed PCNSL (n = 21) or GBM (n = 93) were analysed. For qualitative analysis, tumours were visually scored into five categories based on ASL-CBF maps. For quantitative analysis, normalised CBF values were derived by contralateral grey matter (GM) in intra- and peritumoral areas (nCBFintratumoral and nCBFperitumoral , respectively). Visual scoring scales and quantitative parameters from PCNSL and GBM were compared. In addition, the area under the receiver-operating characteristic (ROC) curve was used to determine the diagnostic accuracy of ASL-PWI for differentiating PCNSL from GBM. Weighted kappa or intraclass correlation coefficients (ICCs) were used to assess reliability between two observers.

RESULTS: In qualitative analysis, scores 5 (CBFintratumoral >CBFGM , 68.8% [64/93]) and 4 (CBFintratumoral ≈ CBFGM , 47.6% [10/21]) were the most frequently reported scores for GBM and PCNSL, respectively. In quantitative analysis, both nCBFintratumoral and nCBFperitumoral in PCNSL were significantly lower than those in the GBM (nCBFintratumoral , 0.89 ± 0.59 [mean and SD] vs. 2.68 ± 1.89, p < 0.001; nCBFperitumoral , 0.17 ± 0.08 vs. 0.45 ± 0.28, p < 0.001). nCBFperitumoral demonstrated the best diagnostic performance (area under the ROC curve: visual scoring, 0.814; nCBFintratumoral , 0.849; nCBFperitumoral , 0.908; p < 0.001 for all). Interobserver agreements for visual scoring (weighted kappa = 0.869), nCBFintratumoral_GM (ICC = 0.958) and nCBFperitumoral_GM (ICC = 0.947) were all excellent.

CONCLUSIONS: ASL-PWI performs well in differentiating PCNSL from GBM in both qualitative and quantitative analyses.

KEY POINTS: • ASL-PWI performs well (AUC > 0.8) in differentiating PCNSL from GBM. • The visual scoring template demonstrated good diagnostic performance, similar to quantitative analysis. • nCBFperitumoral demonstrated better diagnostic performance than nCBFintratumoral or visual scoring.

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