Differentiating primary central nervous system lymphoma from glioblastoma by time-dependent diffusion using oscillating gradient

Kiyohisa Kamimura; Tsubasa Nakano; Tomohito Hasegawa; Masanori Nakajo; Chihiro Yamada; Yoshiki Kamimura; Kentaro Akune; Fumitaka Ejima; Takuro Ayukawa; Hiroaki Nagano; Koji Takumi; Masatoyo Nakajo; Nayuta Higa; Hajime Yonezawa; Ryosuke Hanaya; Mari Kirishima; Akihide Tanimoto; Takashi Iwanaga; Hiroshi Imai; Thorsten Feiweier; Takashi Yoshiura

doi:10.1186/s40644-023-00639-7

Differentiating primary central nervous system lymphoma from glioblastoma by time-dependent diffusion using oscillating gradient

Cancer Imaging. 2023 Nov 30;23(1):114. doi: 10.1186/s40644-023-00639-7.

Authors

Kiyohisa Kamimura¹, Tsubasa Nakano², Tomohito Hasegawa², Masanori Nakajo², Chihiro Yamada², Yoshiki Kamimura², Kentaro Akune², Fumitaka Ejima², Takuro Ayukawa², Hiroaki Nagano², Koji Takumi², Masatoyo Nakajo², Nayuta Higa³, Hajime Yonezawa³, Ryosuke Hanaya³, Mari Kirishima⁴, Akihide Tanimoto⁴, Takashi Iwanaga⁵, Hiroshi Imai⁶, Thorsten Feiweier⁷, Takashi Yoshiura^{8

2}

Affiliations

¹ Department of Advanced Radiological Imaging, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan. kiyohisa@m2.kufm.kagoshima-u.ac.jp.
² Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan.
³ Department of Neurosurgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan.
⁴ Department of Pathology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan.
⁵ Department of Radiological Technology, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan.
⁶ Siemens Healthcare K.K., Gate City Osaki West Tower, 1-11-1 Osaki, Shinagawa-Ku, Tokyo, 141-8644, Japan.
⁷ Siemens Healthcare GmbH, Henkestrasse 127, 91052, Erlangen, Germany.
⁸ Department of Advanced Radiological Imaging, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan.

Abstract

Background: This study aimed to elucidate the impact of effective diffusion time setting on apparent diffusion coefficient (ADC)-based differentiation between primary central nervous system lymphomas (PCNSLs) and glioblastomas (GBMs) and to investigate the usage of time-dependent diffusion magnetic resonance imaging (MRI) parameters.

Methods: A retrospective study was conducted involving 21 patients with PCNSLs and 66 patients with GBMs using diffusion weighted imaging (DWI) sequences with oscillating gradient spin-echo (Δ_eff = 7.1 ms) and conventional pulsed gradient (Δ_eff = 44.5 ms). In addition to ADC maps at the two diffusion times (ADC_{7.1 ms} and ADC_{44.5 ms}), we generated maps of the ADC changes (cADC) and the relative ADC changes (rcADC) between the two diffusion times. Regions of interest were placed on enhancing regions and non-enhancing peritumoral regions. The mean and the fifth and 95^th percentile values of each parameter were compared between PCNSLs and GBMs. The area under the receiver operating characteristic curve (AUC) values were used to compare the discriminating performances among the indices.

Results: In enhancing regions, the mean and fifth and 95^th percentile values of ADC_{44.5 ms} and ADC_{7.1 ms} in PCNSLs were significantly lower than those in GBMs (p = 0.02 for 95^th percentile of ADC_{44.5 ms}, p = 0.04 for ADC_{7.1 ms}, and p < 0.01 for others). Furthermore, the mean and fifth and 95^th percentile values of cADC and rcADC were significantly higher in PCNSLs than in GBMs (each p < 0.01). The AUC of the best-performing index for ADC_{7.1 ms} was significantly lower than that for ADC_{44.5 ms} (p < 0.001). The mean rcADC showed the highest discriminating performance (AUC = 0.920) among all indices. In peritumoral regions, no significant difference in any of the three indices of ADC_{44.5 ms}, ADC_{7.1 ms}, cADC, and rcADC was observed between PCNSLs and GBMs.

Conclusions: Effective diffusion time setting can have a crucial impact on the performance of ADC in differentiating between PCNSLs and GBMs. The time-dependent diffusion MRI parameters may be useful in the differentiation of these lesions.

Keywords: Diffusion; Glioblastoma; Magnetic resonance imaging; Primary central nervous system lymphoma.

MeSH terms

Brain Neoplasms* / diagnostic imaging
Brain Neoplasms* / pathology
Central Nervous System / pathology
Diagnosis, Differential
Diffusion Magnetic Resonance Imaging / methods
Glioblastoma* / diagnostic imaging
Glioblastoma* / pathology
Humans
Lymphoma* / diagnostic imaging
Retrospective Studies