Differentiation of brain abscesses from glioblastomas and metastatic brain tumors: comparisons of diagnostic performance of dynamic susceptibility contrast-enhanced perfusion MR imaging before and after mathematic contrast leakage correction

Cheng Hong Toh; Kuo-Chen Wei; Chen-Nen Chang; Shu-Hang Ng; Ho-Fai Wong; Ching-Po Lin

doi:10.1371/journal.pone.0109172

Differentiation of brain abscesses from glioblastomas and metastatic brain tumors: comparisons of diagnostic performance of dynamic susceptibility contrast-enhanced perfusion MR imaging before and after mathematic contrast leakage correction

PLoS One. 2014 Oct 17;9(10):e109172. doi: 10.1371/journal.pone.0109172. eCollection 2014.

Authors

Cheng Hong Toh¹, Kuo-Chen Wei², Chen-Nen Chang², Shu-Hang Ng³, Ho-Fai Wong³, Ching-Po Lin⁴

Affiliations

¹ Departments of Medical Imaging and Intervention, Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou and Chang Gung University College of Medicine, Tao-Yuan, Taiwan; Department of Biomedical Imaging and Radiological Sciences, Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan; Brain Connectivity Laboratory, Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan.
² Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou and Chang Gung University College of Medicine, Tao-Yuan, Taiwan.
³ Departments of Medical Imaging and Intervention, Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou and Chang Gung University College of Medicine, Tao-Yuan, Taiwan.
⁴ Department of Biomedical Imaging and Radiological Sciences, Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan; Brain Connectivity Laboratory, Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan.

Abstract

Purpose: To compare the diagnostic performance of dynamic susceptibility contrast-enhanced perfusion MRI before and after mathematic contrast leakage correction in differentiating pyogenic brain abscesses from glioblastomas and/or metastatic brain tumors.

Materials and methods: Cerebral blood volume (CBV), leakage-corrected CBV and leakage coefficient K2 were measured in enhancing rims, perifocal edema and contralateral normal appearing white matter (NAWM) of 17 abscesses, 19 glioblastomas and 20 metastases, respectively. The CBV and corrected CBV were normalized by dividing the values in the enhancing rims or edema to those of contralateral NAWM. For each study group, a paired t test was used to compare the K2 of the enhancing rims or edema with those of NAWM, as well as between CBV and corrected CBV of the enhancing rims or edema. ANOVA was used to compare CBV, corrected CBV and K2 among three lesion types. The diagnostic performance of CBV and corrected CBV was assessed with receiver operating characteristic (ROC) curve analysis.

Results: The CBV and correction CBV of enhancing rim were 1.45±1.17 and 1.97±1.01 for abscesses, 3.85±2.19 and 4.39±2.33 for glioblastomas, and 2.39±0.90 and 2.97±0.78 for metastases, respectively. The CBV and corrected CBV in the enhancing rim of abscesses were significantly lower than those of glioblastomas and metastases (P = 0.001 and P = 0.007, respectively). In differentiating abscesses from glioblastomas and metastases, the AUC values of corrected CBV (0.822) were slightly higher than those of CBV (0.792).

Conclusions: Mathematic leakage correction slightly increases the diagnostic performance of CBV in differentiating pyogenic abscesses from necrotic glioblastomas and cystic metastases. Clinically, DSC perfusion MRI may not need mathematic leakage correction in differentiating abscesses from glioblastomas and/or metastases.

Publication types

Comparative Study
Evaluation Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Brain Abscess / diagnosis*
Brain Neoplasms / diagnosis*
Diagnosis, Differential
Female
Glioblastoma / diagnosis*
Humans
Image Processing, Computer-Assisted / methods*
Magnetic Resonance Angiography / methods*
Male
Middle Aged
Neoplasm Metastasis / diagnosis

Grants and funding

This work was supported by grants from the Ministry of Science and Technology, and Chang Gung Memorial Hospital, Linkou, Taiwan (BMRPB07 to C.H. Toh). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.