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Differentiation between Glioblastoma and Solitary Metastasis: Morphologic Assessment by Conventional Brain MR Imaging and Diffusion-Weighted Imaging

Investigative Magnetic Resonance Imaging 2021년 25권 1호 p.23 ~ 34
정보영, 이은자, 배종면, 최영재, 이은경, 김대봉,
소속 상세정보
정보영 ( Jung Bo-Young ) - Dongguk University Ilsan Hospital Department of Radiology
이은자 ( Lee Eun-Ja ) - Dongguk University Ilsan Hospital Department of Radiology
배종면 ( Bae Jong-Myon ) - Jeju National University School of Medicine Department of Preventive Medicine
최영재 ( Choi Young-Jae ) - Dongguk University Ilsan Hospital Department of Radiology
이은경 ( Lee Eun-Kyoung ) - Dongguk University Ilsan Hospital Department of Radiology
김대봉 ( Kim Dae-Bong ) - Dongguk University Ilsan Hospital Department of Radiology

Abstract


Purpose: Differentiating between glioblastoma and solitary metastasis is very important for the planning of further workup and treatment. We assessed the ability of various morphological parameters using conventional MRI and diffusion-based techniques to distinguish between glioblastomas and solitary metastases in tumoral and peritumoral regions.

Materials and Methods: We included 38 patients with solitary brain tumors (21 glioblastomas, 17 solitary metastases). To find out if there were differences in the morphologic parameters of enhancing tumors, we analyzed their shape, margins, and enhancement patterns on postcontrast T1-weighted images. During analyses of peritumoral regions, we assessed the extent of peritumoral non-enhancing lesion on T2- and postcontrast T1-weighted images. We also aimed to detect peritumoral neoplastic cell infiltration by visual assessment of T2-weighted and diffusion-based images, including DWI, ADC maps, and exponential DWI, and evaluated which sequence depicted peritumoral neoplastic cell infiltration most clearly.

Results: The shapes, margins, and enhancement patterns of tumors all significantly differentiated glioblastomas from metastases. Glioblastomas had an irregular shape, ill-defined margins, and a heterogeneous enhancement pattern; on the other hand, metastases had an ovoid or round shape, well-defined margins, and homogeneous enhancement. Metastases had significantly more extensive peritumoral T2 high signal intensity than glioblastomas had. In visual assessment of peritumoral neoplastic cell infiltration using T2-weighted and diffusion-based images, all sequences differed significantly between the two groups. Exponential DWI had the highest sensitivity for the diagnosis of both glioblastoma (100%) and metastasis (70.6%). A combination of exponential DWI and ADC maps was optimal for the depiction of peritumoral neoplastic cell infiltration in glioblastoma.

Conclusion: In the differentiation of glioblastoma from solitary metastatic lesions, visual morphologic assessment of tumoral and peritumoral regions using conventional MRI and diffusion-based techniques can also offer diagnostic information.

키워드

Glioblastoma; Intracranial metastasis; MR imaging; Diffusion weighted imaging

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