Table 1.
The Demographic Data and Conventional MR Imaging Features of GBMs and PCLs.
Fig 1.
A 74-year-old female with pathologically-proven primary cerebral lymphoma after biopsy.
(A) Axial T1-weighted MR imaging (T1WI) and (B) T2-weighted MR imaging (T2WI) showed a heterogeneous tumor mass with central tumor necrosis and peritumoral edema involving the right basal ganglia, right internal capsule, and right thalamus. Spot hemorrhage in the tumor mass is shown as hyperintensity (arrow) on T1WI (A). (C) Axial contrast-enhanced T1WI revealed rim-enhancing mass in the right basal ganglia and internal capsule. (D) Diffusion-weighted imaging (DWI) showed a ring-shaped hyperintense tumor mass, central hypointense necrosis, and isointense peritumoral edema. (E) Apparent diffusion coefficient (ADC) map showed ROIs (circles) in the tumor necrosis (n), the most strongly-enhanced tumor area (t), and the peritumoral edema (e). Measured ADC (b = 1000 sec/mm2) in the tumor necrosis (ADCn) is 2.44 x 10−3 mm2/s; the most strongly-enhanced tumor area (ADCt), 0.84 x 10−3 mm2/s; the peritumoral edema (ADCe), 2.52 x 10−3 mm2/s.
Fig 2.
A 64-year-old female with pathologically-proven glioblastoma multiforme after biopsy.
(A) Axial contrast-enhanced T1WI showed a tumor mass with rim enhancement and central hypointense non-enhancing necrosis in the left frontal lobe. (B) Axial T2WI showed extensive peritumoral edema associating with the mass lesion. (C) DWI showed a ring-shaped hyperintense tumor mass, central hypointense tumor necrosis, and isointense peritumoral edema. (D) ADC map showed ROIs (circles) in the tumor necrosis (n), the most strongly-enhanced tumor area (t), and the gradient of peritumoral edema from the most proximally-located area (e1) of the peritumoral edema to the most peripheral location (e3). Measured ADC (b = 1000 sec/mm2) in the tumor necrosis (ADCn) is 1.85 x 10−3 mm2/s; the most strongly-enhanced tumor area (ADCt), 0.87 x 10−3 mm2/s; proximal peritumoral edema (ADCe1), 1.3 x 10−3 mm2/s; middle peritumoral edema (ADCe2), 1.36 x 10−3 mm2/s; distal peritumoral edema (ADCe3), 1.43 x 10−3 mm2/s.
Table 2.
Signals of DWI in the Tumor necrosis, The most strongly-enhanced tumor area, and the Peritumoral edema between GBMs and PCLs.
Fig 3.
Box plot of diffusion characteristics in patients with GBM and PCL.
There is statistically significant difference (P<0.05) between the ADC values (x10-3 mm2/s, at b = 1000 sec/mm2) of GBMs and PCLs in the most strongly-enhanced tumor area (white box) and the peritumoral edema (gray box). Boxes indicate interquartile range, and whiskers indicate range. Circles represent outliers, defined as distances greater than 1.5 times interquartile range below first quartile or above third quartile. In each box, horizontal line represents median.
Table 3.
The Median and Quartiles (Q1, Q3) of ADC values (x10-3 mm2/s, b = 1000 sec/mm2) in the Tumor necrosis, The most strongly-enhanced tumor area, and the Peritumoral edema between GBMs and PCLs.
Fig 4.
Receiver operating characteristic (ROC) curves of ADC values for differentiation between GBM and PCL.
(A) The left diagram represents the ROC curves of ADC values (x10-3 mm2/s, b = 1000 sec/mm2) in the tumor necrosis (ADCn) (full line), the most strongly-enhanced tumor area (ADCt) (dash—dot line), and the peritumoral edema (ADCe) (dot line). The optimal cutoff values of ADCn, ADCt, and ADCe are 1.85, 0.77, and 1.81 respectively. Area under ROC curve (AUC) in the ADCn, ADCt, and the ADCe are 0.63, 0.78, and 0.71 respectively. (B) The middle diagram represents the ROC curve of combined ADCt and ADCe, with AUC value of 0.83. (C) The right diagram represents the ROC curve of combined ADCn, ADCt, and ADCe, with AUC value of 0.94.
Table 4.
Sensitivity and Specificity in Differentiation of GBMs from PCLs with Receiver Operating Characteristic (ROC) Curve Analysis.
Fig 5.
Box plot of the ADC gradients in the peritumoral edema between GBM and PCL.
Table 5.
The Median and Quartiles (Q1, Q3) of ADC Gradients in Peritumoral edema in a subset of GBMs and PCLs.