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Elevated peritumoural rCBV values as a mean to differentiate metastases from high-grade gliomas

  • Clinical Article
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Abstract

Purpose

Increased relative cerebral blood volume (rCBV) was previously found in peritumoural oedema of glioblastomas (GBM). Supposing that peritumoural rCBV is not increased in metastases, we aimed to evaluate whether rCBV values of the whole peritumoural area are accurate to differentiate solitary metastasis from GBM irrespective of the peritumoural oedema.

Methods

Contrast-enhanced T1-weighted (T1-w) and T2*-weighted dynamic susceptibility contrast MRI was performed in 52 patients with contrast-enhancing solitary brain tumours before surgery. In each T1-w slice depicting the contrast-enhancing tumour, a rim within approximately 15 mm was defined in the peritumoural area. The rCBV values were normalised to rCBV values of the contralateral normal white matter. Differences between metastases and GBM for normalised rCBV values for each slice were determined with the Mann–Whitney U test (p < 0.05).

Results

Histopathological examination revealed 29 GBM and 23 metastases. Peritumoural rCBV was significantly lower in metastases than in GBM (p < 0.01). Using the cutoff value 1.0 for discriminating metastases from GBM yielded a sensitivity of 96%, specificity of 64%, a positive predictive value of 68% and a negative predictive value of 95%.

Conclusions

The rCBV in the peritumoural area of contrast-enhancing brain tumours has a high diagnostic accuracy to discriminate metastases from GBM irrespective of surrounding oedema and without the bias of slice selection and ROI positioning. Metastases should be excluded, if at least one tumour-depicting slice reveals an increase of peritumoural rCBV compared to the normal contralateral brain (normalised rCBV value >1). Conversely, the decrease of peritumoural rCBV may not reliably exclude GBM.

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Conflicts of interest

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Authors and Affiliations

  1. Institute of Neuroradiology, University of Frankfurt, Schleusenweg 2-16, Frankfurt, 60528, Germany

    Stella Blasel, Alina Jurcoane, Stefanie Pellikan & Elke Hattingen

  2. Department of Neurosurgery, University of Frankfurt, Frankfurt, Germany

    Kea Franz

  3. Department of Biomathematics, University of Frankfurt, Frankfurt, Germany

    Gerald Morawe

Authors
  1. Stella Blasel
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  2. Alina Jurcoane
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  3. Kea Franz
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  4. Gerald Morawe
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  5. Stefanie Pellikan
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  6. Elke Hattingen
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Corresponding author

Correspondence to Stella Blasel.

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Comment

The purpose of this investigation was to analyse the challenging issue of the preoperative discrimination between solitary metastasis and glioblastoma. The authors evaluated rCBV values of the peritumoural area that they considered as the 15-mm-wide rim outside the outer contrast-enhancing tumour. One element of originality in this study consists of measuring the rCBV of the entire peritumoural area without the bias of ROI selection as reported by previous investigations. In the presented study, rCBV values were significantly lower in metastases than in GBM and a cutoff value was finally proposed to differentiate metastases from GBM. The technique is able to discriminate metastases from GBMs with a sensitivity of 96% and a specificity of 64%. We believe that it may provide additional useful data in the current neuro-oncological setting.

Domenico d’Avella

Alessandro Della Puppa

Padua, Italy

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Blasel, S., Jurcoane, A., Franz, K. et al. Elevated peritumoural rCBV values as a mean to differentiate metastases from high-grade gliomas. Acta Neurochir 152, 1893–1899 (2010). https://doi.org/10.1007/s00701-010-0774-7

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  • DOI: https://doi.org/10.1007/s00701-010-0774-7

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