Permeability measurement using dynamic susceptibility contrast magnetic resonance imaging enhances differential diagnosis of primary central nervous system lymphoma from glioblastoma.

Abstract

To test if adding permeability measurement to perfusion obtained from dynamic susceptibility contrast MRI (DSC-MRI) improves diagnostic performance in the differentiation of primary central nervous system lymphoma (PCNSL) from glioblastoma. DSC-MRI was acquired in 145 patients with pathologically proven glioblastoma (n = 89) or PCNSL (n = 56). The permeability metrics of contrast agent extraction fraction (E_x), apparent permeability (K_a), and leakage-corrected perfusion of normalized cerebral blood volume (nCBV_res) and cerebral blood flow (nCBF_res) were derived from a tissue residue function. For comparison purposes, the leakage-corrected normalized CBV (nCBV) and relative permeability constant (K₂) were also obtained using the established Weisskoff-Boxerman leakage correction method. The area under the receiver operating characteristics curve (AUC) and cross-validation were used to compare the diagnostic performance of the single DSC-MRI parameters with the performance obtained with the addition of permeability metrics. PCNSL demonstrated significantly higher permeability (E_x, p < .001) and lower perfusion (nCBV_res, nCBF_res, and nCBV, all p < .001) than glioblastoma. The combination of E_x and nCBV_res showed the highest performance (AUC, 0.96; 95% confidence interval, 0.92-0.99) for differentiating PCNSL from glioblastoma, which was a significant improvement over the single perfusion (nCBV: AUC, 0.84; nCBV_res: AUC, 0.84; nCBF_res: AUC, 0.82; all p < .001) or E_x (AUC, 0.80; p < .001) parameters. Analysis of the combined permeability and perfusion metrics obtained from a single DSC-MRI acquisition improves the diagnostic value for differentiating PCNSL from glioblastoma in comparison with single-parameter nCBV analysis. • Permeability measurement can be calculated from DSC-MRI with a tissue residue function-based leakage correction. • Adding E_xto CBV aids in the differentiation of PCNSL from glioblastoma. • CBV and E_xmeasurements from DSC-MRI were highly reproducible.