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Yang X, Deng X, Wu M, Chen SW, Jiang M, Long L, Chen BT. Neuroimaging features of primary central nervous system post-transplantation lymphoproliferative disorder following hematopoietic stem cell transplant in patients with β-thalassemia: a case series and review of literature. Insights Imaging 2024; 15:40. [PMID: 38353902 PMCID: PMC10866827 DOI: 10.1186/s13244-024-01605-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 12/31/2023] [Indexed: 02/17/2024] Open
Abstract
PURPOSE Primary central nervous system post-transplantation lymphoproliferative disorder (PCNS-PTLD) is a rare but serious complication of hematopoietic stem cell transplantation (HSCT) in patients with severe β-thalassemia. This study aimed to assess the clinical presentation, pathological characteristics, neuroimaging findings, and treatment strategies in patients with β-thalassemia who developed PCNS-PTLD and to compare a case series from our transplant center to reported cases from literature. METHODS We retrospectively reviewed our hospital database and identified four cases of pathologically confirmed PCNS-PTLD without a history of systemic PTLD in patients with severe β-thalassemia after HSCT. We also performed a relevant literature review on PCNS-PTLD. RESULTS The median time from transplantation to diagnosis of PCNS-PTLD was 5.5 months. Intracerebral lesions were usually multiple involving both supratentorial and infratentorial regions with homogeneous or rim enhancement. All patients had pathologically confirmed PCNS-PTLD with three patients having diffuse large B-cell lymphoma and the fourth patient having plasmacytic hyperplasia. There was low response to treatment with a median survival of 83 days. CONCLUSION PCNS-PTLD should be considered in the differential diagnosis of patients with β-thalassemia who had an intracranial lesion on neuroimaging after HSCT. CRITICAL RELEVANCE STATEMENT This case series with a comprehensive review of neuroimaging and clinical characteristics of children with primary central nervous system post-transplantation lymphoproliferative disorder should advance our understanding and improve management of this rare yet severe complication following transplant for β-thalassemia. KEY POINTS • We assessed clinical presentation, treatment strategies, and neuroimaging characteristics of PCNS-PTLD in patients with β-thalassemia after transplantation. • Patients with β-thalassemia may have post-transplantation lymphoproliferative disorder presenting as brain lesions on neuroimaging. • Neuroimaging findings of the brain lesions are helpful for prompt diagnosis and proper management.
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Affiliation(s)
- Xueqing Yang
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Xi Deng
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Meiqing Wu
- Department of Hematology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Sean W Chen
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, 1500 E, Duarte, CA, 91010, USA
| | - Muliang Jiang
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China.
| | - Liling Long
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China.
| | - Bihong T Chen
- Department of Diagnostic Radiology, City of Hope Comprehensive Cancer Center, 1500 E, Duarte, CA, 91010, USA
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Hung ND, Anh NN, Minh ND, Huyen DK, Duc NM. Differentiation of glioblastoma and primary central nervous system lymphomas using multiparametric diffusion and perfusion magnetic resonance imaging. Biomed Rep 2023; 19:82. [PMID: 37881606 PMCID: PMC10594071 DOI: 10.3892/br.2023.1664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/13/2023] [Indexed: 10/27/2023] Open
Abstract
The present study aimed to determine whether combining diffusion-weighted (DWI) and dynamic susceptibility contrast-enhanced perfusion-weighted (DSC-PWI) magnetic resonance imaging (MRI) could differentiate between primary central nervous system lymphoma (PCNSL) and glioblastoma (GBM). The present retrospective study evaluated 45 patients with histologically confirmed brain tumors, of which 18 had PCNSLs and 27 had GBMs. All patients underwent conventional, DWI, and DSC-PWI MRIs before the surgical removal of the lesion or stereotactic biopsy. The solid tumor component, peritumoral edema, and abnormal white matter were measured in three regions of interest to evaluate relative cerebral blood volume (rCBV), apparent diffusion coefficient (ADC) and DWI. In conventional MRI, there were significant differences in tumor numbers, tumor enhancement type, tumor necrosis, hemorrhage and open-ring sign between GBM and PCNSL. Solid tumor ADC and rCBV values (ADCt and rCBVt, respectively) and their ratios with abnormal white matter amounts were significantly higher in GBM cases than in PCNSL cases (P<0.05). The rCBV value for peritumoral edema (rCBVe) and its ratio with abnormal white matter amount (rCBVe/n) were significantly higher in GBM cases than in PCNSL cases (P<0.05). However, ADC values did not differ significantly for peritumoral edema. DWI values did not differ significantly. Combining rCBVt and rCBVe/n provided a perfect area under the receiver operating characteristic curve of 1.00, with 100% sensitivity and 100% specificity for distinguishing GBM from PCNSL. In the results of the present study, the major criterion in the decision-making process distinguishing PCNSL from GBM was the combined rCBVt and rCBVe/n parameter. A minor criterion was the ADCt value of the lesion.
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Affiliation(s)
- Nguyen Duy Hung
- Department of Radiology, Hanoi Medical University, Hanoi 100000, Vietnam
- Department of Radiology, Viet Duc Hospital, Hanoi 100000, Vietnam
| | - Nguyen Ngoc Anh
- Department of Radiology, Hanoi Medical University, Hanoi 100000, Vietnam
| | - Nguyen Dinh Minh
- Department of Radiology, Viet Duc Hospital, Hanoi 100000, Vietnam
| | - Dang Khanh Huyen
- Department of Radiology, Hanoi Medical University, Hanoi 100000, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh 700000, Vietnam
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Ferreri AJM, Calimeri T, Cwynarski K, Dietrich J, Grommes C, Hoang-Xuan K, Hu LS, Illerhaus G, Nayak L, Ponzoni M, Batchelor TT. Primary central nervous system lymphoma. Nat Rev Dis Primers 2023; 9:29. [PMID: 37322012 PMCID: PMC10637780 DOI: 10.1038/s41572-023-00439-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2023] [Indexed: 06/17/2023]
Abstract
Primary central nervous system lymphoma (PCNSL) is a diffuse large B cell lymphoma in which the brain, spinal cord, leptomeninges and/or eyes are exclusive sites of disease. Pathophysiology is incompletely understood, although a central role seems to comprise immunoglobulins binding to self-proteins expressed in the central nervous system (CNS) and alterations of genes involved in B cell receptor, Toll-like receptor and NF-κB signalling. Other factors such as T cells, macrophages or microglia, endothelial cells, chemokines, and interleukins, probably also have important roles. Clinical presentation varies depending on the involved regions of the CNS. Standard of care includes methotrexate-based polychemotherapy followed by age-tailored thiotepa-based conditioned autologous stem cell transplantation and, in patients unsuitable for such treatment, consolidation with whole-brain radiotherapy or single-drug maintenance. Personalized treatment, primary radiotherapy and only supportive care should be considered in unfit, frail patients. Despite available treatments, 15-25% of patients do not respond to chemotherapy and 25-50% relapse after initial response. Relapse rates are higher in older patients, although the prognosis of patients experiencing relapse is poor independent of age. Further research is needed to identify diagnostic biomarkers, treatments with higher efficacy and less neurotoxicity, strategies to improve the penetration of drugs into the CNS, and roles of other therapies such as immunotherapies and adoptive cell therapies.
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Affiliation(s)
| | - Teresa Calimeri
- Lymphoma Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Kate Cwynarski
- Department of Haematology, University College Hospital, London, UK
| | - Jorg Dietrich
- Cancer and Neurotoxicity Clinic and Brain Repair Research Program, Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Christian Grommes
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Khê Hoang-Xuan
- APHP, Groupe Hospitalier Salpêtrière, Sorbonne Université, IHU, ICM, Service de Neurologie 2, Paris, France
| | - Leland S Hu
- Department of Radiology, Neuroradiology Division, Mayo Clinic, Phoenix, AZ, USA
| | - Gerald Illerhaus
- Clinic of Hematology, Oncology and Palliative Care, Klinikum Stuttgart, Stuttgart, Germany
| | - Lakshmi Nayak
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Maurilio Ponzoni
- Pathology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Ateneo Vita-Salute San Raffaele, Milan, Italy
| | - Tracy T Batchelor
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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4
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Feng A, Li L, Huang T, Li S, He N, Huang L, Zeng M, Lyu J. Differentiating glioblastoma from primary central nervous system lymphoma of atypical manifestation using multiparametric magnetic resonance imaging: A comparative study. Heliyon 2023; 9:e15150. [PMID: 37095995 PMCID: PMC10121909 DOI: 10.1016/j.heliyon.2023.e15150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/24/2023] [Accepted: 03/28/2023] [Indexed: 04/26/2023] Open
Abstract
Background The aim of this study is to evaluate the diagnostic efficiency of magnetic resonance imaging (MRI) of single parameters, unimodality, and bimodality in distinguishing glioblastoma (GBM) from atypical primary central nervous system lymphoma (PCNSL) based on diffusion-weighted imaging (DWI), dynamic susceptibility contrast (DSC) enhancement, diffusion tensor imaging (DTI), and proton magnetic resonance spectroscopy (1H-MRS) findings. Methods The cohort included 108 patients pathologically diagnosed with GBM and 54 patients pathologically diagnosed with PCNSL. Pretreatment morphological MRI, DWI, DSC, DTI and MRS were all performed on each patient. The quantitative parameters of multimodal MRI were measured and compared between the patients in the GBM and atypical PCNSL groups, and those parameters showing a significant difference (p < 0.05) between patients in the GBM and atypical PCNSL groups were used to develop one-parameters, unimodality, and bimodality models. We evaluated the efficiency of different models in distinguishing GBM from atypical PCNSL by performing receiver operating characteristic analysis (ROC). Results Atypical PCNSL had lower minimum apparent diffusion coefficient (ADCmin), mean ADC (ADCmean), relative ADC (rADC), mean relative cerebral blood volume (rCBVmean), maximum rCBV (rCBVmax), fractional anisotropy (FA), axial diffusion coefficient (DA) and radial diffusion coefficient (DR) values and higher choline/creatine (Cho/Cr) and lipid/creatine (Lip/Cr) ratios than GBM (all p < 0.05). The rCBVmax, DTI and DSC + DTI data were optimal models of single-parameter, unimodality and bimodality for differentiation of GBM from atypical PCNSL, yielding areas under the curves (AUCs) of 0.905, 0.954, and 0.992, respectively. Conclusions Models of single-parameter, unimodality and bimodality based on muti multiparameter functional MRI may help to discriminate GBM from atypical PCNSL.
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Affiliation(s)
- Aozi Feng
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510632, China
| | - Li Li
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510632, China
| | - Tao Huang
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510632, China
| | - Shuna Li
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510632, China
| | - Ningxia He
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510632, China
| | - Liying Huang
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510632, China
| | - Mengnan Zeng
- College of Pharmacy, Henan University of Chinese Medicine, Zhengzhou, Henan 450046, China
- Corresponding author.
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510632, China
- Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization, Guangzhou, Guangdong 510632, China
- Corresponding author. Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510632, China.
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A Systematic Review of the Current Status and Quality of Radiomics for Glioma Differential Diagnosis. Cancers (Basel) 2022; 14:cancers14112731. [PMID: 35681711 PMCID: PMC9179305 DOI: 10.3390/cancers14112731] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/26/2022] [Accepted: 05/30/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Gliomas can be difficult to discern clinically and radiologically from other brain lesions (either neoplastic or non-neoplastic) since their clinical manifestations as well as preoperative imaging features often overlap and appear misleading. Radiomics could be extremely helpful for non-invasive glioma differential diagnosis (DDx). However, implementation in clinical practice is still distant and concerns have been raised regarding the methodological quality of radiomic studies. In this context, we aimed to summarize the current status and quality of radiomic studies concerning glioma DDx in a systematic review. In total, 42 studies were selected and examined in our work. Our study revealed that, despite promising and encouraging results, current studies on radiomics for glioma DDx still lack the quality required to allow its introduction into clinical practice. This work could provide new insights and help to reach a consensus on the use of the radiomic approach for glioma DDx. Abstract Radiomics is a promising tool that may increase the value of imaging in differential diagnosis (DDx) of glioma. However, implementation in clinical practice is still distant and concerns have been raised regarding the methodological quality of radiomic studies. Therefore, we aimed to systematically review the current status of radiomic studies concerning glioma DDx, also using the radiomics quality score (RQS) to assess the quality of the methodology used in each study. A systematic literature search was performed to identify original articles focused on the use of radiomics for glioma DDx from 2015. Methodological quality was assessed using the RQS tool. Spearman’s correlation (ρ) analysis was performed to explore whether RQS was correlated with journal metrics and the characteristics of the studies. Finally, 42 articles were selected for the systematic qualitative analysis. Selected articles were grouped and summarized in terms of those on DDx between glioma and primary central nervous system lymphoma, those aiming at differentiating glioma from brain metastases, and those based on DDx of glioma and other brain diseases. Median RQS was 8.71 out 36, with a mean RQS of all studies of 24.21%. Our study revealed that, despite promising and encouraging results, current studies on radiomics for glioma DDx still lack the quality required to allow its introduction into clinical practice. This work could provide new insights and help to reach a consensus on the use of the radiomic approach for glioma DDx.
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Role of intra-tumoral vasculature imaging features on susceptibility weighted imaging in differentiating primary central nervous system lymphoma from glioblastoma: a multiparametric comparison with pathological validation. Neuroradiology 2022; 64:1801-1818. [DOI: 10.1007/s00234-022-02946-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 04/04/2022] [Indexed: 10/18/2022]
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Cassinelli Petersen GI, Shatalov J, Verma T, Brim WR, Subramanian H, Brackett A, Bahar RC, Merkaj S, Zeevi T, Staib LH, Cui J, Omuro A, Bronen RA, Malhotra A, Aboian MS. Machine Learning in Differentiating Gliomas from Primary CNS Lymphomas: A Systematic Review, Reporting Quality, and Risk of Bias Assessment. AJNR Am J Neuroradiol 2022; 43:526-533. [PMID: 35361577 PMCID: PMC8993193 DOI: 10.3174/ajnr.a7473] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 01/31/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Differentiating gliomas and primary CNS lymphoma represents a diagnostic challenge with important therapeutic ramifications. Biopsy is the preferred method of diagnosis, while MR imaging in conjunction with machine learning has shown promising results in differentiating these tumors. PURPOSE Our aim was to evaluate the quality of reporting and risk of bias, assess data bases with which the machine learning classification algorithms were developed, the algorithms themselves, and their performance. DATA SOURCES Ovid EMBASE, Ovid MEDLINE, Cochrane Central Register of Controlled Trials, and the Web of Science Core Collection were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. STUDY SELECTION From 11,727 studies, 23 peer-reviewed studies used machine learning to differentiate primary CNS lymphoma from gliomas in 2276 patients. DATA ANALYSIS Characteristics of data sets and machine learning algorithms were extracted. A meta-analysis on a subset of studies was performed. Reporting quality and risk of bias were assessed using the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) and Prediction Model Study Risk Of Bias Assessment Tool. DATA SYNTHESIS The highest area under the receiver operating characteristic curve (0.961) and accuracy (91.2%) in external validation were achieved by logistic regression and support vector machines models using conventional radiomic features. Meta-analysis of machine learning classifiers using these features yielded a mean area under the receiver operating characteristic curve of 0.944 (95% CI, 0.898-0.99). The median TRIPOD score was 51.7%. The risk of bias was high for 16 studies. LIMITATIONS Exclusion of abstracts decreased the sensitivity in evaluating all published studies. Meta-analysis had high heterogeneity. CONCLUSIONS Machine learning-based methods of differentiating primary CNS lymphoma from gliomas have shown great potential, but most studies lack large, balanced data sets and external validation. Assessment of the studies identified multiple deficiencies in reporting quality and risk of bias. These factors reduce the generalizability and reproducibility of the findings.
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Affiliation(s)
- G I Cassinelli Petersen
- From the Department of Radiology and Biomedical Imaging (G.I.C.P., T.V., H.S., R.C.B., S.M., T.Z., L.H.S., J.C., R.A.B., A.M., M.S.A.)
- Universitätsmedizin Göttingen (G.I.C.P.), Göttingen, Germany
| | - J Shatalov
- University of Richmond (J.S.), Richmond, Virginia
| | - T Verma
- From the Department of Radiology and Biomedical Imaging (G.I.C.P., T.V., H.S., R.C.B., S.M., T.Z., L.H.S., J.C., R.A.B., A.M., M.S.A.)
- New York University (T.V.), New York, New York
| | - W R Brim
- Whiting School of Engineering (W.R.B.), Johns Hopkins University, Baltimore, Maryland
| | - H Subramanian
- From the Department of Radiology and Biomedical Imaging (G.I.C.P., T.V., H.S., R.C.B., S.M., T.Z., L.H.S., J.C., R.A.B., A.M., M.S.A.)
| | | | - R C Bahar
- From the Department of Radiology and Biomedical Imaging (G.I.C.P., T.V., H.S., R.C.B., S.M., T.Z., L.H.S., J.C., R.A.B., A.M., M.S.A.)
| | - S Merkaj
- From the Department of Radiology and Biomedical Imaging (G.I.C.P., T.V., H.S., R.C.B., S.M., T.Z., L.H.S., J.C., R.A.B., A.M., M.S.A.)
| | - T Zeevi
- From the Department of Radiology and Biomedical Imaging (G.I.C.P., T.V., H.S., R.C.B., S.M., T.Z., L.H.S., J.C., R.A.B., A.M., M.S.A.)
| | - L H Staib
- From the Department of Radiology and Biomedical Imaging (G.I.C.P., T.V., H.S., R.C.B., S.M., T.Z., L.H.S., J.C., R.A.B., A.M., M.S.A.)
| | - J Cui
- From the Department of Radiology and Biomedical Imaging (G.I.C.P., T.V., H.S., R.C.B., S.M., T.Z., L.H.S., J.C., R.A.B., A.M., M.S.A.)
| | - A Omuro
- Department of Neurology (A.O.), Yale School of Medicine, New Haven, Connecticut
| | - R A Bronen
- From the Department of Radiology and Biomedical Imaging (G.I.C.P., T.V., H.S., R.C.B., S.M., T.Z., L.H.S., J.C., R.A.B., A.M., M.S.A.)
| | - A Malhotra
- From the Department of Radiology and Biomedical Imaging (G.I.C.P., T.V., H.S., R.C.B., S.M., T.Z., L.H.S., J.C., R.A.B., A.M., M.S.A.)
| | - M S Aboian
- From the Department of Radiology and Biomedical Imaging (G.I.C.P., T.V., H.S., R.C.B., S.M., T.Z., L.H.S., J.C., R.A.B., A.M., M.S.A.)
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Filtration-Histogram Based Magnetic Resonance Texture Analysis (MRTA) for the Distinction of Primary Central Nervous System Lymphoma and Glioblastoma. J Pers Med 2021; 11:jpm11090876. [PMID: 34575653 PMCID: PMC8472730 DOI: 10.3390/jpm11090876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 11/16/2022] Open
Abstract
Primary central nervous system lymphoma (PCNSL) has variable imaging appearances, which overlap with those of glioblastoma (GBM), thereby necessitating invasive tissue diagnosis. We aimed to investigate whether a rapid filtration histogram analysis of clinical MRI data supports the distinction of PCNSL from GBM. Ninety tumours (PCNSL n = 48, GBM n = 42) were analysed using pre-treatment MRI sequences (T1-weighted contrast-enhanced (T1CE), T2-weighted (T2), and apparent diffusion coefficient maps (ADC)). The segmentations were completed with proprietary texture analysis software (TexRAD version 3.3). Filtered (five filter sizes SSF = 2-6 mm) and unfiltered (SSF = 0) histogram parameters were compared using Mann-Whitney U non-parametric testing, with receiver operating characteristic (ROC) derived area under the curve (AUC) analysis for significant results. Across all (n = 90) tumours, the optimal algorithm performance was achieved using an unfiltered ADC mean and the mean of positive pixels (MPP), with a sensitivity of 83.8%, specificity of 8.9%, and AUC of 0.88. For subgroup analysis with >1/3 necrosis masses, ADC permitted the identification of PCNSL with a sensitivity of 96.9% and specificity of 100%. For T1CE-derived regions, the distinction was less accurate, with a sensitivity of 71.4%, specificity of 77.1%, and AUC of 0.779. A role may exist for cross-sectional texture analysis without complex machine learning models to differentiate PCNSL from GBM. ADC appears the most suitable sequence, especially for necrotic lesion distinction.
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Barajas RF, Politi LS, Anzalone N, Schöder H, Fox CP, Boxerman JL, Kaufmann TJ, Quarles CC, Ellingson BM, Auer D, Andronesi OC, Ferreri AJM, Mrugala MM, Grommes C, Neuwelt EA, Ambady P, Rubenstein JL, Illerhaus G, Nagane M, Batchelor TT, Hu LS. Consensus recommendations for MRI and PET imaging of primary central nervous system lymphoma: guideline statement from the International Primary CNS Lymphoma Collaborative Group (IPCG). Neuro Oncol 2021; 23:1056-1071. [PMID: 33560416 PMCID: PMC8248856 DOI: 10.1093/neuonc/noab020] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Advanced molecular and pathophysiologic characterization of primary central nervous system lymphoma (PCNSL) has revealed insights into promising targeted therapeutic approaches. Medical imaging plays a fundamental role in PCNSL diagnosis, staging, and response assessment. Institutional imaging variation and inconsistent clinical trial reporting diminishes the reliability and reproducibility of clinical response assessment. In this context, we aimed to: (1) critically review the use of advanced positron emission tomography (PET) and magnetic resonance imaging (MRI) in the setting of PCNSL; (2) provide results from an international survey of clinical sites describing the current practices for routine and advanced imaging, and (3) provide biologically based recommendations from the International PCNSL Collaborative Group (IPCG) on adaptation of standardized imaging practices. The IPCG provides PET and MRI consensus recommendations built upon previous recommendations for standardized brain tumor imaging protocols (BTIP) in primary and metastatic disease. A biologically integrated approach is provided to addresses the unique challenges associated with the imaging assessment of PCNSL. Detailed imaging parameters facilitate the adoption of these recommendations by researchers and clinicians. To enhance clinical feasibility, we have developed both “ideal” and “minimum standard” protocols at 3T and 1.5T MR systems that will facilitate widespread adoption.
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Affiliation(s)
- Ramon F Barajas
- Department of Radiology, Neuroradiology Section, Oregon Health & Science University, Portland Oregon, USA.,Advanced Imaging Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Knight Cancer Institute Translational Oncology Program, Oregon Health & Science University, Portland, Oregon, USA
| | - Letterio S Politi
- Humanitas University and Humanitas Research and Clinical Center - IRCCS, Milan, Italy.,Boston Children's Hospital, Boston, Massachusetts, USA
| | - Nicoletta Anzalone
- Neuroradiology Unit, IRCCS San Raffaele Hospital and Vita-Salute University, Milan, Italy
| | - Heiko Schöder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Christopher P Fox
- Department of Clinical Haematology, Nottingham University Hospitals NHS Trust, School of Medicine, University of Nottingham, Nottingham, UK
| | - Jerrold L Boxerman
- Department of Diagnostic Imaging, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | | | - C Chad Quarles
- Department of Neuroimaging Research & Barrow Neuroimaging Innovation Center, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Benjamin M Ellingson
- UCLA Brain Tumor Imaging Laboratory (BTIL), Departments of Radiological Sciences and Psychiatry, David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California, USA.,Departments of Radiological Sciences, Psychiatry, and Biobehavioral Sciences, David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California, USA
| | - Dorothee Auer
- Versus Arthritis Pain Centre, University of Nottingham, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, Queen's Medical Centre, University of Nottingham, Nottingham, UK.,Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Ovidiu C Andronesi
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Andres J M Ferreri
- Lymphoma Unit, Department of Onco-Hematology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maciej M Mrugala
- Department of Medicine, Division of Hematology and Oncology, Mayo Clinic Cancer Center, Phoenix, Arizona, USA.,Department of Neurology, Mayo Clinic, Phoenix, Arizona, USA
| | - Christian Grommes
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Neurology, Weill Cornell Medical School, New York, New York, USA
| | - Edward A Neuwelt
- Blood-Brain Barrier Program, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA.,Portland Veterans Affairs Medical Center, Portland, Oregon, USA
| | - Prakash Ambady
- Blood-Brain Barrier Program, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - James L Rubenstein
- Division of Hematology/Oncology, University of California, San Francisco, California, USA.,Department of Medicine, University of California, San Francisco, California, USA.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California, USA
| | - Gerald Illerhaus
- Clinic of Hematology, Oncology and Palliative Care, Klinikum Stuttgart, Stuttgart, Germany
| | - Motoo Nagane
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Tracy T Batchelor
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Leland S Hu
- Department of Radiology, Neuroradiology Division, Mayo Clinic, Phoenix, Arizona, USA
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Togao O, Chikui T, Tokumori K, Kami Y, Kikuchi K, Momosaka D, Kikuchi Y, Kuga D, Hata N, Mizoguchi M, Iihara K, Hiwatashi A. Gamma distribution model of diffusion MRI for the differentiation of primary central nerve system lymphomas and glioblastomas. PLoS One 2020; 15:e0243839. [PMID: 33315914 PMCID: PMC7737570 DOI: 10.1371/journal.pone.0243839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 11/29/2020] [Indexed: 01/03/2023] Open
Abstract
The preoperative imaging-based differentiation of primary central nervous system lymphomas (PCNSLs) and glioblastomas (GBs) is of high importance since the therapeutic strategies differ substantially between these tumors. In this study, we investigate whether the gamma distribution (GD) model is useful in this differentiation of PNCSLs and GBs. Twenty-seven patients with PCNSLs and 57 patients with GBs were imaged with diffusion-weighted imaging using 13 b-values ranging from 0 to 1000 sec/mm2. The shape parameter (κ) and scale parameter (θ) were obtained with the GD model. Fractions of three different areas under the probability density function curve (f1, f2, f3) were defined as follows: f1, diffusion coefficient (D) <1.0×10-3 mm2/sec; f2, D >1.0×10-3 and <3.0×10-3 mm2/sec; f3, D >3.0 × 10-3 mm2/sec. The GD model-derived parameters were compared between PCNSLs and GBs. Receiver operating characteristic (ROC) curve analyses were performed to assess diagnostic performance. The correlations with intravoxel incoherent motion (IVIM)-derived parameters were evaluated. The PCNSL group's κ (2.26 ± 1.00) was significantly smaller than the GB group's (3.62 ± 2.01, p = 0.0004). The PCNSL group's f1 (0.542 ± 0.107) was significantly larger than the GB group's (0.348 ± 0.132, p<0.0001). The PCNSL group's f2 (0.372 ± 0.098) was significantly smaller than the GB group's (0.508 ± 0.127, p<0.0001). The PCNSL group's f3 (0.086 ± 0.043) was significantly smaller than the GB group's (0.144 ± 0.062, p<0.0001). The combination of κ, f1, and f3 showed excellent diagnostic performance (area under the curve, 0.909). The f1 had an almost perfect inverse correlation with D. The f2 and f3 had very strong positive correlations with D and f, respectively. The GD model is useful for the differentiation of GBs and PCNSLs.
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Affiliation(s)
- Osamu Togao
- Department of Molecular Imaging & Diagnosis, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toru Chikui
- Department of Oral and Maxillofacial Radiology, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Kenji Tokumori
- Department of Clinical Radiology, Faculty of Medical Technology, Teikyo University, Fukuoka, Japan
| | - Yukiko Kami
- Department of Oral and Maxillofacial Radiology, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Kazufumi Kikuchi
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Daichi Momosaka
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshitomo Kikuchi
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Daisuke Kuga
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Nobuhiro Hata
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masahiro Mizoguchi
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Iihara
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akio Hiwatashi
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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11
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Zhang HW, Lyu GW, He WJ, Lei Y, Lin F, Feng YN, Wang MZ. Differential diagnosis of central lymphoma and high-grade glioma: dynamic contrast-enhanced histogram. Acta Radiol 2020; 61:1221-1227. [PMID: 31902220 DOI: 10.1177/0284185119896519] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND In clinical diagnosis, some central nervous system lymphomas (CNSL) are difficult to distinguish from high-grade gliomas (HGG). PURPOSE To evaluate the diagnostic efficacy of the histogram analysis of dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) in the identification of CNSL and HGG. MATERIAL AND METHODS In all, 43 patients diagnosed with HGG (n = 28) and CNSL (n = 15) by histopathology underwent DCE-MRI scanning. Differences in histogram parameters based on DCE-MRI between HGG and CNSL were analyzed by Mann-Whitney U test. In addition, receiver operating characteristic (ROC) analysis was performed. Short-term follow-up of patients was performed using Kaplan-Meier analysis to explore the survival rates of HGG and CNSL. RESULTS For the ROC curve analysis, we demonstrate that the 10th percentile of Ktrans (area under the curve [AUC] = 0.912, sensitivity = 86.7%, specificity = 92.9%), Kep (AUC = 0.940, sensitivity = 93.3%, specificity = 79.6%), Ve (AUC = 0.907, sensitivity = 86.7%, specificity = 89.3%), and AUC (AUC = 0.904, sensitivity = 86.7%, specificity = 92.9%) were significantly different between the CNSL and HGG groups (P < 0.001), with high diagnostic efficiency. Table 2 shows that the histogram features based on AUC maps (10th, 25th, median, 75th, 90th, and mean) were always significantly higher in the CNSL group than in the HGG group (P < 0.001). There was no significant difference in Vp or in the 75th, 90th and mean of Ktrans, Kep, and Ve between the CNSL and HGG groups (P > 0.05). CONCLUSION A histogram analysis of DCE-MRI identified significant differences between HGG and CNSL, and this will help in the clinical differential diagnosis of these conditions.
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Affiliation(s)
- Han-wen Zhang
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People’s Hospital, Shenzhen, PR China
| | - Gui-wen Lyu
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People’s Hospital, Shenzhen, PR China
| | - Wen-jie He
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People’s Hospital, Shenzhen, PR China
| | - Yi Lei
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People’s Hospital, Shenzhen, PR China
| | - Fan Lin
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People’s Hospital, Shenzhen, PR China
| | - Yu-ning Feng
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People’s Hospital, Shenzhen, PR China
| | - Meng-zhu Wang
- Department of MR Scientific Marketing, Siemens Healthineers, Guangzhou, Guangdong Province, PR China
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12
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He YX, Qu CX, He YY, Shao J, Gao Q. Conventional MR and DW imaging findings of cerebellar primary CNS lymphoma: comparison with high-grade glioma. Sci Rep 2020; 10:10007. [PMID: 32561819 PMCID: PMC7305207 DOI: 10.1038/s41598-020-67080-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 06/01/2020] [Indexed: 12/14/2022] Open
Abstract
Primary central nervous system lymphomas (PCNSLs) and high-grade gliomas (HGGs) arising in the cerebellum is extremely low, making the differential diagnosis difficult or even impossible. The purpose of this study was to define the MR features of cerebellar PCNSL in immunocompetent patients, and to determine whether a combination of conventional MR and DW imaging can assist in the differentiation of PCNSLs and HGGs. Twelve PCNSLs and 15 HGGs confirmed by pathological analysis were retrospectively identified. The apparent diffusion coefficient (ADC) and conventional MRI parameters were compared for differences between PCNSL and HGG groups using the independent sample t test or chi-square test. Both ADCmin and ADCtotal values were lower in the PCNSL group than those in the HGG group (ADCmin: 0.53 × 10−3 vs. 0.83 × 10−3 mm2/sec, P < 0.001; ADCtotal: 0.66 × 10−3 vs. 0.98 × 10−3 mm2/sec, P = 0.001). As for conventional MR features, there were significant difference in the tumor size, enhancement patterns, the presence of cystic changes, edema degree and streak-like edema (all P < 0.01); but there were no significant difference in lesion type, the presence of bleeding, and involvement of brain surface between two groups (P = 0.554, 0.657 and 0.157, respectively). The results revealed that several conventional MR features, including enhancement patterns, branch-like enhancement and streak-like edema may be useful for the differentiation of PCNSL and HGG in cerebellum and, when combined with ADC values, further improve the discriminating ability.
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Affiliation(s)
- Ye-Xin He
- Department of Radiology, Shanxi Provincial People's Hospital, Affiliated People's Hospital of Shanxi Medical University, Taiyuan, 030012, China.
| | - Chong-Xiao Qu
- Department of Pathology, Shanxi Provincial People's Hospital, Affiliated People's Hospital of Shanxi Medical University, Taiyuan, 030012, China
| | - Yuan-Yan He
- Department of Medical Imaging, Shanxi Medical University, Taiyuan, 030001, China
| | - Jia Shao
- Department of Medical Imaging, Shanxi Medical University, Taiyuan, 030001, China
| | - Qiang Gao
- Department of Radiology, Shanxi Provincial People's Hospital, Affiliated People's Hospital of Shanxi Medical University, Taiyuan, 030012, China
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Anwar SSM, Baig MZ, Laghari AA, Mubarak F, Shamim MS, Jilani UA, Khalid MU. Accuracy of apparent diffusion coefficients and enhancement ratios on magnetic resonance imaging in differentiating primary cerebral lymphomas from glioblastoma. Neuroradiol J 2019; 32:328-334. [PMID: 31188064 DOI: 10.1177/1971400919857556] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND PURPOSE This study aimed to determine the accuracy of apparent diffusion coefficient (ADC) and enhancement ratio (ER) in discriminating primary cerebral lymphomas (PCL) and glioblastomas. MATERIALS AND METHODS Circular regions of interest were randomly placed centrally within the largest solid-enhancing area of all lymphomas and glioblastomas on both post-contrast T1-weighted images and corresponding ADC maps. Regions of interest were also drawn in the contralateral hemisphere to obtain enhancement and ADC values of normal-appearing white matter. This helped us to calculate the ER and ADC ratio. RESULTS Mean enhancement and ADC (mm2/s) values for PCL were 2220.56 ± 2948.30 and 712.00 ± 137.87, respectively. Mean enhancement and ADC values for glioblastoma were 1537.07 ± 1668.33 and 1037.93 ± 280.52, respectively. Differences in ADC values, ratios and ERs were all statistically significant between the two groups (p < 0.05). ADC values correctly predicted 71.4% of the lesions as glioblastoma and 83.3% as PCL (area under the curve (AUC) = 0.86 on receiver operating characteristic curve analysis). ADC ratios correctly predicted 85.7% of the lesions as glioblastoma and 100% as PCL (AUC = 0.93). ERs correctly predicted 71.4% of the lesions as glioblastoma and 88.9% as PCL (AUC = 0.92). The combination of ADC ratio and ER correctly predicted 100% tumour type in both patient subgroups. CONCLUSIONS ADC values, ADC ratios and ERs may serve as useful variables to distinguish PCL from glioblastoma. The combination of ADC ratio and ER yielded the best results in identification of both patient subgroups.
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Affiliation(s)
| | | | | | - Fatima Mubarak
- 1 Department of Radiology, Aga Khan University Hospital, Pakistan
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