Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2014 Nov 13;9(11):e112948.
doi: 10.1371/journal.pone.0112948. eCollection 2014.

Differentiation between primary cerebral lymphoma and glioblastoma using the apparent diffusion coefficient: comparison of three different ROI methods

Sung Jun Ahn  1 , Hyun Joo Shin  1 , Jong-Hee Chang  2 , Seung-Koo Lee  1
Affiliations
Comparative Study

Differentiation between primary cerebral lymphoma and glioblastoma using the apparent diffusion coefficient: comparison of three different ROI methods

Sung Jun Ahn et al. PLoS One. .

Abstract

Objective: Apparent diffusion coefficients (ADC) can help differentiate between central nervous system (CNS) lymphoma and Glioblastoma (GBM). However, overlap between ADCs for GBM and lymphoma have been reported because of various region of interest (ROI) methods. Our aim is to explore ROI method to provide the most reproducible results for differentiation.

Materials and methods: We studied 25 CNS lymphomas and 62 GBMs with three ROI methods: (1) ROI1, whole tumor volume; (2) ROI2, multiple ROIs; and (3) ROI3, a single ROI. Interobserver variability of two readers for each method was analyzed by intraclass correlation(ICC). ADCs were compared between GBM and lymphoma, using two-sample t-test. The discriminative ability was determined by ROC analysis.

Results: ADCs from ROI1 showed most reproducible results (ICC >0.9). For ROI1, ADCmean for lymphoma showed significantly lower values than GBM (p = 0.03). The optimal cut-off value was 0.98×10(-3) mm2/s with 85% sensitivity and 90% specificity. For ROI2, ADCmin for lymphoma was significantly lower than GBM (p = 0.02). The cut-off value was 0.69×10(-3) mm2/s with 87% sensitivity and 88% specificity.

Conclusion: ADC values were significantly dependent on ROI method. ADCs from the whole tumor volume had the most reproducible results. ADCmean from the whole tumor volume may aid in differentiating between lymphoma and GBM. However, multi-modal imaging approaches are recommended than ADC alone for differentiation.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Representative case.
A 43-year-old female with biopsy proven GBM. On Gd enhanced T1-weighed image (A), GBM shows heterogeneous enhancement in the left basal ganglia. ADC maps were coregistered to Gd enhanced T1-weighted image. Whole tumor volume ROI (ROI1) was drawn along the tumor border for each consecutive slice of the coregistered image (B). Multiple circular ROIs (ROI2) were drawn on coregistered image (area = 10 mm2) (C). A single circular ROI (ROI3) was drawn on any solid area, avoiding necrosis (area = 20 mm2) in coregistered image (D).
Figure 2
Figure 2. Box-and-whisker plots of representative ADC variables for lymphoma and GBM: mean ADC in ROI1 (A) and minimum ADC in ROI2 (B).
The central box represents the value from the lower to upper quartile. The middle line represents the median. The horizontal line extends from the minimum to the maximum value. An outside value are plotted with s square marker.
See this image and copyright information in PMC

References

    1. Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, et al. (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352: 987–996. - PubMed
    1. Surawicz TS, McCarthy BJ, Kupelian V, Jukich PJ, Bruner JM, et al. (1999) Descriptive epidemiology of primary brain and CNS tumors: results from the Central Brain Tumor Registry of the United States, 1990–1994. Neuro Oncol 1: 14–25. - PMC - PubMed
    1. Giese A, Westphal M (2001) Treatment of malignant glioma: a problem beyond the margins of resection. J Cancer Res Clin Oncol 127: 217–225. - PMC - PubMed
    1. Batchelor T, Loeffler JS (2006) Primary CNS lymphoma. J Clin Oncol 24: 1281–1288. - PubMed
    1. Haldorsen IS, Espeland A, Larsson EM (2011) Central nervous system lymphoma: characteristic findings on traditional and advanced imaging. AJNR Am J Neuroradiol 32: 984–992. - PMC - PubMed

Publication types