Predictors for the Differentiation between Glioblastoma, Primary Central Nervous System Lymphoma, and Metastasis in Patients with a Solitary Enhancing Intracranial Mass

Abstract

Introduction Differentiation between glioblastoma (GBM), primary central nervous system lymphoma (PCNSL), and metastasis is important in decision-making before surgery. However, these malignant brain tumors have overlapping features. This study aimed to identify predictors differentiating between GBM, PCNSL, and metastasis. Materials and Methods Patients with a solitary intracranial enhancing tumor and a histopathological diagnosis of GBM, PCNSL, or metastasis were investigated. All patients with intracranial lymphoma had PCNSL without extracranial involvement. Demographic, clinical, and radiographic data were analyzed to determine their associations with the tumor types. Results The predictors associated with GBM were functional impairment ( p = 0.001), large tumor size ( p < 0.001), irregular tumor margin ( p < 0.001), heterogeneous contrast enhancement ( p < 0.001), central necrosis ( p < 0.001), intratumoral hemorrhage ( p = 0.018), abnormal flow void ( p < 0.001), and hypodensity component on noncontrast cranial computed tomography (CT) scan ( p < 0.001). The predictors associated with PCNSL comprised functional impairment ( p = 0.005), deep-seated tumor location ( p = 0.006), homogeneous contrast enhancement ( p < 0.001), absence of cystic appearance ( p = 0.008), presence of hypointensity component on precontrast cranial T1-weighted magnetic resonance imaging (MRI; p = 0.027), and presence of isodensity component on noncontrast cranial CT ( p < 0.008). Finally, the predictors for metastasis were an infratentorial ( p < 0.001) or extra-axial tumor location ( p = 0.035), smooth tumor margin ( p < 0.001), and presence of isointensity component on cranial fluid-attenuated inversion recovery MRI ( p = 0.047). Conclusion These predictors may be used to differentiate between GBM, PCNSL, and metastasis, and they are useful in clinical management.

Keywords: brain metastasis; differentiation; glioblastoma; predictor; primary central nervous system lymphoma (PCNSL).

Fig. 1

Cranial images of patients with GBM. ( A ) GBM with irregular margin (arrowheads) on contrast-enhanced T1W MRI; ( B ) contrast-enhanced T1W MRI showing heterogeneous enhancement, including solid (arrow) and cystic (arrowhead) components; ( C ) central necrosis (arrowhead) on contrast-enhanced CT; ( D ) intratumoral hemorrhage (arrowhead) on noncontrast-enhanced CT; ( E ) abnormal flow void (arrowhead) on T2W MRI; ( F ) hypodensity component (arrow) on noncontrast-enhanced CT. CT, computed tomography; GBM, glioblastoma; MRI, magnetic resonance imaging; T1W, T1-weighted; T2W, T2-weighted.

Fig. 2

Cranial images of patients with PCNSL. ( A ) Contrast-enhanced CT and ( B ) contrast-enhanced T1W MRI showing the periventricular location of a tumor (arrowhead); ( C ) contrast-enhanced T1W MRI showing basal ganglial involvement (arrowhead); ( D ) lymphoma involving the splenium of the corpus callosum (arrowhead) on T1W MRI after contrast injection; ( E ) tumor with isodensity appearance (arrowhead) on noncontrast-enhanced CT; ( F ) contrast-enhanced CT showing homogeneous enhancement of a tumor (arrowhead). CT computed tomography; MRI, magnetic resonance imaging; PCNSL, primary central nervous system lymphoma; T1W, T1-weighted.

Fig. 3

Cranial images of patients with brain metastasis. ( A ) Contrast-enhanced CT revealing a tumor arising in the posterior cranial fossa (arrowhead); ( B ) contrast-enhanced CT, and ( C ) FLAIR MRI showing smooth margin of a tumor (arrowhead). CT, computed tomography; FLAIR, fluid-attenuated inversion recovery; MRI, magnetic resonance imaging.