Advanced diffusion imaging reveals microstructural characteristics of primary CNS lymphoma, allowing differentiation from glioblastoma

Neuro-Oncology Advances, vol. 6, pp. vdae093

Abstract

Background: Primary CNS lymphoma (PCNSL) and glioblastoma (GBM) both represent frequent intracranial malignancies with differing clinical management. However, distinguishing PCNSL from GBM with conventional MRI can be challenging when atypical imaging features are present. We employed advanced dMRI for noninvasive characterization of the microstructure of PCNSL and differentiation from GBM as the most frequent primary brain malignancy. Methods: Multiple dMRI metrics including Diffusion Tensor Imaging, Neurite Orientation Dispersion and Density Imaging, and Diffusion Microstructure Imaging were extracted from the contrast-enhancing tumor component in 10 PCNSL and 10 age-matched GBM on 3T MRI. Imaging findings were correlated with cell density and axonal markers obtained from histopathology. Results: < .01). Receiver-operating characteristic analysis revealed high predictive values regarding the presence of a PCNSL for MD, aD, microADC, V-intra, ICVF, microFA, V-CSF, and V-ISO (area under the curve [AUC] in all >0.840, highest for MD and ICVF with an AUC of 0.960). Comparative histopathology between PCNSL and GBM revealed a significantly increased cell density in PCNSL and the presence of axonal remnants in a higher proportion of samples. Conclusions: Advanced diffusion imaging enables the characterization of the microstructure of PCNSL and reliably distinguishes PCNSL from GBM. Both imaging and histopathology revealed a relatively increased cell density and a preserved axonal microstructure in PCNSL.

Authors 15

1. Urs Würtemberger corresponding

   University of Freiburg · University Medical Center Freiburg

   Affiliation as printed

   Department of Neuroradiology, Medical Center—University of Freiburg, University of Freiburg , Freiburg , Germany

   Department of Neuroradiology, Medical Center- University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany

2. Martin Diebold

   University of Freiburg · University Medical Center Freiburg

   Affiliation as printed

   IMM-PACT Clinician Scientist Program, University of Freiburg , Freiburg , Germany

   Institute of Neuropathology, Medical Center—University of Freiburg, University of Freiburg , Freiburg , Germany

3. Alexander Rau

   University of Freiburg · University Medical Center Freiburg

   Affiliation as printed

   Department of Diagnostic and Interventional Radiology, Medical Center—University of Freiburg, University of Freiburg , Freiburg , Germany

   Department of Neuroradiology, Medical Center—University of Freiburg, University of Freiburg , Freiburg , Germany

   Department of Neuroradiology, Medical Center- University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany

4. Veysel Akgün

   University of Freiburg · University Medical Center Freiburg

   Affiliation as printed

   Department of Neuroradiology, Medical Center—University of Freiburg, University of Freiburg , Freiburg , Germany

   Department of Neuroradiology, Medical Center- University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany

5. L. E. Becker

   University of Freiburg · University Medical Center Freiburg

   Affiliation as printed

   Department of Neuroradiology, Medical Center—University of Freiburg, University of Freiburg , Freiburg , Germany

   Department of Neuroradiology, Medical Center- University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany

6. Jürgen Beck

   University of Freiburg · University Medical Center Freiburg

   Affiliation as printed

   Department of Neurosurgery, Medical Center—University of Freiburg, University of Freiburg , Freiburg , Germany

7. Peter Christoph Reinacher Aachen Fraunhofer Institute for Laser Technology (ILT)

   University of Freiburg · University Medical Center Freiburg · Fraunhofer Institute for Laser Technology

   Affiliation as printed

   Department of Stereotactic and Functional Neurosurgery, Medical Center—University of Freiburg, University of Freiburg , Freiburg , Germany

   Fraunhofer Institute for Laser Technology , Aachen , Germany

   Fraunhofer Institute for Laser Technology, 52074 Aachen, Germany

8. Christian A. Taschner

   University of Freiburg · University Medical Center Freiburg

   Affiliation as printed

   Department of Neuroradiology, Medical Center—University of Freiburg, University of Freiburg , Freiburg , Germany

   Department of Neuroradiology, Medical Center- University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany

9. Marco Reisert

   University of Freiburg · University Medical Center Freiburg

   Affiliation as printed

   Department of Medical Physics, Medical Center—University of Freiburg, University of Freiburg , Freiburg , Germany

   Department of Stereotactic and Functional Neurosurgery, Medical Center—University of Freiburg, University of Freiburg , Freiburg , Germany

10. Luca Fehrenbacher

    University of Freiburg · University Medical Center Freiburg

    Affiliation as printed

    Institute of Neuropathology, Medical Center—University of Freiburg, University of Freiburg , Freiburg , Germany

11. Daniel Erny

    University of Freiburg · University Medical Center Freiburg

    Affiliation as printed

    Institute of Neuropathology, Medical Center—University of Freiburg, University of Freiburg , Freiburg , Germany

12. Florian Scherer

    University of Freiburg · University Medical Center Freiburg

    Affiliation as printed

    Department of Medicine I, Medical Center—University of Freiburg, University of Freiburg , Freiburg , Germany

    Department of Medicine I, Medical Center - University of Freiburg,, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany

13. Marc Hohenhaus

    University of Freiburg · University Medical Center Freiburg

    Affiliation as printed

    Department of Neurosurgery, Medical Center—University of Freiburg, University of Freiburg , Freiburg , Germany

14. Horst Urbach

    University of Freiburg · University Medical Center Freiburg

    Affiliation as printed

    Department of Neuroradiology, Medical Center—University of Freiburg, University of Freiburg , Freiburg , Germany

    Department of Neuroradiology, Medical Center- University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany

15. Theo Demerath

    University of Freiburg · University Medical Center Freiburg

    Affiliation as printed

    Department of Neuroradiology, Medical Center—University of Freiburg, University of Freiburg , Freiburg , Germany

    Department of Neuroradiology, Medical Center- University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany