Diagnostic examination performance by using microvascular leakage, cerebral blood volume, and blood flow derived from 3-T dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging in the differentiation of glioblastoma multiforme and brain metastasis

Neuroradiology. 2011 May;53(5):319-30. doi: 10.1007/s00234-010-0740-3. Epub 2010 Jul 13.


Introduction: Conventional magnetic resonance (MR) imaging has limited capacity to differentiate between glioblastoma multiforme (GBM) and metastasis. The purposes of this study were: (1) to compare microvascular leakage (MVL), cerebral blood volume (CBV), and blood flow (CBF) in the distinction of metastasis from GBM using dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging (DSC-MRI), and (2) to estimate the diagnostic accuracy of perfusion and permeability MR imaging.

Methods: A prospective study of 61 patients (40 GBMs and 21 metastases) was performed at 3 T using DSC-MRI. Normalized rCBV and rCBF from tumoral (rCBVt, rCBFt), peri-enhancing region (rCBVe, rCBFe), and by dividing the value in the tumor by the value in the peri-enhancing region (rCBVt/e, rCBFt/e), as well as MVL were calculated. Hemodynamic and histopathologic variables were analyzed statistically and Spearman/Pearson correlations. Receiver operating characteristic curve analysis was performed for each of the variables.

Results: The rCBVe, rCBFe, and MVL were significantly greater in GBMs compared with those of metastases. The optimal cutoff value for differentiating GBM from metastasis was 0.80 which implies a sensitivity of 95%, a specificity of 92%, a positive predictive value of 86%, and a negative predictive value of 97% for rCBVe ratio. We found a modest correlation between rCBVt and rCBFt ratios.

Conclusion: MVL measurements in GBMs are significantly higher than those in metastases. Statistically, both rCBVe, rCBVt/e and rCBFe, rCBFt/e were useful in differentiating between GBMs and metastases, supporting the hypothesis that perfusion MR imaging can detect infiltration of tumor cells in the peri-enhancing region.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Blood Volume*
  • Brain / blood supply*
  • Brain / pathology
  • Brain / physiopathology
  • Brain Neoplasms / blood supply
  • Brain Neoplasms / diagnosis*
  • Brain Neoplasms / physiopathology
  • Brain Neoplasms / secondary*
  • Cerebrovascular Circulation
  • Contrast Media
  • Diagnosis, Differential
  • Female
  • Glioblastoma / blood supply
  • Glioblastoma / diagnosis*
  • Glioblastoma / physiopathology
  • Humans
  • Image Enhancement / methods
  • Magnetic Resonance Angiography
  • Magnetic Resonance Imaging* / methods
  • Male
  • Microvessels / physiopathology
  • Middle Aged
  • Prospective Studies


  • Contrast Media