Combined 3 Tesla MRI Biomarkers Improve the Differentiation between Benign vs Malignant Single Ring Enhancing Brain Masses
PurposeTo evaluate whether the combination of imaging biomarkers obtained by means of different 3 Tesla (3T) Magnetic Resonance Imaging (MRI) advanced techniques can improve the diagnostic accuracy in the differentiation between benign and malignant single ring-enhancing brain masses.Materials and Methods14 patients presenting at conventional 3T MRI single brain mass with similar appearance as regard ring enhancement, presence of peri-lesional edema and absence of hemorrhage signs were included in the study. All lesions were histologically proven: 5 pyogenic abscesses, 6 glioblastomas, and 3 metastases. MRI was performed at 3 Tesla and included Diffusion Weighted Imaging (DWI), Dynamic Susceptibility Contrast -Perfusion Weighted Imaging (DSC-PWI), Magnetic Resonance Spectroscopy (MRS), and Diffusion Tensor Imaging (DTI). Imaging biomarkers derived by those advanced techniques [Cerebral Blood Flow (CBF), relative Cerebral Blood Volume (rCBV), relative Main Transit Time (rMTT), Choline (Cho), Creatine (Cr), Succinate, N-Acetyl Aspartate (NAA), Lactate (Lac), Lipids, relative Apparent Diffusion Coefficient (rADC), and Fractional Anisotropy (FA)] were detected by two experienced neuroradiologists in joint session in 4 areas: Internal Cavity (IC), Ring Enhancement (RE), Peri-Lesional edema (PL), and Contralateral Normal Appearing White Matter (CNAWM). Significant differences between benign (n = 5) and malignant (n = 9) ring enhancing lesions were tested with Mann-Withney U test. The diagnostic accuracy of MRI biomarkers taken alone and MRI biomarkers ratios were tested with Receiver Operating Characteristic (ROC) analysis with an Area Under the Curve (AUC) ≥ 0.9 indicating a very good diagnostic accuracy of the variable.ResultsFive MRI biomarker ratios achieved excellent accuracy: IC-rADC/PL-NAA (AUC = 1), IC-rADC/IC-FA (AUC = 0.978), RE-rCBV/RE-FA (AUC = 0.933), IC-rADC/RE-FA (AUC = 0.911), and IC-rADC/PL-FA (AUC = 0.911). Only IC-rADC achieved a very good diagnostic accuracy (AUC = 0.909) among MRI biomarkers taken alone.ConclusionAlthough the major limitation of the study was the small sample size, preliminary results seem to suggest that combination of multiple 3T MRI biomarkers is a feasible approach to MRI biomarkers in order to improve diagnostic accuracy in the differentiation between benign and malignant single ring enhancing brain masses. Further studies in larger cohorts are needed to reach definitive conclusions.
[…] Significant differences between malignant lesions and benign lesions as well as between metastases and GBMs were assessed by using Mann-Withney U test.Principal component analysis (PCA) and Partial Least Square Discriminant Analysis (PLS-DA) were performed in order to find MRI variables discriminating between malignant and benign lesions. Data were mean centered, scaled to unit variance, and log transformed before analysis.The diagnostic accuracy of MRI biomarkers taken alone or combined by calculating the ratios between pairs of MRI biomarkers, were also investigated by using the Receiver Operating Characteristic (ROC) curve analysis. ROC curve provides the sensitivity (true positive rate) and the specificity (false positive rate) of a diagnostic test, representing the ability of a variable to discriminate between two groups; an Area Under the Curve (AUC) ≥ 0.9 indicates a very good diagnostic accuracy.ROC curve analysis was performed by using the ROC curve analysis tool [ROC Curve Explorer and Tester (ROCCET) available at http://www.roccet.ca]. Softwares used for statistical analysis were SIMCA P+ version 11.0 (Umetrics, Umeá, Sweden), and Statistica 6.0 (Statsoft, Tulsa, OK). […]
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