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Published online before print February 1, 2002, 10.1148/radiol.2223010558
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(Radiology 2002;222:715-721.)
© RSNA, 2002

Neuroradiology

High-Grade Gliomas and Solitary Metastases: Differentiation by Using Perfusion and Proton Spectroscopic MR Imaging1

Meng Law, MD, Soonmee Cha, MD, Edmond A. Knopp, MD, Glyn Johnson, PhD, John Arnett, BS and Andrew W. Litt, MD

1 From the Departments of Radiology (M.L., S.C., E.A.K., G.J., J.A., A.W.L.) and Neurosurgery (E.A.K.), NYU Medical Center, 560 First Ave, RIM Rm 234, New York, NY 10016. From the 2000 RSNA scientific assembly. M.L. supported by a 2000 RSNA Fellow Research Trainee Prize and a grant from the Royal Australian and New Zealand College of Radiologists. S.C. supported by an RSNA Seed Grant. Received March 5, 2001; revision requested April 12; revision received July 9; accepted August 15. Address correspondence to M.L. (e-mail: lawm01@med.nyu.edu).

PURPOSE: To determine whether perfusion-weighted and proton spectroscopic MR imaging can be used to differentiate high-grade primary gliomas and solitary metastases on the basis of differences in vascularity and metabolite levels in the peritumoral region.

MATERIALS AND METHODS: Fifty-one patients with a solitary brain tumor (33 gliomas, 18 metastases) underwent conventional, contrast material–enhanced perfusion-weighted, and proton spectroscopic MR imaging before surgical resection or stereotactic biopsy. Of the 33 patients with gliomas, 22 underwent perfusion-weighted MR imaging; nine, spectroscopic MR imaging; and two underwent both. Of the 18 patients with metastases, 12 underwent perfusion-weighted MR imaging, and six, spectroscopic MR imaging. The peritumoral region was defined as the area in the white matter immediately adjacent to the enhancing (hyperintense on T2-weighted images, but not enhancing on postcontrast T1-weighted images) portion of the tumor. Relative cerebral blood volumes in these regions were calculated from perfusion-weighted MR data. Spectra from the enhancing tumor, the peritumoral region, and normal brain were obtained from the two-dimensional spectroscopic MR acquisition. The Student t test was used to determine if there was a statistically significant difference in relative cerebral blood volume and metabolic ratios between high-grade gliomas and metastases.

RESULTS: The measured relative cerebral blood volumes in the peritumoral region in high-grade gliomas and metastases were 1.31 ± 0.97 (mean ± SD) and 0.39 ± 0.19, respectively. The difference was statistically significant (P < .001). Spectroscopic imaging demonstrated elevated choline levels (choline-to-creatine ratio was 2.28 ± 1.24) in the peritumoral region of gliomas but not in metastases (choline-to-creatine ratio was 0.76 ± 0.23). The difference was statistically significant (P = .001).

CONCLUSION: Although conventional MR imaging characteristics of solitary metastases and primary high-grade gliomas may sometimes be similar, perfusion-weighted and spectroscopic MR imaging enable distinction between the two.

© RSNA, 2002

Index terms: Brain neoplasms, diagnosis, 13.363, 13.3634, 13.38 • Brain neoplasms, MR, 13.121412, 13.121415, 13.121416, 13.12143, 13.12144, 13.12145 • Brain neoplasms, secondary, 13.38 • Magnetic resonance (MR), spectroscopy, 13.12144, 13.12145 • Magnetic resonance (MR), perfusion study, 13.12144, 13.12145




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