PurposeThis study describes a distinct MR imaging feature, placing emphasis on fluid-attenuation inversion recovery (FLAIR) and contrast-enhanced T1 weighted (T1C) images for the preoperative differentiation of glioblastoma (GBM) from primary central nervous system lymphoma (PCNSL).
The preoperative MRI findings of 116 pathologically comfirmed glioblastoma (n=72) and PCNSL (n=44) were retrospectively reviewed. Two neuroimaging specialists analyzed the MR images, and image analysis was focused on the presence or absence of a shapping and nonenhancing peritumoral hyperintense gyral lesion on FLAIR imaging (SNEPGF, i.e., hyperintense lesion in a shapping and nonenhancing peritumoral gyral area on FLAIR imaging). The gyral area adjacent to and within 3 cm of the enhanced tumor was defined as the peritumoral gyrus region. The FLAIR hyperintensity lesion were termed as the signal intensity ratio (SIR) ≥ 30% compared with contralateral normal gray matter. Then, the differential diagnostic efficacy of SNEFPG sign for GBM and PCNSL was anayzed.
The SNEPGF sign was found in 33 GBM cases (33/72, 45.8%), and the FLAIR signal intensity and ADC value of these area were lower than the peritumoral edema area (p<0.0001). In 44 PCNSL cases, no SNEPGF sign was found. A slightly higher FLAIR signal intensity was seen in nine PCNSLs, but uniform and marked enhancement was seen in these areas. The sensitivity, specificity, positive predictive value, and negative predictive value of the differential diagnosis of GBM and PCNSL with SNEPGF sign were 45.8%, 100%, 100%, and 53.0%, respectively.
The SNEPGF sign is effective in identifying GBM from PCNSL, especially with high specificity.