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Research ArticleBrain
Open Access

Improved Conspicuity and Delineation of High-Grade Primary and Metastatic Brain Tumors Using “Restriction Spectrum Imaging”: Quantitative Comparison with High B-Value DWI and ADC

N.S. White, C.R. McDonald, N. Farid, J.M. Kuperman, S. Kesari and A.M. Dale
American Journal of Neuroradiology May 2013, 34 (5) 958-964; DOI: https://doi.org/10.3174/ajnr.A3327
N.S. White
aFrom the University of California, San Diego, Departments of Radiology (N.S.W., N.F., J.M.K., A.M.D.)
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C.R. McDonald
bPsychiatry (C.R.M.)
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N. Farid
aFrom the University of California, San Diego, Departments of Radiology (N.S.W., N.F., J.M.K., A.M.D.)
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J.M. Kuperman
aFrom the University of California, San Diego, Departments of Radiology (N.S.W., N.F., J.M.K., A.M.D.)
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S. Kesari
cNeurosciences (S.K., A.M.D.), La Jolla, California
dTranslational Neuro-Oncology Laboratories (S.K.), Moores Cancer Center, University of California, San Diego, La Jolla, California.
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A.M. Dale
cNeurosciences (S.K., A.M.D.), La Jolla, California
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    Fig 1.

    Anatomic T1-weighted postcontrast (A) and T2-weighted FLAIR (B) in an 84-year-old man with glioblastoma (patient 3). DWI images at b = 500 (C), b = 1500 (D), and b = 4000 (E); ADC (F); and an RSI-CM are shown (G). VOIs for tumor (red), peritumoral edema (blue), and normal-appearing WM (green) used for quantitative analysis are shown in H.

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    Fig 2.

    Anatomic T1-weighted postcontrast (A) and T2-weighted FLAIR (B) in a 67-year-old man with lymphoma (patient 7). Shown also are DWI images at b = 500 (C), b = 1500 (D), and b = 4000 (E); ADC (F); and an RSI-CM (G). VOIs for tumor (red), peritumoral edema (blue), and normal-appearing WM (green) used for quantitative analysis are shown in H.

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    Fig 3.

    Anatomic T1-weighted postcontrast (A) and T2-weighted FLAIR (B) for a 73-year-old woman with metastatic non-small cell lung cancer (patient 10). Shown also are DWI images at b = 500 (C), b = 1500 (D), and b = 4000 (E); ADC (F); and an RSI-CM (G). VOIs for tumor (red), peritumoral edema (blue), and normal-appearing WM (green) used for quantitative analysis are shown in H.

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    Fig 4.

    Box-and-whisker plots of intensity ratios quantifying tumor and edema conspicuity (A) and relative sensitivity to edema (B). On each box, the central mark is the median, the edges of the box are the 25th and 75th percentiles, the whiskers represent data ranges, and the red dots indicate potential outliers. A, TC is significant on the RSI-CM (P = .001) and DWI-4000 (P = .005), but not on ADC (P = .11). TC is significantly greater on the RSI-CM compared with DWI-4000 (P = .002) and ADC (P < .001). B, RSE is significantly less in the RSI-CM versus DWI-4000 (P < .001) and ADC (P < .001). C, Box-and-whisker plots of the predicted infiltrative baseline, defined as the percentage of tumor signal required within edema to equalize the signal to normal-appearing WM. The predicted infiltrative baseline of ADC is significantly greater than that of the RSI-CM (P < .001) and DWI-4000 (P < .001). Note that negative data points may reflect tumor infiltrated edema.

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    Fig 6.

    Shown are normalized intensity histograms (A) and corresponding receiver operating characteristic curves (B) quantifying the increased sensitivity and specificity and overall accuracy (AUC) of the RSI-CM for distinguishing tumor from normal-appearing WM compared with DWI-4000 and ADC.

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    Fig 5.

    Close-up comparison of GBM (patient 2) and non-small cell lung metastasis (patient 10). Anatomic T1-weighted postcontrast (A), T2-weighted FLAIR (B), ADC (C), and an RSI-CM (D). Arrows indicate a region of possible GBM tumor infiltration in nonenhancing peritumoral edema.

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    Table 1:

    Histologic diagnosis and patient demographics

    PatientSexAge (yr)PathologyStatus
    1Male51Glioblastoma, astrocytic, gemistocyticPostbiopsy, postradiation (6 mo)a
    2Male53Glioblastoma, astrocytic, small cellPostbiopsy, postradiation (8 mo)a
    3Male84Glioblastoma, astrocytic, small cellPrebiopsy, preradiation
    4Male66Glioblastoma, astrocytic, gemistocyticPrebiopsy, preradiation
    5Male55Primary CNS lymphoma, large B-cellPostbiopsy, preradiation
    6Female74Primary CNS lymphoma, large B-cellPrebiopsy, preradiation
    7Male67Primary CNS lymphoma, large B-cellPrebiopsy, preradiation
    8Female72Metastatic adenocarcinoma, primary colonPrebiopsy, postradiosurgery (14 mo)a
    9Male58Metastatic renal cell carcinomaPrebiopsy, postradiosurgery (10 mo)a
    10Female73Metastatic non-small cell lungPrebiopsy, postradiosurgery (6 mo)a
    • ↵a Interval in months between radiation treatment and MRI.

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    Table 2:

    Quantitative image contrast measures

    RSI-CMDWI-4000ADC
    TC (A/C)5.78 (3.23)1.71 (0.61)0.91 (0.16)
    EC (B/C)1.50 (1.57)1.17 (0.31)1.19 (0.10)
    RSEa (B/A)0.24 (0.12)0.73 (0.20)1.33 (0.17)
    Predicted infiltration baseline (%) 100* (C-B)/A for RSI-CM and DWI-4000b 100* (B-C)/A for ADC0.01 (19.68)−7.57 (17.78)18.69 (11.34)
    • Note:—A indicates mean intensity in tumor; B, mean intensity in edema; C, mean intensity in normal-appearing WM.

    • ↵a Values <1 indicate greater relative sensitivity to tumor versus edema, and values >1 indicate greater relative sensitivity to edema versus tumor.

    • ↵b Negative values may reflect tumor infiltrated edema.

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American Journal of Neuroradiology: 34 (5)
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N.S. White, C.R. McDonald, N. Farid, J.M. Kuperman, S. Kesari, A.M. Dale
Improved Conspicuity and Delineation of High-Grade Primary and Metastatic Brain Tumors Using “Restriction Spectrum Imaging”: Quantitative Comparison with High B-Value DWI and ADC
American Journal of Neuroradiology May 2013, 34 (5) 958-964; DOI: 10.3174/ajnr.A3327

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Improved Conspicuity and Delineation of High-Grade Primary and Metastatic Brain Tumors Using “Restriction Spectrum Imaging”: Quantitative Comparison with High B-Value DWI and ADC
N.S. White, C.R. McDonald, N. Farid, J.M. Kuperman, S. Kesari, A.M. Dale
American Journal of Neuroradiology May 2013, 34 (5) 958-964; DOI: 10.3174/ajnr.A3327
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