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Research ArticleBrain

Evaluation of Microvascular Permeability with Dynamic Contrast-Enhanced MRI for the Differentiation of Primary CNS Lymphoma and Glioblastoma: Radiologic-Pathologic Correlation

P. Kickingereder, F. Sahm, B. Wiestler, M. Roethke, S. Heiland, H.-P. Schlemmer, W. Wick, A. von Deimling, M. Bendszus and A. Radbruch
American Journal of Neuroradiology August 2014, 35 (8) 1503-1508; DOI: https://doi.org/10.3174/ajnr.A3915
P. Kickingereder
aFrom the Departments of Neuroradiology (P.K., S.H., M.B., A.R.)
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F. Sahm
bNeuropathology (F.S., A.v.D.)
dGerman Cancer Consortium, Clinical Cooperation Unit Neuropathology (F.S., A.v.D.)
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B. Wiestler
cNeuro-oncology (B.W., W.W.), Neurology Clinic, University of Heidelberg Medical Center, Heidelberg, Germany
eClinical Cooperation Unit Neuro-oncology (B.W., W.W.)
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M. Roethke
fDepartment of Radiology (M.R., H.-P.S., A.R.), German Cancer Research Center, Heidelberg, Germany.
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S. Heiland
aFrom the Departments of Neuroradiology (P.K., S.H., M.B., A.R.)
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H.-P. Schlemmer
fDepartment of Radiology (M.R., H.-P.S., A.R.), German Cancer Research Center, Heidelberg, Germany.
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W. Wick
cNeuro-oncology (B.W., W.W.), Neurology Clinic, University of Heidelberg Medical Center, Heidelberg, Germany
eClinical Cooperation Unit Neuro-oncology (B.W., W.W.)
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A. von Deimling
bNeuropathology (F.S., A.v.D.)
dGerman Cancer Consortium, Clinical Cooperation Unit Neuropathology (F.S., A.v.D.)
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M. Bendszus
aFrom the Departments of Neuroradiology (P.K., S.H., M.B., A.R.)
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A. Radbruch
aFrom the Departments of Neuroradiology (P.K., S.H., M.B., A.R.)
fDepartment of Radiology (M.R., H.-P.S., A.R.), German Cancer Research Center, Heidelberg, Germany.
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    Fig 1.

    Boxplots of microvascular permeability parameters in primary CNS lymphoma and glioblastoma, including the volume transfer constant (minute−1), the volume of extravascular extracellular space per volume unit of tissue, and the flux rate constant between extravascular extracellular space and plasma (minute−1). The solid line inside the box represents the median value, while the edges represent the 25th and 75th percentiles. The straight line (bar) on each box indicates the range of data distribution. Circles represent outliers (values >1.5 box length from the 75th and 25th percentile).

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    Fig 2.

    Tissue concentration of contrast agent after bolus injection of 0.1 mmol/g of gadoterate meglumine (left column) in primary CNS lymphoma (upper row) and glioblastoma (lower row). Note the differences in the relative enhancement curve within the region of interest, encompassing the tumor (red square), which peaks at 0.53 in PCNSL and at 0.34 in GB. Perfusion parameters from kinetic modeling parameter maps (right column) were measured by using freehand region-of-interest placement within the solid part of the entire contrast-enhancing tumor (dashed red line within the zoomed kinetic maps; only 1 section is shown here). In these samples, median Ktrans values were 0.147 ± 0.031 for PCNSL and 0.045 ± 0.014 for GB.

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    Fig 3.

    Histopathologic assessment of vascular integrity from those patients shown in Fig 2 (original magnification ×200 for all stains): Immunohistochemistry for CD31 (left column) highlights endothelium in primary CNS lymphoma (PCNSL) (upper row) and glioblastoma (GB) tissue (lower row). Black arrows point to the endothelium and indicate the actual lumen of the vessel in PCNSL tissue. In contrast, white arrows in the reticulin staining of the PCNSL tissue (upper row, right) illustrate the outer border of the vessel wall, which is infiltrated by tumor cells, destroyed, and detached from the inner endothelial membrane and thus contributing to decreased vascular integrity. White arrows in the reticulin staining of the GB tissue (lower row, right) underline the integer basal membrane of vessels despite endothelial proliferation.

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American Journal of Neuroradiology: 35 (8)
American Journal of Neuroradiology
Vol. 35, Issue 8
1 Aug 2014
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P. Kickingereder, F. Sahm, B. Wiestler, M. Roethke, S. Heiland, H.-P. Schlemmer, W. Wick, A. von Deimling, M. Bendszus, A. Radbruch
Evaluation of Microvascular Permeability with Dynamic Contrast-Enhanced MRI for the Differentiation of Primary CNS Lymphoma and Glioblastoma: Radiologic-Pathologic Correlation
American Journal of Neuroradiology Aug 2014, 35 (8) 1503-1508; DOI: 10.3174/ajnr.A3915

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Evaluation of Microvascular Permeability with Dynamic Contrast-Enhanced MRI for the Differentiation of Primary CNS Lymphoma and Glioblastoma: Radiologic-Pathologic Correlation
P. Kickingereder, F. Sahm, B. Wiestler, M. Roethke, S. Heiland, H.-P. Schlemmer, W. Wick, A. von Deimling, M. Bendszus, A. Radbruch
American Journal of Neuroradiology Aug 2014, 35 (8) 1503-1508; DOI: 10.3174/ajnr.A3915
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  • Comparison of Dynamic Contrast-Enhancement Parameters between Gadobutrol and Gadoterate Meglumine in Posttreatment Glioma: A Prospective Intraindividual Study
  • Clinical Value of Vascular Permeability Estimates Using Dynamic Susceptibility Contrast MRI: Improved Diagnostic Performance in Distinguishing Hypervascular Primary CNS Lymphoma from Glioblastoma
  • Differentiation of Enhancing Glioma and Primary Central Nervous System Lymphoma by Texture-Based Machine Learning
  • Diagnostic Accuracy of T1-Weighted Dynamic Contrast-Enhanced-MRI and DWI-ADC for Differentiation of Glioblastoma and Primary CNS Lymphoma
  • The Combined Performance of ADC, CSF CXC Chemokine Ligand 13, and CSF Interleukin 10 in the Diagnosis of Central Nervous System Lymphoma
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