Added Value of Arterial Spin-Labeling MR Imaging for the Differentiation of Cerebellar Hemangioblastoma from Metastasis

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Fig 1.
Contrast-enhanced T1WI (A and C) and CBF maps derived from ASL imaging (B and D) for 2 representative cases. A and B, A cerebellar hemangioblastoma in a 36-year-old woman with a high size ratio of 1.92 and rTBF of 6.16. C and D, A cerebellar metastasis in a 42-year-old woman with breast cancer with a relatively low size ratio of 0.71 and rTBF of 2.1. E and F, A cerebellar metastasis in a 56-year-old man with renal cell carcinoma with a size ratio of 0.82 and rTBF of 14.36.
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Fig 2.
ROC curves used to differentiate hemangioblastomas from metastases by comparing size ratio and rTBF values. The AUC values for the rTBF and size ratio were 0.777 and 0.991, respectively.
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Fig 3.
ROC curves used to differentiate hemangioblastomas from metastases before and after the addition of ASL MR images for both observers. A, For observer 1, the AUC was significantly improved after additional review of the ASL MR images (from 0.594 to 0.969). B, For observer 2, the AUC was also significantly improved after this review (from 0.683 to 1).

Table 1:

Results of intra- and interobserver reproducibility^{^a}

	Hemangioblastomas		Metastases
	Intraobserver	Interobserver	Intraobserver	Interobserver
Size of an enhancing mass on postcontrast T1WI (a)	0.900 (0.739–0.964)	0.975 (0.931–0.991)	0.987 (0.927–0.998)	0.983 (0.916–0.997)
Size of a hyperintense mass on ASL images (b)	0.786 (0.489–0.920)	0.958 (0.886–0.985)	0.973 (0.850–0.995)	0.935 (0.705–0.998)
Size ratio (b/a)	0.862 (0.649–0.949)	0.934 (0.825–0.976)	0.730 (0.049–0.948)	0.801 (−0.159–0.966)
rTBF	0.824 (0.567–0.935)	0.643 (0.246–0.858)	0.996 (0.979–0.999)	0.969 (0.853–0.995)

↵a Data are intraclass correlation coefficient values, and the numbers in parentheses are 95% CIs.

Table 3:

Diagnostic predictive values for the differentiation of hemangioblastomas from metastases^{^a}

Reading Session and Statistic	Observer 1	Observer 2
Conventional image set
AUC^{^b}	0.594 (0.400–0.768)	0.683 (0.489–0.840)
Sensitivity (%)	18.8 (3/16)	43.7 (7/16)
Specificity (%)	100 (14/14)	92.9 (13/14)
Accuracy (%)	57 (17/30)	67 (20/30)
Combined ASL image set
AUC^{^b}	0.969 (0.831–0999)	1.000 (0.884–1.000)
Sensitivity (%)	93.7 (15/16)	100 (16/16)
Specificity (%)	100 (14/14)	100 (14/14)
Accuracy (%)	97 (29/30)	100 (30/30)
P value for pair-wise comparison of ROC curves	<.001	<.0001
P value calculated with the McNemar test for the comparison of accuracy	<.001	.022

↵a Unless otherwise indicated, the numbers in parentheses are raw data. Sensitivity, specificity, and accuracy were calculated under the assumption that a confidence score of 4 or higher was considered positive for the diagnosis of hemangioblastoma.
↵b Data in parentheses are 95% CIs.