Glioblastoma Multiforme versus Solitary Supratentorial Brain Metastasis: Differentiation Based on Morphology and Magnetic Resonance Signal Characteristics

Abstract

Purpose: To evaluate the diagnostic potential of a multi-factor analysis of morphometric parameters and magnetic resonance (MR) signal characteristics of a mass and peritumoral area to distinguish solitary supratentorial metastasis from glioblastoma multiforme (GBM).

Materials and Methods: MR examinations of 51 patients with histologically proven GBM and 44 with a single supratentorial metastasis were evaluated. A large variety of morphologic criteria and MR signal characteristics in different sequences were analyzed. The data were subjected to logistic regression to investigate their ability to discriminate between GBM and cerebral metastasis. Receiver-operating characteristic (ROC) analysis was used to select an optimal cut-off point for prediction and to assess the predictive value in terms of sensitivity, specificity, and accuracy of the final model.

Results: The logistic regression analysis revealed that the ratio of the maximum diameter of the peritumoral area measured on T2-weighted images (d T2) to the maximum diameter of the enhancing mass area (d T1, post-contrast) is the only useful criterion to distinguish single supratentorial brain metastasis from GBM with a lower ratio favoring GBM (accuracy 68 %, sensitivity 84 % and specificity 45 %). The cut-off point for the ratio d T2/d T1 post-contrast was calculated as 2.35.

Conclusion: Measurement of maximum diameters of the peritumoral area in relation to the enhancing mass can be evaluated easily in the clinical routine to discriminate GBM from solitary supratentorial metastasis with an accuracy comparable to that of advanced MRI techniques.

Zusammenfassung

Ziel: Evaluation der diagnostischen Wertigkeit einer multifaktoriellen Analyse zur Differenzierung solitärer supratentorieller Hirnmetastasen von einem Glioblastoma multiforme (GBM) unter Berücksichtigung morphologischer Parameter und magnetresonanztomografischer Signalcharakteristika der Tumormasse und der peritumoralen Zone.

Material und Methoden: Magnetresonanztomografie(MRT)-Untersuchungen von 51 Patienten mit einem jeweils histologisch gesicherten GBM und 44 Patienten mit einer singulären supratentoriellen Hirnmetastase wurden evaluiert. Hierbei wurde eine Vielzahl morphologischer Kriterien und MRT-Signalcharakteristika in verschiedenen Sequenzen analysiert. Mittels einer logistischen Regressionsanalyse wurde die Wertigkeit der verschiedenen Kriterien zur Differenzierung zwischen einem GBM und einer singulären Metastase untersucht. Mit einer Receiver-Operating-Characteristics(ROC)-Analyse wurde ein optimaler Schwellenwert zur Vorhersage ermittelt unter Berücksichtigung der Sensitivität, Spezifität und Genauigkeit des finalen Modells.

Ergebnisse: Die logistische Regressionsanalyse ergab, dass das Verhältnis des maximalen Durchmessers des peritumoralen Areals in T2-gewichteten Sequenzen (d T2) im Verhältnis mit dem maximalen Durchmesser der kontrastmittelaufnehmenden Tumormasse (d T1, post contrast) das einzige dienliche Kriterium zur Differenzierung einer singulären supratentoriellen Metastase von einem GBM darstellt (Genauigkeit 68 %, Sensitivität 84 % und Spezifität 45 %). Der Schwellenwert für das Verhältnis d T2/d T1, post contrast betrug 2,35.

Schlussfolgerung: Das Verhältnis aus den maximalen Durchmessern des peritumoralen Areals und der kontrastmittelaufnehmenden Tumormasse kann in der klinischen Routine einfach erfasst werden und ermöglicht bei der Differenzierung von singulären Hirnmetastasen und GBM eine Genauigkeit ähnlich derjenigen neuester MRT-Techniken.

Key words

glioblastoma multiforme - brain metastases - multi-factor analysis - morphologic criteria - magnetic resonance imaging

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