Combining Diffusion Tensor Metrics and DSC Perfusion Imaging: Can It Improve the Diagnostic Accuracy in Differentiating Tumefactive Demyelination from High-Grade Glioma?
Fourteen patients with tumefactive demyelinating lesions and 21 patients with high-grade gliomas underwent MR imaging with conventional, DTI, and DSC perfusion imaging. Conventional imaging sequences had a sensitivity of 80.9% and specificity of 57.1% in differentiating high-grade gliomas from tumefactive demyelinating lesions. DTI metrics (p:q tensor decomposition) and DSC perfusion demonstrated a statistically significant difference among enhancing portions in tumefactive demyelinating lesions and high-grade gliomas. The highest specificity was found for ADC, the anisotropic component of the diffusion tensor, and relative CBV. The authors conclude that DTI and DSC perfusion add profoundly to conventional imaging in differentiating tumefactive demyelinating lesions and high-grade gliomas.