Differentiation of Multiple Brain Metastases and Glioblastoma with Multiple Foci Using MRI Criteria

Overview

Journal BMC Med Imaging

Publisher Biomed Central

Specialty Radiology

Date 2024 Jan 3

PMID 38166651

Authors

Sebastian Johannes Muller

Eya Khadhraoui

Marielle Ernst

Veit Rohde

Bawarjan Schatlo

Vesna Malinova

Affiliations

Soon will be listed here.

Abstract

Objective: Glioblastoma with multiple foci (mGBM) and multiple brain metastases share several common features on magnetic resonance imaging (MRI). A reliable preoperative diagnosis would be of clinical relevance. The aim of this study was to explore the differences and similarities between mGBM and multiple brain metastases on MRI.

Methods: We performed a retrospective analysis of 50 patients with mGBM and compared them with a cohort of 50 patients with multiple brain metastases (2-10 lesions) histologically confirmed and treated at our department between 2015 and 2020. The following imaging characteristics were analyzed: lesion location, distribution, morphology, (T2-/FLAIR-weighted) connections between the lesions, patterns of contrast agent uptake, apparent diffusion coefficient (ADC)-values within the lesion, the surrounding T2-hyperintensity, and edema distribution.

Results: A total of 210 brain metastases and 181 mGBM lesions were analyzed. An infratentorial localization was found significantly more often in patients with multiple brain metastases compared to mGBM patients (28 vs. 1.5%, p < 0.001). A T2-connection between the lesions was detected in 63% of mGBM lesions compared to 1% of brain metastases. Cortical edema was only present in mGBM. Perifocal edema with larger areas of diffusion restriction was detected in 31% of mGBM patients, but not in patients with metastases.

Conclusion: We identified a set of imaging features which improve preoperative diagnosis. The presence of T2-weighted imaging hyperintensity connection between the lesions and cortical edema with varying ADC-values was typical for mGBM.

Citing Articles

Feasibility Study of Detecting and Segmenting Small Brain Tumors in a Small MRI Dataset with Self-Supervised Learning.

Zhang W, Chen W, Liu C, Chen S, Lai Y, You S Diagnostics (Basel). 2025; 15(3).

PMID: 39941179 PMC: 11817956. DOI: 10.3390/diagnostics15030249.

Quantitative Physiologic MRI Combined with Feature Engineering for Developing Machine Learning-Based Prediction Models to Distinguish Glioblastomas from Single Brain Metastases.

Hosseini S, Servaes S, Hall B, Bhaduri S, Rajan A, Rosa-Neto P Diagnostics (Basel). 2025; 15(1.

PMID: 39795566 PMC: 11720653. DOI: 10.3390/diagnostics15010038.

Comparison of a new MR rapid wash-out map with MR perfusion in brain tumors.

Khadhraoui E, Schmidt L, Klebingat S, Schwab R, Hernandez-Duran S, Gihr G BMC Cancer. 2024; 24(1):1139.

PMID: 39267002 PMC: 11395865. DOI: 10.1186/s12885-024-12909-z.

Accuracy of Intra-Axial Brain Tumor Characterization in the Emergency MRI Reports: A Retrospective Human Performance Benchmarking Pilot Study.

Siren A, Turkia E, Nyman M, Hirvonen J Diagnostics (Basel). 2024; 14(16).

PMID: 39202279 PMC: 11353410. DOI: 10.3390/diagnostics14161791.

References

Thomas R, Xu L, Lober R, Li G, Nagpal S . The incidence and significance of multiple lesions in glioblastoma. J Neurooncol. 2013; 112(1):91-7. DOI: 10.1007/s11060-012-1030-1. View

Visted T, Enger P, Lund-Johansen M, Bjerkvig R . Mechanisms of tumor cell invasion and angiogenesis in the central nervous system. Front Biosci. 2003; 8:e289-304. DOI: 10.2741/1026. View

Cellina M, Fetoni V, Baron P, Orsi M, Oliva G . Unusual primary central nervous system lymphoma location involving the fourth ventricle and hypothalamus. Neuroradiol J. 2015; 28(2):120-5. PMC: 4757149. DOI: 10.1177/1971400915576671. View

Kikuchi K, Hiratsuka Y, Kohno S, Ohue S, Miki H, Mochizuki T . Radiological features of cerebellar glioblastoma. J Neuroradiol. 2016; 43(4):260-5. DOI: 10.1016/j.neurad.2015.10.006. View

Gavrilovic I, Posner J . Brain metastases: epidemiology and pathophysiology. J Neurooncol. 2005; 75(1):5-14. DOI: 10.1007/s11060-004-8093-6. View

Baro V, Cerretti G, Todoverto M, Della Puppa A, Chioffi F, Volpin F . Newly Diagnosed Multifocal GBM: A Monocentric Experience and Literature Review. Curr Oncol. 2022; 29(5):3472-3488. PMC: 9139839. DOI: 10.3390/curroncol29050280. View

Beig Zali S, Alinezhad F, Ranjkesh M, Daghighi M, Poureisa M . Accuracy of apparent diffusion coefficient in differentiation of glioblastoma from metastasis. Neuroradiol J. 2021; 34(3):205-212. PMC: 8165902. DOI: 10.1177/1971400920983678. View

Mouthuy N, Cosnard G, Abarca-Quinones J, Michoux N . Multiparametric magnetic resonance imaging to differentiate high-grade gliomas and brain metastases. J Neuroradiol. 2011; 39(5):301-7. DOI: 10.1016/j.neurad.2011.11.002. View

Shutran M, Mosbach D, Tataryn Z, Arkun K, Wu J . Case Report: Metastasis of a Trigeminal Malignant Peripheral Nerve Sheath Tumor to the Corpus Callosum. Neurosurgery. 2018; 84(1):E63-E67. DOI: 10.1093/neuros/nyy016. View

10.

Garber S, Khoury L, Bell D, Schomer D, Janku F, McCutcheon I . Metastatic Adenoid Cystic Carcinoma Mimicking Butterfly Glioblastoma: A Rare Presentation in the Splenium of the Corpus Callosum. World Neurosurg. 2016; 95:621.e13-621.e19. DOI: 10.1016/j.wneu.2016.07.111. View

11.

Singh Achrol A, Rennert R, Anders C, Soffietti R, Ahluwalia M, Nayak L . Brain metastases. Nat Rev Dis Primers. 2019; 5(1):5. DOI: 10.1038/s41572-018-0055-y. View

12.

Huang B, Geng D, Zee C, Ji Y, Cheng H, Dai Y . A unique magnetic resonance imaging feature of glioblastoma multiforme: the 'pseudopalisade' sign. J Int Med Res. 2010; 38(2):686-93. DOI: 10.1177/147323001003800233. View

13.

Cha S, Lupo J, Chen M, Lamborn K, McDermott M, Berger M . Differentiation of glioblastoma multiforme and single brain metastasis by peak height and percentage of signal intensity recovery derived from dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging. AJNR Am J Neuroradiol. 2007; 28(6):1078-84. PMC: 8134129. DOI: 10.3174/ajnr.A0484. View

14.

Dong F, Li Q, Jiang B, Zhu X, Zeng Q, Huang P . Differentiation of supratentorial single brain metastasis and glioblastoma by using peri-enhancing oedema region-derived radiomic features and multiple classifiers. Eur Radiol. 2020; 30(5):3015-3022. DOI: 10.1007/s00330-019-06460-w. View

15.

Muller S, Khadhraoui E, Neef N, Riedel C, Ernst M . Differentiation of brain metastases from small and non-small lung cancers using apparent diffusion coefficient (ADC) maps. BMC Med Imaging. 2021; 21(1):70. PMC: 8048287. DOI: 10.1186/s12880-021-00602-7. View

16.

Jung W, Park C, Hong C, Suh S, Ahn S . Diffusion-Weighted Imaging of Brain Metastasis from Lung Cancer: Correlation of MRI Parameters with the Histologic Type and Gene Mutation Status. AJNR Am J Neuroradiol. 2018; 39(2):273-279. PMC: 7410588. DOI: 10.3174/ajnr.A5516. View

17.

Tukey J . Comparing individual means in the analysis of variance. Biometrics. 1949; 5(2):99-114. View

18.

Stark A, van de Bergh J, Hedderich J, Mehdorn H, Nabavi A . Glioblastoma: clinical characteristics, prognostic factors and survival in 492 patients. Clin Neurol Neurosurg. 2012; 114(7):840-5. DOI: 10.1016/j.clineuro.2012.01.026. View

19.

Ostrom Q, Patil N, Cioffi G, Waite K, Kruchko C, Barnholtz-Sloan J . CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2013-2017. Neuro Oncol. 2020; 22(12 Suppl 2):iv1-iv96. PMC: 7596247. DOI: 10.1093/neuonc/noaa200. View

20.

Batzdorf U, MALAMUD N . THE PROBLEM OF MULTICENTRIC GLIOMAS. J Neurosurg. 1963; 20:122-36. DOI: 10.3171/jns.1963.20.2.0122. View