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CC BY-NC-ND 4.0 · Asian J Neurosurg 2024; 19(02): 186-201
DOI: 10.1055/s-0044-1787051
Research Article

Predictors for the Differentiation between Glioblastoma, Primary Central Nervous System Lymphoma, and Metastasis in Patients with a Solitary Enhancing Intracranial Mass

Autoren

  • Pornthida Chuthip

    1   Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
    2   Department of Surgery, Pattani Hospital, Pattani, Thailand

  • Bunpot Sitthinamsuwan 

    1   Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

  • Theerapol Witthiwej

    1   Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

  • Chottiwat Tansirisithikul

    1   Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

  • Inthira Khumpalikit 

    1   Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

  • Sarun Nunta-aree

    1   Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

Funding None.
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Abstract

Introduction Differentiation between glioblastoma (GBM), primary central nervous system lymphoma (PCNSL), and metastasis is important in decision-making before surgery. However, these malignant brain tumors have overlapping features. This study aimed to identify predictors differentiating between GBM, PCNSL, and metastasis.

Materials and Methods Patients with a solitary intracranial enhancing tumor and a histopathological diagnosis of GBM, PCNSL, or metastasis were investigated. All patients with intracranial lymphoma had PCNSL without extracranial involvement. Demographic, clinical, and radiographic data were analyzed to determine their associations with the tumor types.

Results The predictors associated with GBM were functional impairment (p = 0.001), large tumor size (p < 0.001), irregular tumor margin (p < 0.001), heterogeneous contrast enhancement (p < 0.001), central necrosis (p < 0.001), intratumoral hemorrhage (p = 0.018), abnormal flow void (p < 0.001), and hypodensity component on noncontrast cranial computed tomography (CT) scan (p < 0.001). The predictors associated with PCNSL comprised functional impairment (p = 0.005), deep-seated tumor location (p = 0.006), homogeneous contrast enhancement (p < 0.001), absence of cystic appearance (p = 0.008), presence of hypointensity component on precontrast cranial T1-weighted magnetic resonance imaging (MRI; p = 0.027), and presence of isodensity component on noncontrast cranial CT (p < 0.008). Finally, the predictors for metastasis were an infratentorial (p < 0.001) or extra-axial tumor location (p = 0.035), smooth tumor margin (p < 0.001), and presence of isointensity component on cranial fluid-attenuated inversion recovery MRI (p = 0.047).

Conclusion These predictors may be used to differentiate between GBM, PCNSL, and metastasis, and they are useful in clinical management.

Keywords

glioblastoma - brain metastasis - primary central nervous system lymphoma (PCNSL) - predictor - differentiation

Authors' Contributions

P.C.: development or design of methodology, project administration, software, investigation, data collection, formal analysis, visualization, writing—original draft preparation, and approval of the final manuscript; B.S.: conceptualization, development or design of methodology, supervision, formal analysis, writing—reviewing and editing, corresponding author, and approval of the final manuscript; T.W.: writing—reviewing and editing, and approval of the final manuscript; C.T.: writing—reviewing and editing, and approval of the final manuscript; I.K.: writing—reviewing and editing, and approval of the final manuscript; S.N.: writing—reviewing and editing, and approval of the final manuscript.


Ethical Approval

This study was approved by the Ethics Committee of the Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand; Certificate of Approval (COA) number SI 556/2014. All the patients' data retained full confidentiality in compliance with the Declaration of Helsinki.




Publikationsverlauf

Artikel online veröffentlicht:
06. Juni 2024

© 2024. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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