Abstract
Background
The imaging appearance of neoplastic hematoma can be complicated by the presence of a large hematoma, even on magnetic resonance imaging (MRI). We describe the role of MR perfusion (MRP) in detecting neoplastic hematomas in patients with intraparenchymal hematoma (IPH).
Material and Methods
A retrospective review was performed for consecutive patients with IPH, where MRP was performed. Routine, post-gadolinium MRI and MRP were analyzed. All patients were either operated on for evacuation of IPH or followed up on imaging. The MRP parameters of cerebral blood volume (CBV) and cerebral blood flow (CBF) and pattern of enhancement (peripheral linear vs. nodular) were recorded. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) were calculated for these parameters for diagnosing neoplastic hematoma.
Results
Of 116 patients with MRP, 16 patients (male 8; mean age—65.5 years) had IPH on their initial MRI. For diagnosing neoplastic hematoma, the sensitivity, specificity, PPV and NPV for increased CBF and CBV were 100%, 88.9%, 87.5%, and 100%; for peripheral linear enhancement were 100%, 28.6%, 50%, 100% and for nodular enhancement were 85.7%, 77.8%, 75% and 12.5%, respectively. The combination of peripheral linear enhancement and increased CBF and CBV showed 100% sensitivity, specificity, PPV and NPV.
Conclusion
In our small series, the combination of peripheral linear enhancement and increased CBF and CBV showed 100% sensitivity, specificity, PPV and NPV for diagnosing a neoplastic hematoma. These findings need to be validated in a larger study.
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References
Destian S, Sze G, Krol G, Zimmerman RD, Deck MD. MR imaging of hemorrhagic intracranial neoplasms. AJR Am J Roentgenol. 1989;152:137–44.
Atlas SW, Grossman RI, Gomori JM, Hackney DB, Goldberg HI, Zimmerman RA, Bilaniuk LT. Hemorrhagic intracranial malignant neoplasms: spin-echo MR imaging. Radiology. 1987;164:71–7.
Law M, Yang S, Babb JS, Knopp EA, Golfinos JG, Zagzag D, Johnson G. Comparison of cerebral blood volume and vascular permeability from dynamic susceptibility contrast-enhanced perfusion MR imaging with glioma grade. AJNR Am J Neuroradiol. 2004;25:746–55.
Law M, Cha S, Knopp EA, Johnson G, Arnett J, Litt AW. High-grade gliomas and solitary metastases: differentiation by using perfusion and proton spectroscopic MR imaging. Radiology. 2002;222:715–21.
Ellika SK, Jain R, Patel SC, Scarpace L, Schultz LR, Rock JP, Mikkelsen T. Role of perfusion CT in glioma grading and comparison with conventional MR imaging features. AJNR Am J Neuroradiol. 2007;28:1981–7.
Jain R, Ellika SK, Scarpace L, Schultz LR, Rock JP, Gutierrez J, Patel SC, Ewing J, Mikkelsen T. Quantitative estimation of permeability surface-area product in astroglial brain tumors using perfusion CT and correlation with histopathologic grade. AJNR Am J Neuroradiol. 2008;29:694–700.
Parks NE, Bhan V, Shankar JJ. Perfusion imaging and contrast enhancement characteristics of tumefactive demyelinating lesions compared to high grade gliomas. Can J Neurol Sci. 2016;43:316–8.
Shankar JJ, Woulfe J, Silva VD, Nguyen TB. CT perfusion and permeability in the prognosis of high grade gliomas. AJR Am J Roentgenol. 2013;200:W504–9.
Olivot JM, Mlynash M, Kleinman JT, Straka M, Venkatasubramanian C, Bammer R, Moseley ME, Albers GW, Wijman CA; DASH investigators. MRI profile of the perihematomal region in acute intracerebral hemorrhage. Stroke. 2010;41:2681–3.
Greenlaw G, Shankar JJS. Correlation of CT and MR perfusion and permeability parameters for intracranial tumors. Electronic poster in ASNR; 26.–28.05.2016; Washington DC. 2016.
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J.J.S. Shankar and N. Sinha declare that they have no competing interests.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
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Shankar, J.J.S., Sinha, N. Diagnosing Neoplastic Hematoma: Role of MR Perfusion. Clin Neuroradiol 29, 263–268 (2019). https://doi.org/10.1007/s00062-018-0664-6
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DOI: https://doi.org/10.1007/s00062-018-0664-6