ArticleBMC medical imaging2025
Late enhancement and wash-out maps for differentiation of glioblastoma and metastases.
Article in BMC medical imaging, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAdvanced MR imaging methods, such as perfusion, spectroscopy and diffusion-weighted imaging (DWI), help to distinguish between different types of brain tumors. We have established a rapid wash-out and late-enhancement map in our clinic. The aim of our study was to evaluate the potential usefulness of this map for the initial diagnosis.
methodsWe included patients with a histologically confirmed initial diagnosis of brain metastasis and glioblastoma who underwent our MR protocol, including MR perfusion and rapid wash-out imaging, between January 1, 2024, and March 31, 2025. The rapid wash-out and late enhancement maps are derived from two contrast-enhanced T1-weighted 3D datasets acquired at 5 and 25 min after contrast injection. We volumetrically measured the late-enhancement and wash-out of brain tumors at initial diagnosis, and analyzed the wash-out ratio as volume (wash-out) ∶ volume (wash-out + late enhancement). Additionally, we evaluated the relative cerebral blood volume (rCBV) and the apparent diffusion coefficient (ADC) ratios.
resultsForty-three patients were included in the study: 21 with glioblastoma and 22 with brain metastases. For glioblastoma, the mean wash-out ratio was 0.39 ± 0.21, the ADC ratio 1.41 ± 0.33, and the rCBV ratio 3.49 ± 1.25. In comparison, brain metastases showed a mean wash-out ratio of 0.23 ± 0.15, an ADC ratio of 1.38 ± 0.47, and an rCBV ratio of 2.25 ± 1.55. While rCBV ratio and wash-out ratio exhibited significant differences between glioblastomas and brain metastases, no such differences were observed in ADC ratios. An area-under-curve analysis revealed a ratio of 0.29 as the best threshold (for tumors larger than 1 cm³) for the wash-out ratio to distinguish glioblastomas and brain metastases with a sensitivity of 70% and a specificity of 75%.
conclusionsThe wash-out ratio serves as an additional valuable marker for distinguishing between glioblastoma and brain metastases. Since MR perfusion is not always reliable for this differentiation, this novel method provides additional diagnostic confidence during the initial assessment. Combining rCBV and wash-out ratios may provide higher diagnostic accuracy than using either method individually. CLINICAL TRIAL NUMBER: Not applicable.
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