ArticleFrontiers in oncology2026
Tumor apparent diffusion coefficient combined with the lipid-to-creatine ratio for preoperative differentiation of primary central nervous system lymphoma from high-grade glioma: a single-center diagnostic model development and internal validation study.
Article in Frontiers in oncology, 2026. 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
Background and purpose: Primary central nervous system lymphoma (PCNSL) and high-grade glioma (HGG) may share overlapping conventional MRI appearances. We developed and internally validated a parsimonious model combining tumor apparent diffusion coefficient (ADC) and the lipid-to-creatine ratio (Lip/Cr), compared it with every single predictor, and evaluated the secondary contribution of proximal peritumoral ADC. Materials and methods: This retrospective, availability-based cohort included 83 consecutive eligible patients with pathologically confirmed PCNSL (n = 38) or HGG (n = 45) who underwent pretreatment 3.0-T MRI with diffusion-weighted imaging and proton magnetic resonance spectroscopy. Four prespecified logistic models were evaluated. Internal validation used 2,000 stratified bootstrap resamples with standardization repeated within each resample. Distribution-appropriate summaries, paired incremental performance, empirical calibration, sensitivity analyses, and exploratory decision-curve analysis were reported. Results: Tumor ADC was lower and Lip/Cr was higher in PCNSL than in HGG (both P < 0.001). The tumor ADC plus Lip/Cr model achieved an apparent AUC of 0.925 and an optimism-corrected AUC of 0.918 (95% CI, 0.868-0.980); the corrected Brier score was 0.114 (95% CI, 0.073-0.160). Relative to Lip/Cr alone, the corrected changes were small and uncertain (ΔAUC, 0.021; 95% CI, -0.039 to 0.055; ΔBrier, -0.020; 95% CI, -0.044 to 0.023). Adding proximal peritumoral ADC also produced small and uncertain changes (ΔAUC, 0.004; 95% CI, -0.039 to 0.023; ΔBrier, -0.005; 95% CI, -0.018 to 0.027). Findings were directionally stable after log transformation of Lip/Cr and restriction of the HGG comparator to IDH-wildtype glioblastoma. Conclusions: Tumor ADC plus Lip/Cr showed favorable exploratory internal-validation performance, but superiority over Lip/Cr alone was not established. The model requires multicenter external validation with prespecified MRS quality control and should support, rather than replace, expert interpretation and histopathologic confirmation.
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