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Background <p>Advanced 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.</p> Methods <p>We 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&#xa0;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.</p> Results <p>Forty-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&#xa0;cm³) for the wash-out ratio to distinguish glioblastomas and brain metastases with a sensitivity of 70% and a specificity of 75%.</p> Conclusions <p>The 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.</p> Clinical trial number <p>Not applicable.</p>

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Late enhancement and wash-out maps for differentiation of glioblastoma and metastases

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年8月27日

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  • Leon Schmidt,
  • Eya Khadhraoui,
  • Stefan Klebingat,
  • I. Erol Sandalcioglu,
  • Roland Schwab,
  • Belal Neyazi,
  • Daniel Behme,
  • Klaus-Peter Stein,
  • Sebastian Johannes Müller

摘要

Background

Advanced 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.

Methods

We 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.

Results

Forty-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%.

Conclusions

The 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.