The Application of Image Segmentation to Determine the Ratio of Peritumoral Edema Area to Tumor Area on Primary Malignant Brain Tumor and Metastases through Conventional Magnetic Resonance Imaging

BACKGROUND: Primary malignant brain tumor and metastases on the brain have a similar pattern in conventional magnetic resonance imaging (MRI), even though both require entirely different treatment and management. The pathophysiological difference of peritumoral edema can help to distinguish the case of primary malignant brain tumor and brain metastases. AIM: This study aimed to analyze the ratio of the area of peritumoral edema to the tumor using Otsu’s method of image segmentation technique with a user-friendly graphical user interface. METHODS: Data were prepared by obtaining the examination results of anatomical pathology and MRI imaging. The area of peritumoral edema was identified from MRI image segmentation with T2/fluid attenuated inversion recovery sequence. The area of tumor was identified using MRI image segmentation with T1 sequence. RESULTS: The Mann–Whitney test was employed to analyze the ratio of the area of peritumoral edema to tumor on both groups. Data testing produced a significance level of 0.013 (p < 0.05) with a median value (N_max-N_min) of 1.14 (3.31–0.08) for the primary malignant brain tumor group and a median value (N_max-N_min) of 1.17 (10.30–0.90) for the brain metastases group. CONCLUSIONS: There was a significant difference in the ratio of the area of peritumoral edema to the area of tumor from both groups, in which brain metastases have a greater value than the primary malignant brain tumor.