Based on arterial spin labeling helps to differentiate high-grade gliomas from brain solitary metastasis

Gliomas grading is important for treatment plan; we aimed to investigate the application of intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) in gliomas grading, by comparing with the three-dimensional pseudocontinuous arterial spin labeling (3D pCASL). 24 patients (13 high grade gliomas and 11 low grade gliomas) underwent IVIM DWI and 3D pCASL imaging before operation; maps of fast diffusion coefficient (D∗), slow diffusion coefficient (D), fractional perfusion-related volume (f), and apparent diffusion coefficient (ADC) as well as cerebral blood flow (CBF) were calculated and then coregistered to generate the corresponding parameter values. We found CBF andD∗were higher in the high grade gliomas, whereas ADC,D, andfwere lower (allP<0.05). In differentiating the high from low grade gliomas, the maximum areas under the curves (AUC) ofD∗, CBF, and ADC were 0.857, 0.85, and 0.902, respectively. CBF was negatively correlated withfin tumor (r=-0.619,P=0.001). ADC was positively correlated withDin both tumor and white matter (r=0.887,P=0.000andr=0.824,P=0.000, resp.). There was no correlation between CBF andD∗in both tumor and white matter (P>0.05). IVIM DWI showed more efficiency than 3D pCASL but less validity than conventional DWI in differentiating the high from low grade gliomas.

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Arterial spin labeling in the grading of brain gliomas: could it help?

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-020-00352-6 ◽

2020 ◽

Vol 51 (1) ◽

Author(s):

Ahmed A. ElBeheiry ◽

Doaa M. Emara ◽

Amany Abdel-Bary Abdel-Latif ◽

Mohamed Abbas ◽

Amal S. Ismail

Keyword(s):

Perfusion Imaging ◽

Arterial Spin Labeling ◽

Spin Labeling ◽

High Morbidity ◽

Low Grade ◽

Dynamic Susceptibility ◽

High Grade ◽

Low Grade Gliomas ◽

High Grade Gliomas ◽

Brain Gliomas

Abstract Background Gliomas are characterized by high morbidity and mortality with low cure and high recurrence rates, which depends to a great degree on the angiogenesis of the tumor. Assessment of such angiogenesis by perfusion techniques is of utmost importance for the preoperative grading of gliomas. The purpose of this study was to assess the role of arterial spin labeling (ASL) perfusion as a non-contrast MRI technique in the grading of brain gliomas, in correlation with the dynamic susceptibility contrast perfusion imaging (DSC-PI). The study was carried out on 35 patients admitted to the Neurosurgery Department with MRI features of gliomas and sent for further perfusion imaging. Non-contrast ASL followed by DSC-PI was done for all cases. The final diagnosis of the cases was established by histopathology. Results Fourteen patients (14/35) had low-grade gliomas while twenty-one (21/35) had high-grade gliomas. In low-grade gliomas, four cases out of 14 were falsely graded as high-grade tumors showing hyperperfusion on ASL, three of which showed DSC-PI hypoperfusion. In high-grade gliomas, two cases out of 21 were interpreted as an indeterminate grade by ASL showing isoperfusion, however showed hyperperfusion on DSC-PI. ROC curve analysis showed ASL-derived rCBF > 2.08 to have 80.95% sensitivity, 85.71% specificity, and overall accuracy of 82.86% compared to 100% sensitivity, specificity, and accuracy of DSC-PI-derived rCBV and rCBF of > 1.1 and > 0.9, respectively. A significant positive correlation was noted between ASL and DSC-PI with correlation coefficient reaching r = 0.80 between ASL-rCBF and DSC-rCBF (p < 0.01) and r = 0.68 between ASL and DSC-rCBV (p < 0.01). Conclusions ASL is a relatively recent non-contrast perfusion technique that obtains results which are in fair agreement with the more established DSC perfusion imaging making it an alternative method for preoperative assessment of perfusion of gliomas, especially for patients with contraindications to contrast agents.

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Tumor blood flow from arterial spin labeling perfusion MRI: A key parameter in distinguishing high-grade gliomas from primary cerebral lymphomas, and in predicting genetic biomarkers in high-grade gliomas

Journal of Magnetic Resonance Imaging ◽

10.1002/jmri.24026 ◽

2013 ◽

Vol 38 (4) ◽

pp. 852-860 ◽

Cited By ~ 31

Author(s):

Roh-Eul Yoo ◽

Seung Hong Choi ◽

Hye Rim Cho ◽

Tae Min Kim ◽

Se-Hoon Lee ◽

...

Keyword(s):

Blood Flow ◽

Arterial Spin Labeling ◽

Spin Labeling ◽

Perfusion Mri ◽

High Grade ◽

Tumor Blood Flow ◽

Genetic Biomarkers ◽

High Grade Gliomas ◽

Key Parameter

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Utility of intravoxel incoherent motion magnetic resonance imaging and arterial spin labeling for recurrent glioma after bevacizumab treatment

Acta Radiologica ◽

10.1177/0284185118759707 ◽

2018 ◽

Vol 59 (11) ◽

pp. 1372-1379 ◽

Cited By ~ 2

Author(s):

Fuminori Miyoshi ◽

Yuki Shinohara ◽

Atsushi Kambe ◽

Keita Kuya ◽

Atsushi Murakami ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Diffusion Coefficient ◽

Magnetic Resonance ◽

Tumor Progression ◽

Arterial Spin Labeling ◽

Spin Labeling ◽

Intravoxel Incoherent Motion ◽

Low Grade ◽

High Grade ◽

Resonance Imaging

Background Detecting recurrence of glioma on magnetic resonance imaging (MRI) is getting more and more important, especially after administration of new anti-tumor agent. However, it is still hard to identify. Purpose To examine the utility of intravoxel incoherent motion (IVIM) MRI and arterial spin labeling-cerebral blood flow (ASL-CBF) for recurrent glioma after initiation of bevacizumab (BEV) treatment. Material and Methods Thirteen patients (7 men, 6 women; age range = 41–82 years) with glioma (high grade, n = 11; low grade, n = 2) were enrolled in the study. IVIM parameters including apparent diffusion coefficient (ADC), true diffusion coefficient (D), and perfusion fraction (f) were obtained with 14 different b-values. We identified tumor progression during BEV therapy by MRI monitoring consisting of diffusion-weighted imaging (DWI), fluid-attenuated inversion recovery (FLAIR) imaging, and contrast-enhanced T1-weighted (CE-T1W) imaging by measuring tumor area. We also measured each parameter of IVIM and ASL-CBF, and calculated relative ADC (rADC), relative D (rD), relative f (rf), and relative CBF (rCBF) by obtaining the ratio between each area and the contralateral cerebral white matter. We calculated the rate of change (Δ) by subtracting values from those from the preceding MRI study, and obtained Spearman’s rank correlation coefficient (rs). Results Tumor progression was identified in nine patients (high grade, n = 7; low grade, n = 2). Negative correlations were identified between ΔrD and ΔDWI area (rs = –0.583), and between ΔrD and ΔCE-T1W imaging area (rs = –0.605). Conclusion Tumor progression after BEV treatment can be identified by decreasing rD.

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Arterial spin labeling MR imaging for differentiation between high- and low-grade glioma—a meta-analysis

Neuro-Oncology ◽

10.1093/neuonc/noy095 ◽

2018 ◽

Vol 20 (11) ◽

pp. 1450-1461 ◽

Cited By ~ 4

Author(s):

Alberto Falk Delgado ◽

Francesca De Luca ◽

Danielle van Westen ◽

Anna Falk Delgado

Keyword(s):

Mr Imaging ◽

Arterial Spin Labeling ◽

Diagnostic Performance ◽

Meta Analysis ◽

Spin Labeling ◽

Low Grade Glioma ◽

Cochrane Library ◽

Low Grade ◽

High Grade ◽

Operating Characteristics

Abstract Background Arterial spin labeling is an MR imaging technique that measures cerebral blood flow (CBF) non-invasively. The aim of the study is to assess the diagnostic performance of arterial spin labeling (ASL) MR imaging for differentiation between high-grade glioma and low-grade glioma. Methods Cochrane Library, Embase, Medline, and Web of Science Core Collection were searched. Study selection ended November 2017. This study was prospectively registered in PROSPERO (CRD42017080885). Two authors screened all titles and abstracts for possible inclusion. Data were extracted independently by 2 authors. Bivariate random effects meta-analysis was used to describe summary receiver operating characteristics. Trial sequential analysis (TSA) was performed. Results In total, 15 studies with 505 patients were included. The diagnostic performance of ASL CBF for glioma grading was 0.90 with summary sensitivity 0.89 (0.79–0.90) and specificity 0.80 (0.72–0.89). The diagnostic performance was similar between pulsed ASL (AUC 0.90) with a sensitivity 0.85 (0.71–0.91) and specificity 0.83 (0.69–0.92) and pseudocontinuous ASL (AUC 0.88) with a sensitivity 0.86 (0.79–0.91) and specificity 0.80 (0.65–0.87). In astrocytomas, the diagnostic performance was 0.89 with sensitivity 0.86 (0.79 to 0.91) and specificity 0.79 (0.63 to 0.89). Sensitivity analysis confirmed the robustness of the findings. TSA revealed that the meta-analysis was adequately powered. Conclusion Arterial spin labeling MR imaging had an excellent diagnostic accuracy for differentiation between high-grade and low-grade glioma. Given its low cost, non-invasiveness, and efficacy, ASL MR imaging should be considered for implementation in the routine workup of patients with glioma.

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