Abstract
The aim of the study was to evaluate the role of pseudocontinuous arterial spin labeling perfusion (pCASL-perfusion) in preoperative assessment of cerebral glioma grades. The study group consisted of 253 patients, aged 7–78 years with supratentorial gliomas (65 low-grade gliomas (LGG), 188 high-grade gliomas (HGG)). We used 3D pCASL-perfusion for each patient in order to calculate the tumor blood flow (TBF). We obtained maximal tumor blood flow (maxTBF) in small regions of interest (30 ± 10 mm2) and then normalized absolute maximum tumor blood flow (nTBF) to that of the contralateral normal-appearing white matter of the centrum semiovale. MaxTBF and nTBF values significantly differed between HGG and LGG groups (p < 0.001), as well as between patient groups separated by the grades (grade II vs. grade III) (p < 0.001). Moreover, we performed ROC-analysis which demonstrated high sensitivity and specificity in differentiating between HGG and LGG. We found significant differences for maxTBF and nTBF between grade III and IV gliomas, however, ROC-analysis showed low sensitivity and specificity. We did not observe a significant difference in TBF for astrocytomas and oligodendrogliomas. Our study demonstrates that 3D pCASL-perfusion as an effective diagnostic tool for preoperative differentiation of glioma grades.
Highlights
Gliomas are the most common type of primary brain tumors and account for about 80% of all malignant brain neoplasms
Several studies reported a high correlation between tumor blood flow values measured by Arterial spin labeling (ASL)-perfusion and Dynamic Susceptibility Contrast (DSC)-perfusion[15,18]
This study demonstrated the effectiveness of pseudocontinuous ASL (pCASL) in glioma grades differentiation
Summary
Gliomas are the most common type of primary brain tumors and account for about 80% of all malignant brain neoplasms. Preoperative predicting of glioma grade is important for planning optimal treatment strategy and predicting prognosis[1,2]. It is well-known, that advanced diagnostic modalities, for example, MR-perfusion, are more effective in establishing brain tumor grades as compared to the routine MRI3,4. Arterial spin labeling (ASL) is a non-invasive method of measuring CBF (cerebral blood flow) values; its ability to evaluate glioma grades remains controversial. Previous studies have reported that CBF imaging using PASL and pCASL is informative for assessing gliomas, as well as differentiating high- and low-grade gliomas before surgery[8–15], and for disease prognosis[10,16,17]. Several studies reported a high correlation between tumor blood flow values measured by ASL-perfusion and DSC-perfusion[15,18]
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