Abstract
BackgroundGliomas 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.ResultsFourteen 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).ConclusionsASL 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.
Highlights
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
These were classified into 14 low-grade gliomas (LGGs) and 21 high-grade gliomas (HGGs) according to the latest WHO classification criteria (2016)
receiver operating characteristic curve (ROC) curve analysis showed arterial spin labeling (ASL)-derived relative cerebral blood flow (rCBF) > 2.08 to have 80.95% sensitivity and 85.71% specificity and overall accuracy of 82.86% compared to 100% sensitivity, specificity, and accuracy of dynamic susceptibility contrast perfusion imaging (DSC-PI)-derived relative cerebral blood volume (rCBV) and rCBF of > 1.1 and > 0.9, respectively, in differentiation between low- and high-grade gliomas (Tables 4 and 5, Fig. 4)
Summary
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). Contrast-enhanced conventional MR imaging is mostly sufficient for intracranial tumor diagnosis. Enhancement after contrast agent reflects blood-brain barrier disruption rather than a true assessment of tumor vascularity. The differential diagnosis between high- and low-grade tumors is challenged
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