Abstract
Arterial spin-labeled magnetic resonance imaging can provide quantitative perfusion measurements in the brain and can be potentially used to evaluate therapy response assessment in glioblastoma (GBM). The reliability and reproducibility of this method to measure noncontrast perfusion in GBM, however, are lacking. We evaluated the intrasession reliability of brain and tumor perfusion in both healthy volunteers and patients with GBM at 3 T using pseudocontinuous labeling (pCASL) and 3D turbo spin echo (TSE) using Cartesian acquisition with spiral profile reordering (CASPR). Two healthy volunteers at a single time point and 6 newly diagnosed patients with GBM at multiple time points (before, during, and after chemoradiation) underwent scanning (total, 14 sessions). Compared with 3D GraSE, 3D TSE-CASPR generated cerebral blood flow maps with better tumor-to-normal background tissue contrast and reduced image distortions. The intraclass correlation coefficient between the 2 runs of 3D pCASL with TSE-CASPR was consistently high (≥0.90) across all normal-appearing gray matter (NAGM) regions of interest (ROIs), and was particularly high in tumors (0.98 with 95% confidence interval [CI]: 0.97–0.99). The within-subject coefficients of variation were relatively low in all normal-appearing gray matter regions of interest (3.40%–7.12%), and in tumors (4.91%). Noncontrast perfusion measured using 3D pCASL with TSE-CASPR provided robust cerebral blood flow maps in both healthy volunteers and patients with GBM with high intrasession repeatability at 3 T. This approach can be an appropriate noncontrast and noninvasive quantitative perfusion imaging method for longitudinal assessment of therapy response and management of patients with GBM.
Highlights
Oncologic patient care and clinical trials are increasingly relying on radiological images for the assessment of therapy response
No major differences were observed in the cerebral blood flow (CBF) maps between the 2 runs of 3D pseudocontinuous ASL (pCASL) with turbo spin echo (TSE)-Cartesian acquisition with spiral profile reordering (CASPR) and 3D pCASL with gradient and spin echo (GraSE)
Noninvasive methods to quantify tumor perfusion at the baseline and more importantly for longitudinal assessment of therapy response will be beneficial for personalized patient care
Summary
Oncologic patient care and clinical trials are increasingly relying on radiological images for the assessment of therapy response. The radiological assessment of therapy response is predominantly based on tumor size changes measured using methods such as the Response Evaluation Criteria in Solid Tumors (RECIST) [1] or Response Assessment in Neuro-Oncology (RANO) [2]. This is a major limiting factor, as the effects of many therapeutic agents at the microscopic level precede the eventual changes in tumor size. Unlike other perfusion-weighted imaging techniques such as positron emission tomography (PET) using 15O-labeled water, 99mTc-labeled single-photon emission computed tomography, or iodine-based contrast-enhanced computed tomography, MRI
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