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Bayraktar ES, Duygulu G, Çetinoğlu YK, Gelal MF, Apaydın M, Ellidokuz H. Comparison of ASL and DSC perfusion methods in the evaluation of response to treatment in patients with a history of treatment for malignant brain tumor. BMC Med Imaging 2024; 24:70. [PMID: 38519901 PMCID: PMC10958956 DOI: 10.1186/s12880-024-01249-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/15/2024] [Indexed: 03/25/2024] Open
Abstract
OBJECTIVE Perfusion MRI is of great benefit in the post-treatment evaluation of brain tumors. Interestingly, dynamic susceptibility contrast-enhanced (DSC) perfusion has taken its place in routine examination for this purpose. The use of arterial spin labeling (ASL), a perfusion technique that does not require exogenous contrast material injection, has gained popularity in recent years. The aim of the study was to compare two different perfusion techniques, ASL and DSC, using qualitative and quantitative measurements and to investigate the diagnostic effectiveness of both. The fact that the number of patients is higher than in studies conducted with 3D pseudo-continious ASL (pCASL), the study group is heterogeneous as it consists of patients with both metastases and glial tumors, the use of 3D Turbo Gradient Spin Echo (TGSE), and the inclusion of visual (qualitative) assessment make our study unique. METHODS Ninety patients, who were treated for malignant brain tumor, were enrolled in the retrospective study. DSC Cerebral Blood Volume (CBV), Cerebral Blood Flow (CBF) and ASL CBF maps of each case were obtained. In qualitative analysis, the lesions of the cases were visually classified as treatment-related changes (TRC) and relapse/residual mass (RRT). In the quantitative analysis, three regions of interest (ROI) measurements were taken from each case. The average of these measurements was compared with the ROI taken from the contralateral white matter and normalized values (n) were obtained. These normalized values were compared across events. RESULTS Uncorrected DSC normalized CBV (nCBV), DSC normalized CBF (nCBF) and ASL nCBF values of RRT cases were higher than those of TRC cases (p < 0.001). DSC nCBV values were correlated with DSC nCBF (r: 0.94, p < 0.001) and correlated with ASL nCBF (r: 0.75, p < 0.001). Similarly, ASL nCBF was positively correlated with DSC nCBF (r: 0.79 p < 0.01). When the ROC curve parameters were evaluated, the cut-off values were determined as 1.211 for DSC nCBV (AUC: 0.95, 93% sensitivity, 82% specificity), 0.896 for DSC nCBF (AUC; 0.95, 93% sensitivity, 82% specificity), and 0.829 for ASL nCBF (AUC: 0.84, 78% sensitivity, 75% specificity). For qualitative evaluation (visual evaluation), inter-observer agreement was found to be good for ASL CBF (0.714), good for DSC CBF (0.790), and excellent for DSC CBV (0.822). Intra-observer agreement was also evaluated. For the first observer, good agreement was found in ASL CBF (0.626, 70% sensitive, 93% specific), in DSC CBF (0.713, 76% sensitive, 95% specific), and in DSC CBV (0.755, 87% sensitive - 88% specific). In the second observer, moderate agreement was found in ASL CBF (0.584, 61% sensitive, 97% specific) and DSC CBF (0.649, 65% sensitive, 100% specific), and excellent agreement in DSC CBV (0.800, 89% sensitive, 90% specific). CONCLUSION It was observed that uncorrected DSC nCBV, DSC nCBF and ASL nCBF values were well correlated with each other. In qualitative evaluation, inter-observer and intra-observer agreement was higher in DSC CBV than DSC CBF and ASL CBF. In addition, DSC CBV is found more sensitive, ASL CBF and DSC CBF are found more specific for both observers. From a diagnostic perspective, all three parameters DSC CBV, DSC CBF and ASL CBF can be used, but it was observed that the highest rate belonged to DSC CBV.
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Affiliation(s)
- Ezgi Suat Bayraktar
- Department of Radiology, University of Izmir Katip Çelebi, Atatürk Training and Research Hospital, Izmir, 35360, Türkiye
| | - Gokhan Duygulu
- Department of Radiology, University of Izmir Katip Çelebi, Atatürk Training and Research Hospital, Izmir, 35360, Türkiye.
| | | | - Mustafa Fazıl Gelal
- Department of Radiology, University of Izmir Katip Çelebi, Atatürk Training and Research Hospital, Izmir, 35360, Türkiye
| | - Melda Apaydın
- Department of Radiology, University of Izmir Katip Çelebi, Atatürk Training and Research Hospital, Izmir, 35360, Türkiye
| | - Hülya Ellidokuz
- Department of Biostatistics and Medical Informatics, University of Dokuz Eylül, İzmir, 35340, Türkiye
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Chatha G, Dhaliwal T, Castle-Kirszbaum MD, Amukotuwa S, Lai L, Kwan E. The utility of arterial spin labelled perfusion-weighted magnetic resonance imaging in measuring the vascularity of high grade gliomas - A prospective study. Heliyon 2023; 9:e17615. [PMID: 37519684 PMCID: PMC10372548 DOI: 10.1016/j.heliyon.2023.e17615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/13/2023] [Accepted: 06/22/2023] [Indexed: 08/01/2023] Open
Abstract
Background Dynamic susceptibility contrast (DSC) perfusion weighted imaging (PWI) currently remains the gold standard technique for measuring cerebral perfusion in glioma diagnosis and surveillance. Arterial spin labelling (ASL) PWI is a non-invasive alternative that does not require gadolinium contrast administration, although it is yet to be applied in widespread clinical practice. This study aims to assess the utility of measuring signal intensity in ASL PWI in predicting glioma vascularity by measuring maximal tumour signal intensity in patients based on pre-operative imaging and comparing this to maximal vessel density on histopathology. Methods Pseudocontinuous ASL (pCASL) and DSC images were acquired pre-operatively in 21 patients with high grade gliomas. The maximal signal intensity within the gliomas over a region of interest of 100 mm2 was measured and also normalised to the contralateral cerebral cortex (nTBF-C), and cerebellum (nTBF-Cb). Maximal vessel density per 1 mm2 was determined on histopathology using CD31 and CD34 immunostaining on all participants. Results Using ASL, statistically significant correlation was observed between maximal signal intensity (p < 0.05) and nTBF-C (p < 0.05) to maximal vessel density based on histopathology. Although a positive trend was also observed nTBF-Cb, this did not reach statistical significance. Using DSC, no statistically significant correlation was found between signal intensity, nTBF-C and nTBF-Cb. There was no correlation between maximal signal intensity between ASL and DSC. Average vessel density did not correlate with age, sex, previous treatment, or IDH status. Conclusions ASL PWI imaging is a reliable marker of evaluating the vascularity of high grade gliomas and may be used as an adjunct to DSC PWI.
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Affiliation(s)
- Gurkirat Chatha
- Department of Neurosurgery, Monash Health, Melbourne, Australia
| | | | - Mendel David Castle-Kirszbaum
- Department of Neurosurgery, Monash Health, Melbourne, Australia
- Department of Surgery, Monash University, Melbourne, Australia
| | | | - Leon Lai
- Department of Neurosurgery, Monash Health, Melbourne, Australia
- Department of Surgery, Monash University, Melbourne, Australia
| | - Edward Kwan
- Department of Pathology, Monash Health, Melbourne, Australia
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3
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Wamelink IJHG, Hempel HL, van de Giessen E, Vries MHM, De Witt Hamer P, Barkhof F, Keil VC. The patients' experience of neuroimaging of primary brain tumors: a cross-sectional survey study. J Neurooncol 2023; 162:307-315. [PMID: 36977844 PMCID: PMC10167184 DOI: 10.1007/s11060-023-04290-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 03/04/2023] [Indexed: 03/30/2023]
Abstract
PURPOSE To gain insight into how patients with primary brain tumors experience MRI, follow-up protocols, and gadolinium-based contrast agent (GBCA) use. METHODS Primary brain tumor patients answered a survey after their MRI exam. Questions were analyzed to determine trends in patients' experience regarding the scan itself, follow-up frequency, and the use of GBCAs. Subgroup analysis was performed on sex, lesion grade, age, and the number of scans. Subgroup comparison was made using the Pearson chi-square test and the Mann-Whitney U-test for categorical and ordinal questions, respectively. RESULTS Of the 100 patients, 93 had a histopathologically confirmed diagnosis, and seven were considered to have a slow-growing low-grade tumor after multidisciplinary assessment and follow-up. 61/100 patients were male, with a mean age ± standard deviation of 44 ± 14 years and 46 ± 13 years for the females. Fifty-nine patients had low-grade tumors. Patients consistently underestimated the number of their previous scans. 92% of primary brain tumor patients did not experience the MRI as bothering and 78% would not change the number of follow-up MRIs. 63% of the patients would prefer GBCA-free MRI scans if diagnostically equally accurate. Women found the MRI and receiving intravenous cannulas significantly more uncomfortable than men (p = 0.003). Age, diagnosis, and the number of previous scans had no relevant impact on the patient experience. CONCLUSION Patients with primary brain tumors experienced current neuro-oncological MRI practice as positive. Especially women would, however, prefer GBCA-free imaging if diagnostically equally accurate. Patient knowledge of GBCAs was limited, indicating improvable patient information.
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Affiliation(s)
- Ivar J H G Wamelink
- Radiology & Nuclear Medicine Department, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
- Cancer Center Amsterdam, Brain Tumor Center Amsterdam, Amsterdam, The Netherlands.
| | - Hugo L Hempel
- Radiology & Nuclear Medicine Department, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Elsmarieke van de Giessen
- Radiology & Nuclear Medicine Department, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain Imaging, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Mark H M Vries
- Radiology & Nuclear Medicine Department, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Philip De Witt Hamer
- Cancer Center Amsterdam, Brain Tumor Center Amsterdam, Amsterdam, The Netherlands
- Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Radiology & Nuclear Medicine Department, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Queen Square Institute of Neurology and Centre for Medical Image Computing, University College London, London, UK
| | - Vera C Keil
- Radiology & Nuclear Medicine Department, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Brain Tumor Center Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain Imaging, De Boelelaan 1117, Amsterdam, The Netherlands
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Calvo-Imirizaldu M, Aramendía-Vidaurreta V, Sánchez-Albardíaz C, Vidorreta M, García de Eulate R, Domínguez Echávarri PD, Pfeuffer J, Bejarano Herruzo B, Gonzalez-Quarante LH, Martinez-Simon A, Fernández-Seara MA. Clinical utility of intraoperative arterial spin labeling for resection control in brain tumor surgery at 3 T. NMR IN BIOMEDICINE 2023:e4938. [PMID: 36967637 DOI: 10.1002/nbm.4938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 02/28/2023] [Accepted: 03/17/2023] [Indexed: 06/18/2023]
Abstract
Resection control in brain tumor surgery can be achieved in real time with intraoperative MRI (iMRI). Arterial spin labeling (ASL), a technique that measures cerebral blood flow (CBF) non-invasively without the use of intravenous contrast agents, can be performed intraoperatively, providing morpho-physiological information. This study aimed to evaluate the feasibility, image quality and potential to depict residual tumor of a pseudo-continuous ASL (PCASL) sequence at 3 T. Seventeen patients with brain tumors, primary (16) or metastatic (1), undergoing resection surgery with iMRI monitoring, were prospectively recruited (nine men, age 56 ± 16.6 years). A PCASL sequence with long labeling duration (3000 ms) and postlabeling delay (2000 ms) was added to the conventional protocol, which consisted of pre- and postcontrast 3D T1 -weighted (T1w) images, optional 3D-FLAIR, and diffusion. Three observers independently assessed the image quality (four-point scale) of PCASL-derived CBF maps. In those with diagnostic quality (Scores 2-4) they evaluated the presence of residual tumor using the conventional sequences first, and the CBF maps afterwards (three-point scale). Inter-observer agreement for image quality and the presence of residual tumor was assessed using Fleiss kappa statistics. The intraoperative CBF ratio of the surgical margins (i.e., perilesional CBF values normalized to contralateral gray matter CBF) was compared with preoperative CBF ratio within the tumor (Wilcoxon's test). Diagnostic ASL image quality was observed in 94.1% of patients (interobserver Fleiss κ = 0.76). PCASL showed additional foci suggestive of high-grade residual component in three patients, and a hyperperfused area extending outside the enhancing component in one patient. Interobserver agreement was almost perfect in the evaluation of residual tumor with the conventional sequences (Fleiss κ = 0.92) and substantial for PCASL (Fleiss κ = 0.80). No significant differences were found between pre and intraoperative CBF ratios (p = 0.578) in patients with residual tumor (n = 7). iMRI-PCASL perfusion is feasible at 3 T and is useful for the intraoperative assessment of residual tumor, providing in some cases additional information to the conventional sequences.
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Affiliation(s)
| | - Verónica Aramendía-Vidaurreta
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | | | | | | | - Pablo D Domínguez Echávarri
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Josef Pfeuffer
- Application Development, Siemens Healthcare, Erlangen, Germany
| | | | | | - Antonio Martinez-Simon
- Anesthesia and Intensive Care Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - María A Fernández-Seara
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
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Rahman AU, Saeed M, Saeed MH, Zebari DA, Albahar M, Abdulkareem KH, Al-Waisy AS, Mohammed MA. A Framework for Susceptibility Analysis of Brain Tumours Based on Uncertain Analytical Cum Algorithmic Modeling. Bioengineering (Basel) 2023; 10:bioengineering10020147. [PMID: 36829641 PMCID: PMC9952481 DOI: 10.3390/bioengineering10020147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 01/24/2023] Open
Abstract
Susceptibility analysis is an intelligent technique that not only assists decision makers in assessing the suspected severity of any sort of brain tumour in a patient but also helps them diagnose and cure these tumours. This technique has been proven more useful in those developing countries where the available health-based and funding-based resources are limited. By employing set-based operations of an arithmetical model, namely fuzzy parameterised complex intuitionistic fuzzy hypersoft set (FPCIFHSS), this study seeks to develop a robust multi-attribute decision support mechanism for appraising patients' susceptibility to brain tumours. The FPCIFHSS is regarded as more reliable and generalised for handling information-based uncertainties because its complex components and fuzzy parameterisation are designed to deal with the periodic nature of the data and dubious parameters (sub-parameters), respectively. In the proposed FPCIFHSS-susceptibility model, some suitable types of brain tumours are approximated with respect to the most relevant symptoms (parameters) based on the expert opinions of decision makers in terms of complex intuitionistic fuzzy numbers (CIFNs). After determining the fuzzy parameterised values of multi-argument-based tuples and converting the CIFNs into fuzzy values, the scores for such types of tumours are computed based on a core matrix which relates them with fuzzy parameterised multi-argument-based tuples. The sub-intervals within [0, 1] denote the susceptibility degrees of patients corresponding to these types of brain tumours. The susceptibility of patients is examined by observing the membership of score values in the sub-intervals.
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Affiliation(s)
- Atiqe Ur Rahman
- Department of Mathematics, University of Management and Technology, Lahore 54000, Pakistan
| | - Muhammad Saeed
- Department of Mathematics, University of Management and Technology, Lahore 54000, Pakistan
| | - Muhammad Haris Saeed
- Department of Chemistry, University of Management and Technology, Lahore 54000, Pakistan
| | - Dilovan Asaad Zebari
- Department of Computer Science, College of Science, Nawroz University, Duhok 42001, Iraq
| | - Marwan Albahar
- School of Computer Science, Umm Al Qura University, Mecca 24211, Saudi Arabia
- Correspondence: (M.A.); (M.A.M.)
| | | | - Alaa S. Al-Waisy
- Computer Technologies Engineering Department, Information Technology College, Imam Ja’afar Al-Sadiq University, Baghdad 10001, Iraq
| | - Mazin Abed Mohammed
- College of Computer Science and Information Technology, University of Anbar, Anbar 31001, Iraq
- Correspondence: (M.A.); (M.A.M.)
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Troudi A, Tensaouti F, Baudou E, Péran P, Laprie A. Arterial Spin Labeling Perfusion in Pediatric Brain Tumors: A Review of Techniques, Quality Control, and Quantification. Cancers (Basel) 2022; 14:cancers14194734. [PMID: 36230655 PMCID: PMC9564035 DOI: 10.3390/cancers14194734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 09/24/2022] [Accepted: 09/24/2022] [Indexed: 11/16/2022] Open
Abstract
Arterial spin labeling (ASL) is a magnetic resonance imaging (MRI) technique for measuring cerebral blood flow (CBF). This noninvasive technique has added a new dimension to the study of several pediatric tumors before, during, and after treatment, be it surgery, radiotherapy, or chemotherapy. However, ASL has three drawbacks, namely, a low signal-to-noise-ratio, a minimum acquisition time of 3 min, and limited spatial summarize current resolution. This technique requires quality control before ASL-CBF maps can be extracted and before any clinical investigations can be conducted. In this review, we describe ASL perfusion principles and techniques, summarize the most recent advances in CBF quantification, report technical advances in ASL (resting-state fMRI ASL, BOLD fMRI coupled with ASL), set out guidelines for ASL quality control, and describe studies related to ASL-CBF perfusion and qualitative and semi-quantitative ASL weighted-map quantification, in healthy children and those with pediatric brain tumors.
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Affiliation(s)
- Abir Troudi
- Toulouse Neuro Imaging Center (ToNIC), INSERM-University of Toulouse Paul Sebatier, 31300 Toulouse, France
- Correspondence: (A.T.); (A.L.)
| | - Fatima Tensaouti
- Toulouse Neuro Imaging Center (ToNIC), INSERM-University of Toulouse Paul Sebatier, 31300 Toulouse, France
- Radiation Oncology Department, Claudius Regaud Institute, Toulouse University Cancer Institute-Oncopole, 31300 Toulouse, France
| | - Eloise Baudou
- Toulouse Neuro Imaging Center (ToNIC), INSERM-University of Toulouse Paul Sebatier, 31300 Toulouse, France
- Pediatric Neurology Department, Children’s Hospital, Toulouse University Hospital, 31300 Toulouse, France
| | - Patrice Péran
- Toulouse Neuro Imaging Center (ToNIC), INSERM-University of Toulouse Paul Sebatier, 31300 Toulouse, France
| | - Anne Laprie
- Toulouse Neuro Imaging Center (ToNIC), INSERM-University of Toulouse Paul Sebatier, 31300 Toulouse, France
- Radiation Oncology Department, Claudius Regaud Institute, Toulouse University Cancer Institute-Oncopole, 31300 Toulouse, France
- Correspondence: (A.T.); (A.L.)
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7
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Hu F, Zheng XH, Li T, She HL, Zhang SF. Brain Perfusion Abnormalities after Radiotherapy Measured by 3-Dimensional Arterial Spin Labeling MRI and Correlations with Cognitive Impairment. Radiat Res 2022; 197:324-331. [PMID: 35104874 DOI: 10.1667/rade-21-00143.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 12/10/2021] [Indexed: 11/03/2022]
Abstract
The purpose of this study was to use a 3-dimensional arterial spin labeling (3D ASL) magnetic resonance (MR) method to measure cerebral blood flow (CBF) before and after radiotherapy, and correlate changes with time after receiving radiotherapy and cognitive function. Patients with nasopharyngeal carcinoma receiving radiotherapy at our institution were recruited for the study. Participants were divided into three groups: Pre-radiotherapy control (PC) group, acute reaction period (ARP) group, and delayed reaction period (DRP)group. Thirty-four patients were included in the study. Compared with the PC group, the ARP group exhibited significantly decreased perfusion in the left anterior cingulate cortex (ACC) and right putamen, and increased perfusion in the right cerebellum (Crus 1), right inferior occipital gyrus, left lingual gyrus, left precuneus, and left calcarine gyrus. in the DRP group, increased perfusion was noted in the right cerebellum (Crus 1) and decreased perfusion in the left superior frontal gyrus. CBF differences were observed in several brain areas in the DRP group as compared to the ARP group (P < 0.001). Total Montreal Cognitive Assessment score, and subdomain language and delayed memory recall scores were significantly lower in the ARP and DRP groups than in the PC group (P < 0.05). Data suggest that ASL allows for non-invasive detection of radiation-induced whole-brain CBF changes, which is transient, dynamic and complicated and may be a factor contributing to cognitive impairment induced by radiotherapy for nasopharyngeal carcinoma.
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Affiliation(s)
- Fang Hu
- Medical Imaging and Inspection Institute, Xiangnan University, Chenzhou, Hunan Province, P. R. China.,Department of Radiology, the Affiliated Hospital of Xiangnan University, Chenzhou, Hunan Province, China.,Key Laboratory of Medical Imaging and Artifical Intelligence of Hunan Province, Xiangnan University, Chenzhou 423000, China.,Chenzhou Cognitive Degeneration Brain Disease Early Warning Technology Research and Development Center, Affiliated Hospital of Xiangnan University, Chenzhou 423000, China
| | - Xin-Hui Zheng
- Medical Imaging and Inspection Institute, Xiangnan University, Chenzhou, Hunan Province, P. R. China
| | - Tao Li
- Medical Imaging and Inspection Institute, Xiangnan University, Chenzhou, Hunan Province, P. R. China.,Department of Radiology, the Affiliated Hospital of Xiangnan University, Chenzhou, Hunan Province, China.,Key Laboratory of Medical Imaging and Artifical Intelligence of Hunan Province, Xiangnan University, Chenzhou 423000, China.,Chenzhou Cognitive Degeneration Brain Disease Early Warning Technology Research and Development Center, Affiliated Hospital of Xiangnan University, Chenzhou 423000, China
| | - Hua-Long She
- Department of Radiology, the Affiliated Hospital of Xiangnan University, Chenzhou, Hunan Province, China.,Key Laboratory of Medical Imaging and Artifical Intelligence of Hunan Province, Xiangnan University, Chenzhou 423000, China.,Chenzhou Cognitive Degeneration Brain Disease Early Warning Technology Research and Development Center, Affiliated Hospital of Xiangnan University, Chenzhou 423000, China
| | - Sheng-Fu Zhang
- Department of Anus and Intestine Surgery, the First People's Hospital of Chenzhou, Chenzhou, Hunan Province, China.,Medical Imaging Center, the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong Province, China
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Differentiating Glioblastomas from Solitary Brain Metastases: An Update on the Current Literature of Advanced Imaging Modalities. Cancers (Basel) 2021; 13:cancers13122960. [PMID: 34199151 PMCID: PMC8231515 DOI: 10.3390/cancers13122960] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/09/2021] [Accepted: 06/09/2021] [Indexed: 12/12/2022] Open
Abstract
Differentiating between glioblastomas and solitary brain metastases proves to be a challenging diagnosis for neuroradiologists, as both present with imaging patterns consisting of peritumoral hyperintensities with similar intratumoral texture on traditional magnetic resonance imaging sequences. Early diagnosis is paramount, as each pathology has completely different methods of clinical assessment. In the past decade, recent developments in advanced imaging modalities enabled providers to acquire a more accurate diagnosis earlier in the patient's clinical assessment, thus optimizing clinical outcome. Dynamic susceptibility contrast has been optimized for detecting relative cerebral blood flow and relative cerebral blood volume. Diffusion tensor imaging can be used to detect changes in mean diffusivity. Neurite orientation dispersion and density imaging is an innovative modality detecting changes in intracellular volume fraction, isotropic volume fraction, and extracellular volume fraction. Magnetic resonance spectroscopy is able to assist by providing a metabolic descriptor while detecting variable ratios of choline/N-acetylaspartate, choline/creatine, and N-acetylaspartate/creatine. Finally, radiomics and machine learning algorithms have been devised to assist in improving diagnostic accuracy while often utilizing more than one advanced imaging protocol per patient. In this review, we provide an update on all the current evidence regarding the identification and differentiation of glioblastomas from solitary brain metastases.
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Cao H, Xiao X, Hua J, Huang G, He W, Qin J, Wu Y, Li X. The Added Value of Inflow-Based Vascular-Space-Occupancy and Diffusion-Weighted Imaging in Preoperative Grading of Gliomas. NEURODEGENER DIS 2021; 20:123-130. [PMID: 33735873 DOI: 10.1159/000512545] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 10/26/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The present study aimed to study whether combined inflow-based vascular-space-occupancy (iVASO) MR imaging (MRI) and diffusion-weighted imaging (DWI) improve the diagnostic accuracy in the preoperative grading of gliomas. METHODS Fifty-one patients with histopathologically confirmed diffuse gliomas underwent preoperative structural MRI, iVASO, and DWI. We performed 2 qualitative consensus reviews: (1) structural MR images alone and (2) structural MR images with iVASO and DWI. Relative arteriolar cerebral blood volume (rCBVa) and minimum apparent diffusion coefficient (mADC) were compared between low-grade and high-grade gliomas. Receiver operating characteristic (ROC) curve analysis was performed to compare the tumor grading efficiency of rCBVa, mADC, and the combination of the two parameters. RESULTS Two observers diagnosed accurate tumor grade in 40 of 51 (78.4%) patients in the first review and in 46 of 51 (90.2%) in the second review. Both rCBVa and mADC showed significant differences between low-grade and high-grade gliomas. ROC analysis gave a threshold value of 1.52 for rCBVa and 0.85 × 10-3 mm2/s for mADC to provide a sensitivity and specificity of 88.0 and 81.2% and 100.0 and 68.7%, respectively. The area under the ROC curve (AUC) was 0.87 and 0.85 for rCBVa and mADC, respectively. The combination of rCBVa and mADC values increased the AUC to 0.92. CONCLUSION The combined application of iVASO and DWI may improve the diagnostic accuracy of glioma grading.
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Affiliation(s)
- Haimei Cao
- Department of Medical Imaging, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiang Xiao
- Department of Medical Imaging, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jun Hua
- Neurosection, Division of MRI Research, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Meghalaya, USA.,Department of Radiology, F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Johns Hopkins University School of Medicine, Baltimore, Meghalaya, USA
| | - Guanglong Huang
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wenle He
- Department of Medical Imaging, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jie Qin
- Department of Medical Imaging, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yuankui Wu
- Department of Medical Imaging, Nanfang Hospital, Southern Medical University, Guangzhou, China,
| | - Xiaodan Li
- Department of Medical Imaging, Nanfang Hospital, Southern Medical University, Guangzhou, China
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10
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Parikh D, Afshari FT, Sherlala K, Ahmed S, Shad A. Utility of Arterial Spin Labeling Magnetic Resonance Imaging in Differentiating Sellar Region Meningiomas from Pituitary Adenomas. World Neurosurg 2020; 142:e407-e412. [PMID: 32673801 DOI: 10.1016/j.wneu.2020.07.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/05/2020] [Accepted: 07/07/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Differentiating sellar region meningiomas from pituitary adenomas on standard magnetic resonance imaging (MRI) sequences can be difficult. Arterial spin labeling (ASL) is a noninvasive technique of magnetic resonance perfusion imaging. The range of applications of ASL in neurosurgery has increased, and the information provided can be unique and complementary to other MRI sequences. Here we investigate the utility of ASL MRI in differentiating between sellar region meningiomas and pituitary adenomas. METHODS This was a retrospective comparison of quantitative assessments on absolute and normalized tumor blood flow in histologically proven meningiomas versus pituitary adenomas. RESULTS A total of 15 patients with sellar region lesions were identified, including 9 meningiomas and 6 pituitary adenomas. Mean absolute tumor blood flow and normalized tumor blood flow were significantly higher in meningiomas (131 mL/100 g/min and 2.22) than adenomas (47 mL/100 g/min and 0.92; P < 0.05). CONCLUSIONS ASL MRI is a useful adjunct sequence in differentiating sellar region meningiomas, which exhibit high perfusion, from pituitary adenomas, which exhibit relatively low perfusion.
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Affiliation(s)
- Dhruv Parikh
- Department of Neurosurgery, University Hospital of Coventry and Warwickshire, Coventry, United Kingdom
| | - Fardad T Afshari
- Department of Neurosurgery, University Hospital of Coventry and Warwickshire, Coventry, United Kingdom.
| | - Khaled Sherlala
- Department of Radiology, University Hospital of Coventry and Warwickshire, Coventry, United Kingdom
| | - Shahzada Ahmed
- Department of Ear, Nose, and Throat, University Hospital Birmingham, Birmingham, United Kingdom
| | - Amjad Shad
- Department of Neurosurgery, University Hospital of Coventry and Warwickshire, Coventry, United Kingdom
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11
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Manning P, Daghighi S, Rajaratnam MK, Parthiban S, Bahrami N, Dale AM, Bolar D, Piccioni DE, McDonald CR, Farid N. Differentiation of progressive disease from pseudoprogression using 3D PCASL and DSC perfusion MRI in patients with glioblastoma. J Neurooncol 2020; 147:681-690. [PMID: 32239431 DOI: 10.1007/s11060-020-03475-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 03/24/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE To use 3D pseudocontinuous arterial spin labeling (3D PCASL) and dynamic susceptibility contrast-enhanced (DSC) perfusion MRI to differentiate progressive disease from pseudoprogression in patients with glioblastoma (GBM). METHODS Thirty-two patients with GBM who developed progressively enhancing lesions within the radiation field following resection and chemoradiation were included in this retrospective, single-institution study. The updated modified RANO criteria were used to establish progressive disease or pseudoprogression. Following 3D PCASL and DSC MR imaging, perfusion parameter estimates of cerebral blood flow (ASL-nCBF and DSC-nrCBF) and cerebral blood volume (DSC-nrCBV) were calculated. Additionally, contrast enhanced volumes were measured. Mann-Whitney U tests were used to compare groups. Linear discriminant analysis (LDA) and area under receiver operator characteristic curve (AUC) analyses were used to evaluate performance of each perfusion parameter and to determine optimal cut-off points. RESULTS All perfusion parameter measurements were higher in patients with progressive disease (mean, 95% CI ASL-nCBF 2.48, [2.03, 2.93]; DSC-nrCBF = 2.27, [1.85, 2.69]; DSC-nrCBV = 3.51, [2.37, 4.66]) compared to pseudoprogression (mean, 95% CI ASL-nCBF 0.99, [0.47, 1.52]; DSC-nrCBF = 1.05, [0.36, 1.74]; DSC-nCBV = 1.19, [0.34, 2.05]), and findings were significant at the p < 0.0125 level (p = 0.001, 0.003, 0.002; effect size: Cohen's d = 1.48, 1.27, and 0.92). Contrast enhanced volumes were not significantly different between groups (p > 0.447). All perfusion parameters demonstrated high AUC (0.954 for ASL-nCBF, 0.867 for DSC-nrCBF, and 0.891 for DSC-nrCBV), however, ASL-nCBF demonstrated the highest AUC and misclassified the fewest cases (N = 6). Lesions correctly classified by ASL but misclassified by DSC were located along the skull base or adjacent to large resection cavities with residual blood products, at areas of increased susceptibility. CONCLUSION Both 3D PCASL and DSC perfusion MRI techniques have nearly equivalent performance for the differentiation of progressive disease from pseudoprogression in patients with GBM. However, 3D PCASL is less sensitive to susceptibility artifact and may allow for improved classification in select cases.
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Affiliation(s)
- Paul Manning
- Department of Radiology, University of California, San Diego, La Jolla, CA, 92037, USA. .,Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, CA, 92037, USA. .,Department of Radiology, University of California, San Diego, 200 West Arbor Drive, Mailbox # 8756, San Diego, CA, 92103, USA.
| | - Shadi Daghighi
- Department of Radiology, University of California, San Diego, La Jolla, CA, 92037, USA.,Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, CA, 92037, USA
| | - Matthew K Rajaratnam
- Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, CA, 92037, USA
| | - Sowmya Parthiban
- Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, CA, 92037, USA
| | - Naeim Bahrami
- Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, CA, 92037, USA
| | - Anders M Dale
- Department of Radiology, University of California, San Diego, La Jolla, CA, 92037, USA.,Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, CA, 92037, USA.,Department of Neurosciences, University of California, San Diego, La Jolla, CA, 92037, USA
| | - Divya Bolar
- Department of Radiology, University of California, San Diego, La Jolla, CA, 92037, USA.,Center for Functional Magnetic Resonance Imaging, University of California, San Diego, La Jolla, CA, 92037, USA
| | - David E Piccioni
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, 92037, USA
| | - Carrie R McDonald
- Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, CA, 92037, USA.,Department of Neurosciences, University of California, San Diego, La Jolla, CA, 92037, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, CA, 92037, USA
| | - Nikdokht Farid
- Department of Radiology, University of California, San Diego, La Jolla, CA, 92037, USA.,Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, CA, 92037, USA
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12
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Calmon R, Puget S, Varlet P, Dangouloff-Ros V, Blauwblomme T, Beccaria K, Grevent D, Sainte-Rose C, Castel D, Debily MA, Dufour C, Bolle S, Dhermain F, Saitovitch A, Zilbovicius M, Brunelle F, Grill J, Boddaert N. Cerebral blood flow changes after radiation therapy identifies pseudoprogression in diffuse intrinsic pontine gliomas. Neuro Oncol 2019; 20:994-1002. [PMID: 29244086 DOI: 10.1093/neuonc/nox227] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The interval between progression and death in diffuse intrinsic pontine glioma (DIPG) is usually <6 months. However, reports of longer patient survival following radiotherapy, in the presence of radiological signs of progression, suggest that these cases may be comparable to pseudoprogression observed in adult glioblastoma. Our aim was to identify such cases and compare their multimodal MRI features with those of patients who did not present the same evolution. Methods Multimodal MRIs of 43 children treated for DIPG were retrospectively selected at 4 timepoints: baseline, after radiotherapy, during true progression, and at the last visit. The patients were divided into 2 groups depending on whether they presented conventional MRI changes that mimicked progression. The apparent diffusion coefficient, arterial spin labeling cerebral blood flow (ASL-CBF), and dynamic susceptibility contrast perfusion relative cerebral blood volume (DSCrCBV) and flow (DSCrCBF) values were recorded for each tumor voxel, avoiding necrotic areas. Results After radiotherapy, 19 patients (44%) showed radiological signs that mimicked progression: 16 survived >6 months following so-called pseudoprogression, with a median of 8.9 months and a maximum of 35.6 months. All 43 patients exhibited increased blood volume and flow after radiotherapy, but the 90th percentile of those with signs of pseudoprogression had a greater increase of ASL-CBF (P < 0.001). Survival between the 2 groups did not differ significantly. During true progression, DSCrCBF and DSCrCBV values increased only in patients who had not experienced pseudoprogression. Conclusions Pseudoprogression is a frequent phenomenon in DIPG patients. This condition needs to be recognized before considering treatment discontinuation. In this study, the larger increase of the ASL-CBF ratio after radiotherapy accurately distinguished pseudoprogression from true progression.
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Affiliation(s)
- Raphael Calmon
- Hôpital Necker Enfants Malades, Pediatric Radiology Department, Paris, France.,Imagine: Institut de Maladies Génétiques, Paris, France.,INSERM, Paris, France.,Université Paris Descartes, ComUE Sorbonne Paris Cité, Paris, France
| | - Stephanie Puget
- Hôpital Necker Enfants Malades, Pediatric Neurosurgery Department, Paris, France
| | - Pascale Varlet
- INSERM, Paris, France.,Centre Hospitalier Sainte-Anne, Laboratoire de Neuropathologie, Paris, France
| | - Volodia Dangouloff-Ros
- Hôpital Necker Enfants Malades, Pediatric Radiology Department, Paris, France.,Imagine: Institut de Maladies Génétiques, Paris, France.,INSERM, Paris, France.,Université Paris Descartes, ComUE Sorbonne Paris Cité, Paris, France
| | - Thomas Blauwblomme
- Hôpital Necker Enfants Malades, Pediatric Neurosurgery Department, Paris, France
| | - Kevin Beccaria
- Hôpital Necker Enfants Malades, Pediatric Neurosurgery Department, Paris, France
| | - David Grevent
- Hôpital Necker Enfants Malades, Pediatric Radiology Department, Paris, France.,Imagine: Institut de Maladies Génétiques, Paris, France.,INSERM, Paris, France.,Université Paris Descartes, ComUE Sorbonne Paris Cité, Paris, France
| | | | - David Castel
- Centre National de la Recherche Scientifique, Unité Mixte de Recherche 8203 et Universite Paris Saclay, Villejuif, France
| | - Marie-Anne Debily
- Centre National de la Recherche Scientifique, Unité Mixte de Recherche 8203 et Universite Paris Saclay, Villejuif, France.,Université Evry Val-d'Essonne, Département de Biologie, Evry, France
| | - Christelle Dufour
- Gustave Roussy, Département de Cancerologie de l'Enfant et de l'Adolescent, Villejuif, France
| | - Stéphanie Bolle
- Gustave Roussy, Département de Radiothérapie, Villejuif, France
| | - Frederic Dhermain
- Gustave Roussy, Département de Cancerologie de l'Enfant et de l'Adolescent, Villejuif, France.,Gustave Roussy, Département de Radiothérapie, Villejuif, France
| | - Ana Saitovitch
- Imagine: Institut de Maladies Génétiques, Paris, France.,INSERM, Paris, France
| | | | - Francis Brunelle
- Hôpital Necker Enfants Malades, Pediatric Radiology Department, Paris, France.,Imagine: Institut de Maladies Génétiques, Paris, France.,INSERM, Paris, France.,Université Paris Descartes, ComUE Sorbonne Paris Cité, Paris, France
| | - Jacques Grill
- Centre National de la Recherche Scientifique, Unité Mixte de Recherche 8203 et Universite Paris Saclay, Villejuif, France.,Gustave Roussy, Département de Cancerologie de l'Enfant et de l'Adolescent, Villejuif, France
| | - Nathalie Boddaert
- Hôpital Necker Enfants Malades, Pediatric Radiology Department, Paris, France.,Imagine: Institut de Maladies Génétiques, Paris, France.,INSERM, Paris, France.,Université Paris Descartes, ComUE Sorbonne Paris Cité, Paris, France
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13
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Ji B, Wang S, Liu Z, Weinberg BD, Yang X, Liu T, Wang L, Mao H. Revealing hemodynamic heterogeneity of gliomas based on signal profile features of dynamic susceptibility contrast-enhanced MRI. NEUROIMAGE-CLINICAL 2019; 23:101864. [PMID: 31176951 PMCID: PMC6558214 DOI: 10.1016/j.nicl.2019.101864] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 04/30/2019] [Accepted: 05/19/2019] [Indexed: 01/25/2023]
Abstract
Dynamic susceptibility contrast enhanced magnetic resonance imaging (DSC MRI) is widely used for studying blood perfusion in brain tumors. While the time-dependent change of MRI signals related to the concentration of the tracer is used to derive the hemodynamic parameters such as regional blood volume and flow into tumors, the tissue-specific information associated with variations in profiles of signal time course is often overlooked. We report a new approach of combining model free independent component analysis (ICA) identification of specific signal profiles of DSC MRI time course data and extraction of the features from those time course profiles to interrogate time course data followed by calculating the region specific blood volume based on selected individual time courses. Based on the retrospective analysis of DSC MRI data from 38 patients with pathology confirmed low (n = 18) and high (n = 20) grade gliomas, the results reveal the spatially defined intra-tumoral hemodynamic heterogeneity of brain tumors based on features of time course profiles. The hemodynamic heterogeneity as measured by the number of independent components of time course data is associated with the tumor grade. Using 8 selected signal profile features, machine-learning trained algorithm, e.g., logistic regression, was able to differentiate pathology confirmed low intra-tumoral and high grade gliomas with an accuracy of 86.7%. Furthermore, the new method can potentially extract more tumor physiological information from DSC MRI comparing to the traditional model-based analysis and morphological analysis of tumor heterogeneity, thus may improve the characterizations of gliomas for better diagnosis and treatment decisions. Signal profiles of dynamic susceptibility contrast MRI data of brain tumors reflect hemodynamic properties of tumor tissue. Features in signal profiles extracted by machine learning methods revealed the hemodynamic heterogeneity of the gliomas. The reported approach is a new strategy to characterize the intra-tumor heterogeneity and physiological properties of gliomas.
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Affiliation(s)
- Bing Ji
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Silun Wang
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Zhou Liu
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States of America; Medical College of Nanchang University, Nanchang, Jiangxi, China
| | - Brent D Weinberg
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Xiaofeng Yang
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Tianming Liu
- Department of Computer Sciences, University of Georgia, Athens, GA, United States of America
| | - Liya Wang
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States of America; Medical College of Nanchang University, Nanchang, Jiangxi, China; Department of Radiology, The People's Hospital of Longhua, Shenzhen, Guangdong, China.
| | - Hui Mao
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States of America.
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14
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Di N, Cheng W, Chen H, Zhai F, Liu Y, Mu X, Chu Z, Lu N, Liu X, Wang B. Utility of arterial spin labelling MRI for discriminating atypical high-grade glioma from primary central nervous system lymphoma. Clin Radiol 2018; 74:165.e1-165.e9. [PMID: 30415766 DOI: 10.1016/j.crad.2018.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 10/09/2018] [Indexed: 01/19/2023]
Abstract
AIM To evaluate the ability of arterial spin labelling (ASL) magnetic resonance imaging (MRI) in differentiating primary central nervous system lymphoma (PCNSL) from atypical high-grade glioma (HGG), as well as exploring the underlying pathological mechanisms. METHODS AND MATERIALS Twenty-three patients with PCNSL and 17 patients with atypical HGG who underwent ASL-MRI were identified retrospectively. Absolute cerebral blood flow (aCBF) and normalised cerebral blood flow (nCBF) values were obtained, and were compared between PCNSL and atypical HGG using the Mann-Whitney U-test. The performance in discriminating between PCNSL and atypical HGG was evaluated using receiver-operating characteristics analysis and area-under-the-curve (AUC) values for aCBF and nCBF. The correlation between microvessel density (MVD) and aCBF was determined by Spearman's correlation analysis. RESULTS Atypical HGG demonstrated significantly higher aCBF, nCBF, and MVD values than PCNSL (p<0.05). The diagnostic accuracy of discriminating PCNSL from atypical HGG showed AUC=0.877 (95% confidence interval [CI] 0.735-0.959) for aCBF, and AUC=0.836 (95% confidence interval [CI] 0.685-0.934) for nCBF. There was a moderate positive correlation between aCBF values of region of interest (ROI >30 mm2) in the enhanced area and MVD values (rho=0.579, p=0.0001), and a strong positive correlation between aCBF values MVD based on "point-to-point biopsy" (rho=0.83, p=0.0029). Interobserver agreements for aCBF and nCBF were excellent (ICC >0.75). CONCLUSIONS ASL perfusion MRI is a useful imaging technique for the discrimination between atypical HGG and PCNSL, which may be determined by the difference of MVD between them.
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Affiliation(s)
- N Di
- Department of Radiology, Binzhou Medical University Hospital, 661 Huanghe 2nd Rd, 256603 Binzhou, China; Department of Radiology, Huashan Hospital Fudan University, 12 Wulumuqi Rd. Middle, 200040 Shanghai, China
| | - W Cheng
- Department of Pharmacy, Binzhou Medical University Hospital, 661 Huanghe 2nd Rd, 256603 Binzhou, China
| | - H Chen
- Department of Radiology, Weifang Traditional Chinese Hospital, 1055 Weizhou Rd, 261000 Weifang, China
| | - F Zhai
- Department of Radiology, Binzhou Medical University Hospital, 661 Huanghe 2nd Rd, 256603 Binzhou, China
| | - Y Liu
- Department of Pediatrics, Binzhou Medical University Hospital, 661 Huanghe 2nd Rd, 256603 Binzhou, China
| | - X Mu
- Department of Radiology, Binzhou Medical University Hospital, 661 Huanghe 2nd Rd, 256603 Binzhou, China
| | - Z Chu
- Department of Radiology, Binzhou Medical University Hospital, 661 Huanghe 2nd Rd, 256603 Binzhou, China
| | - N Lu
- Department of Radiology, Huashan Hospital Fudan University, 12 Wulumuqi Rd. Middle, 200040 Shanghai, China
| | - X Liu
- Department of Radiology, Binzhou Medical University Hospital, 661 Huanghe 2nd Rd, 256603 Binzhou, China.
| | - B Wang
- Department of Medical Imaging and Nuclear, Binzhou Medical University, 346 Guanhai Rd, 264000 Yantai, China.
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15
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Falk Delgado A, De Luca F, van Westen D, Falk Delgado A. Arterial spin labeling MR imaging for differentiation between high- and low-grade glioma-a meta-analysis. Neuro Oncol 2018; 20:1450-1461. [PMID: 29868920 PMCID: PMC6176798 DOI: 10.1093/neuonc/noy095] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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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Affiliation(s)
| | - Francesca De Luca
- Faculty of Medicine and Surgery, School of Medicine and Health Sciences, University “G. d′Ánnunzio,” Chieti, Italy
| | - Danielle van Westen
- Image and Function, Skane University Hospital, Lund, Sweden, and Institution for Clinical Sciences Lund, Diagnostic Radiology, Lund University, Lund, Sweden
| | - Anna Falk Delgado
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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16
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Thust SC, van den Bent MJ, Smits M. Pseudoprogression of brain tumors. J Magn Reson Imaging 2018; 48:571-589. [PMID: 29734497 PMCID: PMC6175399 DOI: 10.1002/jmri.26171] [Citation(s) in RCA: 168] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 04/07/2018] [Indexed: 12/11/2022] Open
Abstract
This review describes the definition, incidence, clinical implications, and magnetic resonance imaging (MRI) findings of pseudoprogression of brain tumors, in particular, but not limited to, high-grade glioma. Pseudoprogression is an important clinical problem after brain tumor treatment, interfering not only with day-to-day patient care but also the execution and interpretation of clinical trials. Radiologically, pseudoprogression is defined as a new or enlarging area(s) of contrast agent enhancement, in the absence of true tumor growth, which subsides or stabilizes without a change in therapy. The clinical definitions of pseudoprogression have been quite variable, which may explain some of the differences in reported incidences, which range from 9-30%. Conventional structural MRI is insufficient for distinguishing pseudoprogression from true progressive disease, and advanced imaging is needed to obtain higher levels of diagnostic certainty. Perfusion MRI is the most widely used imaging technique to diagnose pseudoprogression and has high reported diagnostic accuracy. Diagnostic performance of MR spectroscopy (MRS) appears to be somewhat higher, but MRS is less suitable for the routine and universal application in brain tumor follow-up. The combination of MRS and diffusion-weighted imaging and/or perfusion MRI seems to be particularly powerful, with diagnostic accuracy reaching up to or even greater than 90%. While diagnostic performance can be high with appropriate implementation and interpretation, even a combination of techniques, however, does not provide 100% accuracy. It should also be noted that most studies to date are small, heterogeneous, and retrospective in nature. Future improvements in diagnostic accuracy can be expected with harmonization of acquisition and postprocessing, quantitative MRI and computer-aided diagnostic technology, and meticulous evaluation with clinical and pathological data. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018.
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Affiliation(s)
- Stefanie C. Thust
- Lysholm Neuroradiology DepartmentNational Hospital for Neurology and NeurosurgeryLondonUK
- Department of Brain Rehabilitation and RepairUCL Institute of NeurologyLondonUK
- Imaging DepartmentUniversity College London HospitalLondonUK
| | - Martin J. van den Bent
- Department of NeurologyThe Brain Tumor Centre at Erasmus MC Cancer InstituteRotterdamThe Netherlands
| | - Marion Smits
- Department of Radiology and Nuclear Medicine, Erasmus MCUniversity Medical Centre RotterdamRotterdamThe Netherlands
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17
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Luna A, Martín Noguerol T, Mata LA. Bases de la imagen funcional II: técnicas emergentes de resonancia magnética y nuevos métodos de análisis. RADIOLOGIA 2018. [DOI: 10.1016/j.rx.2018.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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18
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Arisawa A, Watanabe Y, Tanaka H, Takahashi H, Matsuo C, Fujiwara T, Fujiwara M, Fujimoto Y, Tomiyama N. Comparative study of pulsed-continuous arterial spin labeling and dynamic susceptibility contrast imaging by histogram analysis in evaluation of glial tumors. Neuroradiology 2018; 60:599-608. [DOI: 10.1007/s00234-018-2024-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 04/16/2018] [Indexed: 10/17/2022]
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19
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Perfusion MRI as a diagnostic biomarker for differentiating glioma from brain metastasis: a systematic review and meta-analysis. Eur Radiol 2018; 28:3819-3831. [PMID: 29619517 DOI: 10.1007/s00330-018-5335-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/01/2018] [Accepted: 01/16/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Differentiation of glioma from brain metastasis is clinically crucial because it affects the clinical outcome of patients and alters patient management. Here, we present a systematic review and meta-analysis of the currently available data on perfusion magnetic resonance imaging (MRI) for differentiating glioma from brain metastasis, assessing MRI protocols and parameters. METHODS A computerised search of Ovid-MEDLINE and EMBASE databases was performed up to 3 October 2017, to find studies on the diagnostic performance of perfusion MRI for differentiating glioma from brain metastasis. Pooled summary estimates of sensitivity and specificity were obtained using hierarchical logistic regression modelling. We conducted meta-regression and subgroup analyses to explain the effects of the study heterogeneity. RESULTS Eighteen studies with 900 patients were included. The pooled sensitivity and specificity were 90% (95% CI, 84-94%) and 91% (95% CI, 84-95%), respectively. The area under the hierarchical summary receiver operating characteristic curve was 0.96 (95% CI, 0.94-0.98). The meta-regression showed that the percentage of glioma in the study population and the study design were significant factors affecting study heterogeneity. In a subgroup analysis including patients with glioblastoma only, the pooled sensitivity was 92% (95% CI, 84-97%) and the pooled specificity was 94% (95% CI, 85-98%). CONCLUSIONS Although various perfusion MRI techniques were used, the current evidence supports the use of perfusion MRI to differentiate glioma from brain metastasis. In particular, perfusion MRI showed excellent diagnostic performance for differentiating glioblastoma from brain metastasis. KEY POINTS • Perfusion MRI shows high diagnostic performance for differentiating glioma from brain metastasis. • The pooled sensitivity was 90% and pooled specificity was 91%. • Peritumoral rCBV derived from DSC is a relatively well-validated.
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20
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You SH, Yun TJ, Choi HJ, Yoo RE, Kang KM, Choi SH, Kim JH, Sohn CH. Differentiation between primary CNS lymphoma and glioblastoma: qualitative and quantitative analysis using arterial spin labeling MR imaging. Eur Radiol 2018; 28:3801-3810. [DOI: 10.1007/s00330-018-5359-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 01/19/2018] [Accepted: 01/29/2018] [Indexed: 10/17/2022]
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21
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Wang YL, Chen S, Xiao HF, Li Y, Wang Y, Liu G, Lou X, Ma L. Differentiation between radiation-induced brain injury and glioma recurrence using 3D pCASL and dynamic susceptibility contrast-enhanced perfusion-weighted imaging. Radiother Oncol 2018; 129:68-74. [PMID: 29398151 DOI: 10.1016/j.radonc.2018.01.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/11/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE This study was performed to validate the efficacy of three-dimensional pseudocontinuous arterial spin labeling (pCASL) compared with dynamic susceptibility contrast-enhanced perfusion-weighted imaging (DSC-PWI) in distinguishing radiation-induced brain injury from glioma recurrence in patients with glioma. METHODS Both 3D pCASL and DSC-PWI were performed using a 3.0 Tesla scanner in 69 patients with previously resected and irradiated glioma who displayed newly developed abnormal contrast-enhanced lesions. The included patients were classified into a radiation-induced brain injury group (n = 34) and a glioma recurrence group (n = 35) based on subsequent pathologic analysis or clinical-radiological follow-up. Lesion perfusion parameter values (CBF and nCBF on pCASL, nrCBV and nrCBF on DSC-PWI) were measured and compared between the two groups using Student's t test. Pearson correlation analysis was performed to evaluate the correlation between pCASL (CBF and nCBF) and DSC-PWI (nrCBV and nrCBF) values in the contrast-enhanced lesions and in the perifocal edema regions. RESULTS For the contrast-enhanced lesions, the CBF, nCBF, nrCBV, and nrCBF (29.46 ± 15.08 ml/100 g/min, 1.11 ± 0.50, 1.39 ± 1.15, and 1.30 ± 0.74) in the radiation-induced brain injury group were significantly lower than those (64.52 ± 33.92 ml/100 g/min, 2.73 ± 1.71, 3.39 ± 2.12, and 3.20 ± 1.95) in the glioma recurrence group (P < 0.001). The CBF and nCBF demonstrated strong correlation with nrCBV and nrCBF in the contrast-enhanced lesions. CONCLUSION Radiation-induced brain injury and glioma recurrence can be reliably distinguished using both 3D pCASL and DSC-PWI. Contrast-free 3D pCASL is a suitable alternative to DSC-PWI for long-term follow-up in glioma patients with postoperative radiotherapy.
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Bansal V, Kumar S, Sharma S, Sharma S, Sood RG. Usefulness of Pulsed Arterial Spin Labeling Magnetic Resonance Imaging in New-onset Seizure Patients and Its Comparison with Dynamic Susceptibility Contrast Magnetic Resonance Imaging. J Neurosci Rural Pract 2017; 8:569-574. [PMID: 29204016 PMCID: PMC5709879 DOI: 10.4103/jnrp.jnrp_141_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction Dynamic susceptibility contrast (DSC) perfusion and pulsed arterial spin labeling (PASL) imaging are newer advanced magnetic resonance sequences which are capable of detecting vascular changes in patients with new-onset seizure disorder even when no significant abnormalities are visualized on conventional sequences. The purpose of our study is to establish utility of arterial spin labeling (ASL) in new-onset seizure patients and compare ASL with DSC perfusion sequence. Materials and Methods Twenty-six patients coming to emergency department with new-onset seizure disorder were evaluated using DSC and ASL sequence. Perfusion asymmetry was assessed using region of interests taken at places where signal asymmetry was maximal. Results PASL sequence showed focal vascular changes in form of hyperperfusion in four patients, hypoperfusion in nine patients, and normal perfusion in 13 patients. Altered perfusion whether hypo/hyperperfusion was detected in five out of 16 patients even when conventional sequences were normal. There was strong positive linear correlation between ASL and DSC with P = 0.001. Conclusion Noninvasive PASL is capable of detecting vascular changes induced by seizure and is comparable to DSC sequence. Thus, it is recommended when there is a need for repeated evaluations; in follow-up/therapy response assessment and when contrast administration is contraindicated.
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Affiliation(s)
- Varun Bansal
- Department of Radio-Diagnosis, IGMC, Shimla, Himachal Pradesh, India
| | - Suresh Kumar
- Department of Radio-Diagnosis, IGMC, Shimla, Himachal Pradesh, India
| | - Sudhir Sharma
- Department of Neurology, IGMC, Shimla, Himachal Pradesh, India
| | - Sanjiv Sharma
- Department of Radio-Diagnosis, IGMC, Shimla, Himachal Pradesh, India
| | - R G Sood
- Department of Radio-Diagnosis, IGMC, Shimla, Himachal Pradesh, India
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Xu Q, Liu Q, Ge H, Ge X, Wu J, Qu J, Xu K. Tumor recurrence versus treatment effects in glioma: A comparative study of three dimensional pseudo-continuous arterial spin labeling and dynamic susceptibility contrast imaging. Medicine (Baltimore) 2017; 96:e9332. [PMID: 29390403 PMCID: PMC5815815 DOI: 10.1097/md.0000000000009332] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Gliomas constitute over 90% of primary brain tumors. Accurate identification of glioma recurrence and treatment effects is important, as it can help determine whether to continue with standard adjuvant chemotherapy or to switch to a second-line therapy for recurrence. Our purpose is to compare three dimensional pseudo-continuous arterial spin labeling (3D-pcASL) technique and dynamic susceptibility contrast perfusion magnetic resonance imaging (DSC-MRI) for differentiation tumor recurrence from treatment-related effects in gliomas. METHODS Twenty-nine patients with gliomas previously who showed enlarged, contrast-enhancing lesions within the radiation field after surgery and concurrent chemoradiotherapy (CCRT) were assessed with 3D-pcASL and DSC-MRI. These patients were classified into 2 groups, tumor recurrence group (n = 17) and treatment effects group (n = 12), based on pathologic analysis or clinical-radiologic follow-up. The perfusion imaging quality was assessed using a 3-point scale (1 = poor imaging, 2 = moderate imaging, and 3 = good imaging). Comparison for perfusion imaging-quality score between the 2 techniques was performed with Wilcoxon one-sample test. Quantitative analyses were performed between the 2 groups with cerebral blood flow values (ASL-CBF), relative cerebral blood flow values (ASL-rCBF, DSC-rCBF), and relative cerebral blood volume values (DSC-rCBV) using Wilcoxon one-sample test. The intra-class correlation coefficient (ICC) statistics were calculated for testing intrareader variability in regions of interest (ROIs) measurement of all perfusion parameters. RESULTS The imaging-quality score of 3D-pcASL was higher than that of DSC-MRI (P = .01). The perfusion parameters between tumor recurrence group and treatment effects group had statistically significant differences. There was a significant correlation between ASL-rCBF and DSC-rCBF values (r = 0.803), between ASL-rCBF and DSC-rCBV values (r = 0.763), and between DSC-rCBF and DSC-rCBV (r = 0.907). A receiver operating characteristic (ROC) curve analysis was performed for significant results of perfusion parameters between the 2 groups. Using a cutoff value of 1.110, ASL-rCBF showed the maximum area under the ROC curve (AUC). However, there were no significant differences among different AUCs. The ICC demonstrated excellent agreement for ROIs measurements of ASL-CBF (ICC = 0.9636), dynamic susceptibility contrast- cerebral blood flow (DSC-CBF) (ICC = 0.8508), and dynamic susceptibility contrast-cerebral blood volume (DSC-CBV) (ICC = 0.8543). CONCLUSION 3D-pcASL is an alternative perfusion method to DSC-MRI for the differentiation between tumor recurrence and treatment effects in gliomas. 3D-pcASL is noninvasive and shows fewer susceptibility artifacts than DSC-MRI.
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Affiliation(s)
- Qian Xu
- The First School of Clinical Medicine, Nanjing Medical University
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University
| | - Qi Liu
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University
| | - Haitao Ge
- Department of Medical Imaging, Xuzhou Medical University
| | - Xinting Ge
- Department of Medical Imaging, Xuzhou Medical University
| | | | | | - Kai Xu
- The First School of Clinical Medicine, Nanjing Medical University
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University
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Kang KM, Sohn CH, You SH, Nam JG, Choi SH, Yun TJ, Yoo RE, Kim JH. Added Value of Arterial Spin-Labeling MR Imaging for the Differentiation of Cerebellar Hemangioblastoma from Metastasis. AJNR Am J Neuroradiol 2017; 38:2052-2058. [PMID: 28912280 PMCID: PMC7963584 DOI: 10.3174/ajnr.a5363] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 06/30/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE In adults with only cerebellar masses, hemangioblastoma and metastasis are the 2 most important differential diagnoses. Our aim was to investigate the added value of arterial spin-labeling MR imaging for differentiating hemangioblastoma from metastasis in patients with only cerebellar masses. MATERIALS AND METHODS This retrospective study included a homogeneous cohort comprising patients with only cerebellar masses, including 16 hemangioblastomas and 14 metastases. All patients underwent enhanced MR imaging, including arterial spin-labeling. First, the presence or absence of a hyperperfused mass was determined. Next, in the hyperperfused mass, relative tumor blood flow (mean blood flow in the tumor divided by blood flow measured in normal-appearing cerebellar tissue) and the size ratio (size in the arterial spin-labeling images divided by size in the postcontrast T1WI) were measured. To validate the arterial spin-labeling findings, 2 observers independently evaluated the conventional MR images and the combined set of arterial spin-labeling images. RESULTS All patients with hemangioblastomas and half of the patients with metastases presented with a hyperperfused mass (P < .001). The size ratio and relative tumor blood flow were significantly larger for hemangioblastomas than for metastases (P < .001 and P = .039, respectively). The size ratio revealed excellent diagnostic power (area under the curve = 0.991), and the relative tumor blood flow demonstrated moderate diagnostic power (area under the curve = 0.777). The diagnostic accuracy of both observers was significantly improved after the addition of arterial spin-labeling; the area under the curve improved from 0.574 to 0.969 (P < .001) for observer 2 and from 0.683 to 1 (P < .001) for observer 2. CONCLUSIONS Arterial spin-labeling imaging can aid in distinguishing hemangioblastoma from metastasis in patients with only cerebellar masses.
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Affiliation(s)
- K M Kang
- From the Department of Radiology (K.M.K., C.-H.S., J.G.N., S.H.C., T.J.Y., R.-E.Y., J.-h.K.), Seoul National University Hospital, Seoul, Korea
| | - C-H Sohn
- From the Department of Radiology (K.M.K., C.-H.S., J.G.N., S.H.C., T.J.Y., R.-E.Y., J.-h.K.), Seoul National University Hospital, Seoul, Korea
- Department of Radiology (C.-H.S., S.H.C.), Seoul National University College of Medicine, Seoul, Korea
| | - S-H You
- Department of Radiology (S.-H.Y.), Korea University Hospital, Seoul, Korea
| | - J G Nam
- From the Department of Radiology (K.M.K., C.-H.S., J.G.N., S.H.C., T.J.Y., R.-E.Y., J.-h.K.), Seoul National University Hospital, Seoul, Korea
| | - S H Choi
- From the Department of Radiology (K.M.K., C.-H.S., J.G.N., S.H.C., T.J.Y., R.-E.Y., J.-h.K.), Seoul National University Hospital, Seoul, Korea
- Department of Radiology (C.-H.S., S.H.C.), Seoul National University College of Medicine, Seoul, Korea
| | - T J Yun
- From the Department of Radiology (K.M.K., C.-H.S., J.G.N., S.H.C., T.J.Y., R.-E.Y., J.-h.K.), Seoul National University Hospital, Seoul, Korea
| | - R-E Yoo
- From the Department of Radiology (K.M.K., C.-H.S., J.G.N., S.H.C., T.J.Y., R.-E.Y., J.-h.K.), Seoul National University Hospital, Seoul, Korea
| | - J-H Kim
- From the Department of Radiology (K.M.K., C.-H.S., J.G.N., S.H.C., T.J.Y., R.-E.Y., J.-h.K.), Seoul National University Hospital, Seoul, Korea
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Haller S, Zaharchuk G, Thomas DL, Lovblad KO, Barkhof F, Golay X. Arterial Spin Labeling Perfusion of the Brain: Emerging Clinical Applications. Radiology 2017; 281:337-356. [PMID: 27755938 DOI: 10.1148/radiol.2016150789] [Citation(s) in RCA: 317] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Arterial spin labeling (ASL) is a magnetic resonance (MR) imaging technique used to assess cerebral blood flow noninvasively by magnetically labeling inflowing blood. In this article, the main labeling techniques, notably pulsed and pseudocontinuous ASL, as well as emerging clinical applications will be reviewed. In dementia, the pattern of hypoperfusion on ASL images closely matches the established patterns of hypometabolism on fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) images due to the close coupling of perfusion and metabolism in the brain. This suggests that ASL might be considered as an alternative for FDG, reserving PET to be used for the molecular disease-specific amyloid and tau tracers. In stroke, ASL can be used to assess perfusion alterations both in the acute and the chronic phase. In arteriovenous malformations and dural arteriovenous fistulas, ASL is very sensitive to detect even small degrees of shunting. In epilepsy, ASL can be used to assess the epileptogenic focus, both in peri- and interictal period. In neoplasms, ASL is of particular interest in cases in which gadolinium-based perfusion is contraindicated (eg, allergy, renal impairment) and holds promise in differentiating tumor progression from benign causes of enhancement. Finally, various neurologic and psychiatric diseases including mild traumatic brain injury or posttraumatic stress disorder display alterations on ASL images in the absence of visualized structural changes. In the final part, current limitations and future developments of ASL techniques to improve clinical applicability, such as multiple inversion time ASL sequences to assess alterations of transit time, reproducibility and quantification of cerebral blood flow, and to measure cerebrovascular reserve, will be reviewed. © RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Sven Haller
- From Affidea Centre Diagnostique Radiologique de Carouge, Clos de la Fonderie 1, 1227 Carouge, Switzerland (S.H.); Dept of Surgical Sciences, Div of Radiology, Uppsala Univ, Sweden (S.H.); Dept of Neuroradiology, Univ Hosp Freiburg, Germany (S.H.); Faculty of Medicine Univ of Geneva, Switzerland (S.H.); Dept of Radiology, Stanford Univ, Stanford, Calif (G.Z.); Univ College London, Inst of Neurology, London, England (D.L.T., X.G.); Dept of Diagnostic and Interventional Neuroradiology, Geneva Univ Hosps,Switzerland (K.O.L.); Dept of Radiology & Nuclear Medicine and PET Research, VU Univ Medical Ctr, Amsterdam, the Netherlands (F.B.); and Insts of Neurology and Healthcare Engineering, Univ College London, England (F.B.)
| | - Greg Zaharchuk
- From Affidea Centre Diagnostique Radiologique de Carouge, Clos de la Fonderie 1, 1227 Carouge, Switzerland (S.H.); Dept of Surgical Sciences, Div of Radiology, Uppsala Univ, Sweden (S.H.); Dept of Neuroradiology, Univ Hosp Freiburg, Germany (S.H.); Faculty of Medicine Univ of Geneva, Switzerland (S.H.); Dept of Radiology, Stanford Univ, Stanford, Calif (G.Z.); Univ College London, Inst of Neurology, London, England (D.L.T., X.G.); Dept of Diagnostic and Interventional Neuroradiology, Geneva Univ Hosps,Switzerland (K.O.L.); Dept of Radiology & Nuclear Medicine and PET Research, VU Univ Medical Ctr, Amsterdam, the Netherlands (F.B.); and Insts of Neurology and Healthcare Engineering, Univ College London, England (F.B.)
| | - David L Thomas
- From Affidea Centre Diagnostique Radiologique de Carouge, Clos de la Fonderie 1, 1227 Carouge, Switzerland (S.H.); Dept of Surgical Sciences, Div of Radiology, Uppsala Univ, Sweden (S.H.); Dept of Neuroradiology, Univ Hosp Freiburg, Germany (S.H.); Faculty of Medicine Univ of Geneva, Switzerland (S.H.); Dept of Radiology, Stanford Univ, Stanford, Calif (G.Z.); Univ College London, Inst of Neurology, London, England (D.L.T., X.G.); Dept of Diagnostic and Interventional Neuroradiology, Geneva Univ Hosps,Switzerland (K.O.L.); Dept of Radiology & Nuclear Medicine and PET Research, VU Univ Medical Ctr, Amsterdam, the Netherlands (F.B.); and Insts of Neurology and Healthcare Engineering, Univ College London, England (F.B.)
| | - Karl-Olof Lovblad
- From Affidea Centre Diagnostique Radiologique de Carouge, Clos de la Fonderie 1, 1227 Carouge, Switzerland (S.H.); Dept of Surgical Sciences, Div of Radiology, Uppsala Univ, Sweden (S.H.); Dept of Neuroradiology, Univ Hosp Freiburg, Germany (S.H.); Faculty of Medicine Univ of Geneva, Switzerland (S.H.); Dept of Radiology, Stanford Univ, Stanford, Calif (G.Z.); Univ College London, Inst of Neurology, London, England (D.L.T., X.G.); Dept of Diagnostic and Interventional Neuroradiology, Geneva Univ Hosps,Switzerland (K.O.L.); Dept of Radiology & Nuclear Medicine and PET Research, VU Univ Medical Ctr, Amsterdam, the Netherlands (F.B.); and Insts of Neurology and Healthcare Engineering, Univ College London, England (F.B.)
| | - Frederik Barkhof
- From Affidea Centre Diagnostique Radiologique de Carouge, Clos de la Fonderie 1, 1227 Carouge, Switzerland (S.H.); Dept of Surgical Sciences, Div of Radiology, Uppsala Univ, Sweden (S.H.); Dept of Neuroradiology, Univ Hosp Freiburg, Germany (S.H.); Faculty of Medicine Univ of Geneva, Switzerland (S.H.); Dept of Radiology, Stanford Univ, Stanford, Calif (G.Z.); Univ College London, Inst of Neurology, London, England (D.L.T., X.G.); Dept of Diagnostic and Interventional Neuroradiology, Geneva Univ Hosps,Switzerland (K.O.L.); Dept of Radiology & Nuclear Medicine and PET Research, VU Univ Medical Ctr, Amsterdam, the Netherlands (F.B.); and Insts of Neurology and Healthcare Engineering, Univ College London, England (F.B.)
| | - Xavier Golay
- From Affidea Centre Diagnostique Radiologique de Carouge, Clos de la Fonderie 1, 1227 Carouge, Switzerland (S.H.); Dept of Surgical Sciences, Div of Radiology, Uppsala Univ, Sweden (S.H.); Dept of Neuroradiology, Univ Hosp Freiburg, Germany (S.H.); Faculty of Medicine Univ of Geneva, Switzerland (S.H.); Dept of Radiology, Stanford Univ, Stanford, Calif (G.Z.); Univ College London, Inst of Neurology, London, England (D.L.T., X.G.); Dept of Diagnostic and Interventional Neuroradiology, Geneva Univ Hosps,Switzerland (K.O.L.); Dept of Radiology & Nuclear Medicine and PET Research, VU Univ Medical Ctr, Amsterdam, the Netherlands (F.B.); and Insts of Neurology and Healthcare Engineering, Univ College London, England (F.B.)
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Ma H, Wang Z, Xu K, Shao Z, Yang C, Xu P, Liu X, Hu C, Lu X, Rong Y. Three-dimensional arterial spin labeling imaging and dynamic susceptibility contrast perfusion-weighted imaging value in diagnosing glioma grade prior to surgery. Exp Ther Med 2017; 13:2691-2698. [PMID: 28587332 PMCID: PMC5450692 DOI: 10.3892/etm.2017.4370] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 01/06/2017] [Indexed: 01/26/2023] Open
Abstract
The current study aimed to investigate whole-brain three-dimensional arterial spin labeling imaging (3D ASL) and dynamic susceptibility contrast perfusion-weighted imaging (DSC-PWI), in regards to their diagnostic value of preoperative glioma grade. The parameter values obtained after correction will be correlated with the diagnostic value of 3D ASL and DSC-PWI perfusion. In the current study, 50 patients with gliomas confirmed by pathology were used, including 27 low-grade gliomas (LGGs) and 23 high-grade gliomas (HGGs). Prior to surgery all patients underwent 3 Tesla magnetic resonance imaging (MRI), 3D ASL, DSC-PWI and conventional enhanced MRI scans to obtain original 3D ASL and DSC-PWI images, and the tumor regions with the most obvious parenchyma perfusion and contralateral normal white matter were selected. In these areas, the ASL-relative cerebral blood flow (ASL-rCBF), DSC-relative cerebral blood flow (DSC-rCBF) and DSC-relative cerebral blood volume (DSC-rCBV) parameter values were then obtained after correction for individual differences. The results of the present study show that ASL-CBF, DSC-CBF, DSC-CBV values and ASL-rCBF, DSC-rCBF, DSC-rCBV values increased as the grade of the glioma being imaged increased, and there was a marked difference between the HGGs and the LGGs. ASL-rCBF was significantly positively correlated with DSC-rCBF (r=0.580, P<0.01). In addition, ASL-rCBF was significantly positively correlated with DSC-rCBV (r=0.431, P<0.01). Receiver operating characteristic (ROC) curves were applied to compare the two perfusion parameters of DSC-PWI and 3D ASL in the diagnosis of glioma grade. ASL-rCBF had the highest area value under the ROC curve (0.836). The areas under the ROC curve of DSC-rCBF and DSC-rCBV were analyzed using the Z test, but the difference was not statistically significant. When ASL-rCBF, DSC-rCBF and DSC-rCBV were cutoff at 2.24, 1.85 and 1.68, the sensitivity of HGG diagnosis was 83.2, 91.3 and 91.3%, and the specificity was 77.7, 63.9 and 66.7%, respectively.
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Affiliation(s)
- Hong Ma
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, P.R. China.,Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, P.R. China
| | - Zizheng Wang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, P.R. China
| | - Kai Xu
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, P.R. China
| | - Zefeng Shao
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, P.R. China
| | - Chun Yang
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, P.R. China
| | - Peng Xu
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, P.R. China
| | - Xiaohua Liu
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, P.R. China
| | - Chunfeng Hu
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, P.R. China
| | - Xin Lu
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, P.R. China
| | - Yutao Rong
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, P.R. China
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Calmon R, Puget S, Varlet P, Beccaria K, Blauwblomme T, Grevent D, Sainte-Rose C, Castel D, Dufour C, Dhermain F, Bolle S, Saitovitch A, Zilbovicius M, Brunelle F, Grill J, Boddaert N. Multimodal Magnetic Resonance Imaging of Treatment-Induced Changes to Diffuse Infiltrating Pontine Gliomas in Children and Correlation to Patient Progression-Free Survival. Int J Radiat Oncol Biol Phys 2017; 99:476-485. [PMID: 28871999 DOI: 10.1016/j.ijrobp.2017.04.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 01/30/2017] [Accepted: 04/04/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To use multimodal magnetic resonance imaging (MRI) to quantify treatment-induced changes in the whole volume of diffuse infiltrating pontine gliomas and correlate them with progression-free survival (PFS). METHODS AND MATERIALS This prospective study included 22 children aged 3.3 to 14.7 years (median, 5.9 years). Multimodal MRI was performed at 3 distinct time points: before treatment, the first week following radiation therapy (RT), and 2 months after RT. The imaging protocol included morphologic, multi b-value diffusion; arterial spin labeling; and dynamic susceptibility contrast-enhanced perfusion. Morphologic and multimodal data-lesion volume, diffusion coefficients, relative cerebral blood flow, and relative cerebral blood volume (rCBV)-were recorded at the 3 aforementioned time points. The Wilcoxon test was used to compare each individual parameter variation between time points, and its correlation with PFS was assessed by the Spearman test. RESULTS Following RT, the tumors' solid component volume decreased by 40% (P<.001). Their median diffusion coefficients decreased by 20% to 40% (P<.001), while median relative cerebral blood flow increased by 60% to 80% (P<.001) and median rCBV increased by 70% (P<.001). PFS was positively correlated with rCBV measured immediately after RT (P=.003), and in patients whose rCBV was above the cutoff value of 2.46, the median PFS was 4.6 months longer (P=.001). These indexes tended to return to baseline 2 months after RT. Lesion volume before or after RT was not correlated with survival. CONCLUSIONS Multimodal MRI provides useful information about diffuse infiltrating pontine gliomas' response to treatment; rCBV increases following RT, and higher values are correlated with better PFS. High rCBV values following RT should not be mistaken for progression and could be an indicator of response to therapy.
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Affiliation(s)
- Raphael Calmon
- Pediatric Radiology Department, Hôpital Necker Enfants Malades, Paris, France; Institut National de la Santé et de la Recherche Médicale, Unité 1000, Paris, France; Imagine-Institut des Maladies Génétiques, UMR 1163, Paris, France; Université Paris Descartes, ComUE Sorbonne Paris Cité, Paris, France.
| | - Stephanie Puget
- Pediatric Neurosurgery Department, Hôpital Necker Enfants Malades, Paris, France
| | - Pascale Varlet
- Institut National de la Santé et de la Recherche Médicale, Unité 1000, Paris, France; Centre Hospitalier Sainte-Anne, Laboratoire de Neuropathologie, Paris, France
| | - Kevin Beccaria
- Pediatric Neurosurgery Department, Hôpital Necker Enfants Malades, Paris, France
| | - Thomas Blauwblomme
- Pediatric Neurosurgery Department, Hôpital Necker Enfants Malades, Paris, France
| | - David Grevent
- Pediatric Radiology Department, Hôpital Necker Enfants Malades, Paris, France; Institut National de la Santé et de la Recherche Médicale, Unité 1000, Paris, France; Imagine-Institut des Maladies Génétiques, UMR 1163, Paris, France; Université Paris Descartes, ComUE Sorbonne Paris Cité, Paris, France
| | | | - David Castel
- Centre National de la Recherche Scientifique, Unité Mixte de Recherche 8203, Gustave Roussy et Université Paris-Saclay, Villejuif, France
| | - Christelle Dufour
- Département de Cancerologie de l'Enfant et de l'Adolescent, Institut Gustave Roussy, Villejuif, France
| | - Frédéric Dhermain
- Département de Radiothérapie, Institut Gustave Roussy, Villejuif, France
| | - Stéphanie Bolle
- Département de Radiothérapie, Institut Gustave Roussy, Villejuif, France
| | - Ana Saitovitch
- Institut National de la Santé et de la Recherche Médicale, Unité 1000, Paris, France; Imagine-Institut des Maladies Génétiques, UMR 1163, Paris, France
| | - Monica Zilbovicius
- Institut National de la Santé et de la Recherche Médicale, Unité 1000, Paris, France
| | - Francis Brunelle
- Pediatric Radiology Department, Hôpital Necker Enfants Malades, Paris, France; Institut National de la Santé et de la Recherche Médicale, Unité 1000, Paris, France; Imagine-Institut des Maladies Génétiques, UMR 1163, Paris, France; Université Paris Descartes, ComUE Sorbonne Paris Cité, Paris, France
| | - Jacques Grill
- Centre National de la Recherche Scientifique, Unité Mixte de Recherche 8203, Gustave Roussy et Université Paris-Saclay, Villejuif, France; Département de Cancerologie de l'Enfant et de l'Adolescent, Institut Gustave Roussy, Villejuif, France
| | - Nathalie Boddaert
- Pediatric Radiology Department, Hôpital Necker Enfants Malades, Paris, France; Institut National de la Santé et de la Recherche Médicale, Unité 1000, Paris, France; Imagine-Institut des Maladies Génétiques, UMR 1163, Paris, France; Université Paris Descartes, ComUE Sorbonne Paris Cité, Paris, France
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Kong L, Chen H, Yang Y, Chen L. A meta-analysis of arterial spin labelling perfusion values for the prediction of glioma grade. Clin Radiol 2016; 72:255-261. [PMID: 27932251 DOI: 10.1016/j.crad.2016.10.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 07/23/2016] [Accepted: 10/25/2016] [Indexed: 12/16/2022]
Abstract
AIM To investigate the ability of arterial spin labelling (ASL) perfusion parameters to distinguish high-grade from low-grade gliomas. MATERIALS AND METHODS The PubMed and EMBASE databases were systematically searched for relevant articles published up to September 2015. Studies that evaluated both high- and low-grade gliomas using ASL were included. The random effect model was used to calculate the standardised mean difference (SMD) of maximum mean absolute tumour blood flow values (aTBFmax, aTBFmean) and maximum mean relative tumour blood flow (rTBFmax, rTBFmean) between high- and low-grade gliomas. RESULTS Nine studies encompassing 305 patients with high- and low-grade gliomas, met all inclusion and exclusion criteria and were included in the study. Compared with low-grade gliomas, high-grade gliomas had a significant increase in all ASL perfusion values: aTBFmax (SMD=0.70, 95% confidence interval [CI]: 0.22-1.19, p=0.0046); aTBFmean (SMD=0.86, 95% CI: 0.2-1.52, p=0.01); rTBFmax (SMD=1.08, 95% CI: 0.54-1.63, p=0.0001) and rTBFmean (SMD=0.88, 95% CI: 0.35-1.4, p=0.0011). CONCLUSIONS The current study results indicate that tumour blood flow from ASL differs significantly with respect to the glioma grade. Despite some limitations, there is evidence that ASL may be useful to distinguish high- and low-grade gliomas. Further larger-scale studies are necessary to examine the utility of ASL to distinguish tumour grade.
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Affiliation(s)
- L Kong
- Department of Anesthesiology, Anhui Provincial Cancer Hospital, Hefei 230031, China
| | - H Chen
- Department of Anesthesiology, Nanjing General Hospital of Nanjing Military Command, Nanjing 210002, China
| | - Y Yang
- Department of Anesthesiology, Anhui Provincial Cancer Hospital, Hefei 230031, China
| | - L Chen
- Department of Anesthesiology, Anhui Provincial Cancer Hospital, Hefei 230031, China.
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Lyu Y, Liu S, You H, Hou B, Wang Y, Ma W, Feng F. Evaluation of recurrent high-grade gliomas treated with bevacizumab: A preliminary report of 3D pseudocontinuous artery spin labeling. J Magn Reson Imaging 2016; 46:565-573. [PMID: 27902863 DOI: 10.1002/jmri.25558] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 11/01/2016] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To investigate the role of cerebral blood flow (CBF) derived from a 3D fast spin echo (FSE) pseudocontinuous artery spin labeling (pcASL) sequence in evaluating the survival rate of recurrent high-grade gliomas (rHGGs) that were treated with bevacizumab (BEV). MATERIALS AND METHODS Sixteen patients with rHGGs who underwent 3T 3D FSE pcASL imaging 1-2 days before (baseline or pre-BEV) and within 1 month after BEV treatment initiation (post-BEV) were included in the study. Average (aCBF) and maximum (mCBF) cerebral blood flow of the enhancing tumor, their respective normalized values to contralateral normal-appearing white matter (rCBF_wm and mCBF_wm) and cerebellum (rCBF_cb and mCBF_cb), and the related changes between baseline and post-BEV were evaluated. Receiver operating characteristic (ROC) curve analysis was utilized to define the optimal cutoff perfusion values for overall survival (OS) and progression-free survival (PFS) stratification. Kaplan-Meier analysis with log-rank test was applied to assess and compare PFS and OS rates. RESULTS All the CBF measurements pre-BEV and post-BEV treatment were significantly different except mCBF. The CBF measurements (aCBF, rCBF_wm, rCBF_cb, mCBF_wm and mCBF_cb) pre-BEV all decreased post-BEV treatment. Cutoffs of aCBF (43.72 ml/100g/min) pre-BEV for OS, rCBF_cb (1.09) pre-BEV for PFS and OS, and ΔaCBF (-0.37) for PFS were found to be statistically significant in survival stratification (404 days vs. 140 days, P = 0.026; 251 days vs. 112 days, P = 0.044; 404 days vs. 194 days, P = 0.046; 267 days vs. 116 days, P = 0.048, respectively). CONCLUSION Three dimensional FSE pcASL can detect the decrease of perfusion in rHGGs treated with BEV and is a potential promising technique in stratifying survival rate of rHGGs under BEV treatment. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;46:565-573.
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Affiliation(s)
- Yuelei Lyu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Wangfujing Dongcheng District, Beijing, P.R. China
| | - Shuai Liu
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Wangfujing Dongcheng District, Beijing, P.R. China
| | - Hui You
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Wangfujing Dongcheng District, Beijing, P.R. China
| | - Bo Hou
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Wangfujing Dongcheng District, Beijing, P.R. China
| | - Yu Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Wangfujing Dongcheng District, Beijing, P.R. China
| | - Wenbin Ma
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Wangfujing Dongcheng District, Beijing, P.R. China
| | - Feng Feng
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Wangfujing Dongcheng District, Beijing, P.R. China
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Sunwoo L, Yun TJ, You SH, Yoo RE, Kang KM, Choi SH, Kim JH, Sohn CH, Park SW, Jung C, Park CK. Differentiation of Glioblastoma from Brain Metastasis: Qualitative and Quantitative Analysis Using Arterial Spin Labeling MR Imaging. PLoS One 2016; 11:e0166662. [PMID: 27861605 PMCID: PMC5115760 DOI: 10.1371/journal.pone.0166662] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 11/01/2016] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To evaluate the diagnostic performance of cerebral blood flow (CBF) by using arterial spin labeling (ASL) perfusion magnetic resonance (MR) imaging to differentiate glioblastoma (GBM) from brain metastasis. MATERIALS AND METHODS The institutional review board of our hospital approved this retrospective study. The study population consisted of 128 consecutive patients who underwent surgical resection and were diagnosed as either GBM (n = 89) or brain metastasis (n = 39). All participants underwent preoperative MR imaging including ASL. For qualitative analysis, the tumors were visually graded into five categories based on ASL-CBF maps by two blinded reviewers. For quantitative analysis, the reviewers drew regions of interest (ROIs) on ASL-CBF maps upon the most hyperperfused portion within the tumor and upon peritumoral T2 hyperintensity area. Signal intensities of intratumoral and peritumoral ROIs for each subject were normalized by dividing the values by those of contralateral normal gray matter (nCBFintratumoral and nCBFperitumoral, respectively). Visual grading scales and quantitative parameters between GBM and brain metastasis were compared. In addition, the area under the receiver-operating characteristic curve was used to evaluate the diagnostic performance of ASL-driven CBF to differentiate GBM from brain metastasis. RESULTS For qualitative analysis, GBM group showed significantly higher grade compared to metastasis group (p = 0.001). For quantitative analysis, both nCBFintratumoral and nCBFperitumoral in GBM were significantly higher than those in metastasis (both p < 0.001). The areas under the curve were 0.677, 0.714, and 0.835 for visual grading, nCBFintratumoral, and nCBFperitumoral, respectively (all p < 0.001). CONCLUSION ASL perfusion MR imaging can aid in the differentiation of GBM from brain metastasis.
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Affiliation(s)
- Leonard Sunwoo
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tae Jin Yun
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- * E-mail:
| | - Sung-Hye You
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Roh-Eul Yoo
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Koung Mi Kang
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Seung Hong Choi
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Ji-hoon Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Chul-Ho Sohn
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Sun-Won Park
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Department of Radiology, Seoul Metropolitan Government—Seoul National University Boramae Medical Center, Seoul, Korea
| | - Cheolkyu Jung
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chul-Kee Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
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Noguchi T. A Technical Perspective for Understanding Quantitative Arterial Spin-Labeling MR Imaging Using Continuous ASL. Pol J Radiol 2016; 81:317-21. [PMID: 27471575 PMCID: PMC4939853 DOI: 10.12659/pjr.896795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 12/14/2015] [Indexed: 11/09/2022] Open
Abstract
The current paper describes visually the system of CBF measurement by continuous ASL using schematic illustration. I also discussed the effects of the parameters used in continuous ASL to CBF values as measured with ASL-MRI.
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Affiliation(s)
- Tomoyuki Noguchi
- Department of Radiology, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo, Japan
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Kleijwegt MC, van der Mey AGL, Wiggers-deBruine FT, Malessy MJA, van Osch MJP. Perfusion magnetic resonance imaging provides additional information as compared to anatomical imaging for decision-making in vestibular schwannoma. Eur J Radiol Open 2016; 3:127-33. [PMID: 27366777 PMCID: PMC4919314 DOI: 10.1016/j.ejro.2016.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 05/31/2016] [Indexed: 11/26/2022] Open
Abstract
DSC/ASL-MRI can be acquired in growing VS with sufficient image quality. In most patients DSC and ASL techniques provide similar qualitative scores. These techniques can be of importance in future decision-making.
Objective The added value of perfusion MRI for decision-making in vestibular schwannoma (VS) patients is unknown. MRI offers two perfusion methods: the first employing contrast agent (dynamic susceptibility contrast (DSC)-MRI) that provides information on cerebral blood volume (CBV) and cerebral blood flow (CBF), the second by magnetic labeling of blood (arterial spin labeling (ASL)-MRI), providing CBF-images. The goal of the current study is to investigate whether DSC and ASL perfusion MRI provides complimentary information to current anatomical imaging in treatment selection process of VS. Methods Nine patients with growing VS with extrameatal diameter >9 mm were included (>2 mm/year and 20% volume expansion/year) and one patient with 23 mm extrameatal VS without growth. DSC and ASL perfusion MRI were obtained on 3 T MRI. Perfusion in VS was scored as hyperintense, hypointense or isointense compared to the contralateral region. Results Seven patients showed hyperintense signal on DSC and ASL sequences. Three patients showed iso- or hypointense signal on at least one perfusion map (1 patient hypointense on both DSC-MRI and ASL; 1 patient isointense on DSC-CBF; 1 patient isointense on ASL). All patients showed enhancement on post-contrast T1 anatomical scan. Conclusion Perfusion MR provides additional information compared to anatomical imaging for decision-making in VS.
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Key Words
- AAO-HNS, American Academy of Otolaryngology-Head and Neck Surgery
- ASL, arterial spin labeling
- CA, contrast agent
- CBF, cerebral blood flow
- CBV, cerebral blood volume
- DSC, dynamic susceptibility contrast
- Decision making
- Dynamic susceptibility contrast (DSC) and arterial spin labeling (ASL)
- EPI, echo planar imaging
- FA, flip angle
- FOV, field of view
- Gd, gadolinium
- MR, magnetic resonance
- MRI, magnetic resonance imaging
- PCASL, pseudo-continuous arterial spin labeling
- Perfusion weighted MR
- RF, radiofrequency
- SNR, signal to noise ratio
- TE, echo time
- TR, repetition time
- VS, vestibular schwannoma
- Vestibular schwannoma
- rCBV, relative CBV
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Affiliation(s)
- M C Kleijwegt
- ENT Department, Leiden University Medical Center, Leiden, The Netherlands
| | - A G L van der Mey
- ENT Department, Leiden University Medical Center, Leiden, The Netherlands
| | | | - M J A Malessy
- Neurosurgery Department, Leiden University Medical Center, Leiden, The Netherlands
| | - M J P van Osch
- C.J. Gorter Center for High Field MRI, Radiology Department, Leiden University Medical Center, Leiden, The Netherlands
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Arterial Spin Labeling Techniques 2009-2014. J Med Imaging Radiat Sci 2016; 47:98-107. [PMID: 31047171 DOI: 10.1016/j.jmir.2015.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 07/03/2015] [Accepted: 08/18/2015] [Indexed: 12/23/2022]
Abstract
PURPOSE Arterial spin labeling (ASL) techniques have been implemented across a diverse range of clinical and experimental applications. This review aims to evaluate the current feasibility of ASL in clinical neuroradiology based on recent improvements to ASL sequences and highlight areas for potential clinical applications. METHODS AND MATERIALS In December 2014, a literature search was conducted on PubMed Central, EMBASE, and Scopus using the search terms: "arterial spin labeling, neuroradiology," for studies published between 2009 and 2014 (inclusive). Of 483 studies matching the inclusion criteria, the number of studies using continuous, pseudocontinuous, pulsed, and velocity-selective ASL sequences was 42, 209, 226, and 3, respectively. Studies were classified based on several common clinical applications according to the type of ASL sequence used. Studies using pulsed ASL and pseudo-continuous ASL were grouped based on common sequences. RESULTS The number of clinical studies was 264. Numerous studies applied ASL to stroke management (43 studies), drug testing (21 studies), neurodegenerative diseases (40 studies), and psychiatric disorders (26 studies). CONCLUSIONS This review discusses several factors hindering the implementation of clinical ASL and ASL-related radiofrequency safety issues encountered in clinical practice. However, a limited number of search terms were used. Further development of robust sequences with multislice imaging capabilities and reduced radiofrequency energy deposition will hopefully improve the clinical acceptance of ASL.
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Copen WA, Lev MH, Rapalino O. Brain perfusion: computed tomography and magnetic resonance techniques. HANDBOOK OF CLINICAL NEUROLOGY 2016; 135:117-135. [PMID: 27432662 DOI: 10.1016/b978-0-444-53485-9.00006-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cerebral perfusion imaging provides assessment of regional microvascular hemodynamics in the living brain, enabling in vivo measurement of a variety of different hemodynamic parameters. Perfusion imaging techniques that are used in the clinical setting usually rely upon X-ray computed tomography (CT) or magnetic resonance imaging (MRI). This chapter reviews CT- and MRI-based perfusion imaging techniques, with attention to image acquisition, clinically relevant aspects of image postprocessing, and fundamental differences between CT- and MRI-based techniques. Correlations with cerebrovascular physiology and potential clinical applications of perfusion imaging are reviewed, focusing upon the two major classes of neurologic disease in which perfusion imaging is most often performed: primary perfusion disorders (including ischemic stroke, transient ischemic attack, and reperfusion syndrome), and brain tumors.
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Affiliation(s)
- William A Copen
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Michael H Lev
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Otto Rapalino
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Lai G, Mahadevan A, Hackney D, Warnke PC, Nigim F, Kasper E, Wong ET, Carter BS, Chen CC. Diagnostic Accuracy of PET, SPECT, and Arterial Spin-Labeling in Differentiating Tumor Recurrence from Necrosis in Cerebral Metastasis after Stereotactic Radiosurgery. AJNR Am J Neuroradiol 2015; 36:2250-5. [PMID: 26427832 DOI: 10.3174/ajnr.a4475] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 05/03/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND PURPOSE Radiographic assessment of cerebral metastasis after stereotactic radiosurgery remains a major challenge in neuro-oncology. It is often difficult to distinguish tumor progression from radiation necrosis in this setting using conventional MR imaging. The objective of this study was to compare the diagnostic sensitivity and specificity of different functional imaging modalities for detecting tumor recurrence after stereotactic radiosurgery. MATERIALS AND METHODS We retrospectively reviewed patients treated between 2007 and 2010 and identified 14 patients with cerebral metastasis who had clinical or radiographic progression following stereotactic radiosurgery and were imaged with arterial spin-labeling, FDG-PET, and thallium SPECT before stereotactic biopsy. Diagnostic accuracy, specificity, sensitivity, positive predictive value, and negative predictive value were calculated for each imaging technique by using the pathologic diagnosis as the criterion standard. RESULTS Six patients (42%) had tumor progression, while 8 (58%) developed radiation necrosis. FDG-PET and arterial spin-labeling were equally sensitive in detecting tumor progression (83%). However, the specificity of arterial spin-labeling was superior to that of the other modalities (100%, 75%, and 50%, respectively). A combination of modalities did not augment the sensitivity, specificity, positive predictive value, or negative predictive value of arterial spin-labeling. CONCLUSIONS In our series, arterial spin-labeling positivity was closely associated with the pathologic diagnosis of tumor progression after stereotactic radiosurgery. Validation of this finding in a large series is warranted.
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Affiliation(s)
- G Lai
- From the School of Medicine (G.L., B.S.C., C.C.C.), University of California, San Diego, La Jolla, California
| | | | | | - P C Warnke
- Division of Neurosurgery (P.C.W.), University of Chicago, Chicago, Illinois
| | - F Nigim
- Division of Neurosurgery (F.N., E.K.)
| | - E Kasper
- Division of Neurosurgery (F.N., E.K.)
| | - E T Wong
- Department of Neurology (E.T.W.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - B S Carter
- From the School of Medicine (G.L., B.S.C., C.C.C.), University of California, San Diego, La Jolla, California
| | - C C Chen
- From the School of Medicine (G.L., B.S.C., C.C.C.), University of California, San Diego, La Jolla, California
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Yamashita K, Hiwatashi A, Togao O, Kikuchi K, Hatae R, Yoshimoto K, Mizoguchi M, Suzuki SO, Yoshiura T, Honda H. MR Imaging-Based Analysis of Glioblastoma Multiforme: Estimation of IDH1 Mutation Status. AJNR Am J Neuroradiol 2015; 37:58-65. [PMID: 26405082 DOI: 10.3174/ajnr.a4491] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 05/22/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Glioblastoma multiforme is highly aggressive and the most common type of primary malignant brain tumor in adults. Imaging biomarkers may provide prognostic information for patients with this condition. Patients with glioma with isocitrate dehydrogenase 1 (IDH1) mutations have a better clinical outcome than those without such mutations. Our purpose was to investigate whether the IDH1 mutation status in glioblastoma multiforme can be predicted by using MR imaging. MATERIALS AND METHODS We retrospectively studied 55 patients with glioblastoma multiforme with wild type IDH1 and 11 patients with mutant IDH1. Absolute tumor blood flow and relative tumor blood flow within the enhancing portion of each tumor were measured by using arterial spin-labeling data. In addition, the maximum necrosis area, the percentage of cross-sectional necrosis area inside the enhancing lesions, and the minimum and mean apparent diffusion coefficients were obtained from contrast-enhanced T1-weighted images and diffusion-weighted imaging data. Each of the 6 parameters was compared between patients with wild type IDH1 and mutant IDH1 by using the Mann-Whitney U test. The performance in discriminating between the 2 entities was evaluated by using receiver operating characteristic analysis. RESULTS Absolute tumor blood flow, relative tumor blood flow, necrosis area, and percentage of cross-sectional necrosis area inside the enhancing lesion were significantly higher in patients with wild type IDH1 than in those with mutant IDH1 (P < .05 each). In contrast, no significant difference was found in the ADC(minimum) and ADC(mean). The area under the curve for absolute tumor blood flow, relative tumor blood flow, percentage of cross-sectional necrosis area inside the enhancing lesion, and necrosis area were 0.850, 0.873, 0.739, and 0.772, respectively. CONCLUSIONS Tumor blood flow and necrosis area calculated from MR imaging are useful for predicting the IDH1 mutation status.
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Affiliation(s)
- K Yamashita
- From the Departments of Clinical Radiology (K.Yamashita, A.H., O.T., K.K., T.Y., H.H.)
| | - A Hiwatashi
- From the Departments of Clinical Radiology (K.Yamashita, A.H., O.T., K.K., T.Y., H.H.)
| | - O Togao
- From the Departments of Clinical Radiology (K.Yamashita, A.H., O.T., K.K., T.Y., H.H.)
| | - K Kikuchi
- From the Departments of Clinical Radiology (K.Yamashita, A.H., O.T., K.K., T.Y., H.H.)
| | - R Hatae
- Neurosurgery (R.H., K.Yoshimoto., M.M.)
| | | | | | - S O Suzuki
- Neuropathology (S.O.S.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - T Yoshiura
- From the Departments of Clinical Radiology (K.Yamashita, A.H., O.T., K.K., T.Y., H.H.) Department of Radiology (T.Y.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - H Honda
- From the Departments of Clinical Radiology (K.Yamashita, A.H., O.T., K.K., T.Y., H.H.)
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A neuroradiologist's guide to arterial spin labeling MRI in clinical practice. Neuroradiology 2015; 57:1181-202. [PMID: 26351201 PMCID: PMC4648972 DOI: 10.1007/s00234-015-1571-z] [Citation(s) in RCA: 173] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 08/05/2015] [Indexed: 01/01/2023]
Abstract
Arterial spin labeling (ASL) is a non-invasive MRI technique to measure cerebral blood flow (CBF). This review provides a practical guide and overview of the clinical applications of ASL of the brain, as well its potential pitfalls. The technical and physiological background is also addressed. At present, main areas of interest are cerebrovascular disease, dementia and neuro-oncology. In cerebrovascular disease, ASL is of particular interest owing to its quantitative nature and its capability to determine cerebral arterial territories. In acute stroke, the source of the collateral blood supply in the penumbra may be visualised. In chronic cerebrovascular disease, the extent and severity of compromised cerebral perfusion can be visualised, which may be used to guide therapeutic or preventative intervention. ASL has potential for the detection and follow-up of arteriovenous malformations. In the workup of dementia patients, ASL is proposed as a diagnostic alternative to PET. It can easily be added to the routinely performed structural MRI examination. In patients with established Alzheimer’s disease and frontotemporal dementia, hypoperfusion patterns are seen that are similar to hypometabolism patterns seen with PET. Studies on ASL in brain tumour imaging indicate a high correlation between areas of increased CBF as measured with ASL and increased cerebral blood volume as measured with dynamic susceptibility contrast-enhanced perfusion imaging. Major advantages of ASL for brain tumour imaging are the fact that CBF measurements are not influenced by breakdown of the blood–brain barrier, as well as its quantitative nature, facilitating multicentre and longitudinal studies.
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Zhang J. How far is arterial spin labeling MRI from a clinical reality? Insights from arterial spin labeling comparative studies in Alzheimer's disease and other neurological disorders. J Magn Reson Imaging 2015; 43:1020-45. [PMID: 26250802 DOI: 10.1002/jmri.25022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 07/16/2015] [Accepted: 07/19/2015] [Indexed: 12/26/2022] Open
Affiliation(s)
- Jing Zhang
- Department of Clinical Neurological Sciences, University of Western Ontario, London, ON, Canada
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Astrocytic tumour grading: a comparative study of three-dimensional pseudocontinuous arterial spin labelling, dynamic susceptibility contrast-enhanced perfusion-weighted imaging, and diffusion-weighted imaging. Eur Radiol 2015; 25:3423-30. [PMID: 26002128 PMCID: PMC4636527 DOI: 10.1007/s00330-015-3768-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 03/09/2015] [Accepted: 04/02/2015] [Indexed: 10/25/2022]
Abstract
OBJECTIVES We hypothesized that three-dimensional pseudocontinuous arterial spin labelling (pCASL) may have similar efficacy in astrocytic tumour grading as dynamic susceptibility contrast-enhanced perfusion-weighted imaging (DSC-PWI), and the grading accuracy may be further improved when combined with apparent diffusion coefficient (ADC) values. METHODS Forty-three patients with astrocytic tumours were studied using diffusion weighted imaging (DWI), pCASL, and DSC-PWI. Histograms of ADC and normalized tumour cerebral blood flow values (nCBF on pCASL and nrCBF on DSC-PWI) were measured and analyzed. RESULTS The mean 10 % ADC value was the DWI parameter that provided the best differentiation between low-grade astrocytoma (LGA) and high-grade astrocytoma (HGA). The nCBF and nrCBF (1.810 ± 0.979 and 2.070 ± 1.048) in LGA were significantly lower than those (4.505 ± 2.270 and 5.922 ± 2.630) in HGA. For differentiation between LGA and HGA, the cutoff values of 0.764 × 10(-3) mm(2)/s for mean 10 % ADC, 2.374 for nCBF, and 3.464 for nrCBF provided the optimal accuracy (74.4 %, 86.1 %, and 88.6 %, respectively). Combining the ADC values with nCBF or nrCBF could further improve the grading accuracy to 97.7 % or 95.3 %, respectively. CONCLUSIONS pCASL is an alternative to DSC-PWI for astrocytic tumour grading. The combination of DWI and contrast-free pCASL offers a valuable choice in patients with risk factors. KEY POINTS • pCASL shows positive correlation with DSC-PWI in astrocytic tumour grading. • ADC values based on ADC histograms can be an objective method. • Combination of DWI and pCASL or DSC-PWI can improve grading accuracy.
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Prognostic value of blood flow estimated by arterial spin labeling and dynamic susceptibility contrast-enhanced MR imaging in high-grade gliomas. J Neurooncol 2014; 120:557-66. [DOI: 10.1007/s11060-014-1586-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 08/10/2014] [Indexed: 10/24/2022]
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Treister D, Kingston S, Hoque KE, Law M, Shiroishi MS. Multimodal Magnetic Resonance Imaging Evaluation of Primary Brain Tumors. Semin Oncol 2014; 41:478-495. [DOI: 10.1053/j.seminoncol.2014.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Xiao HF, Lou X, Liu MY, Wang YL, Wang Y, Chen ZY, Shi KN, Ma L. The role of magnetic resonance diffusion-weighted imaging and three-dimensional arterial spin labelling perfusion imaging in the differentiation of parasellar meningioma and cavernous haemangioma. J Int Med Res 2014; 42:915-25. [PMID: 24903554 DOI: 10.1177/0300060514531918] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 03/24/2014] [Indexed: 11/16/2022] Open
Abstract
Objective To evaluate the diagnostic value of magnetic resonance diffusion-weighted imaging (DWI) and three-dimensional arterial spin labelling perfusion imaging (3D-ASL) in distinguishing cavernous haemangioma from parasellar meningioma, using histological data as a reference standard. Methods Patients with parasellar meningioma or parasellar cavernous haemangioma underwent conventional T1- and T2-weighted magnetic resonance imaging (MRI) followed by DWI and 3D-ASL using a 3.0 Tesla MRI. The minimum apparent diffusion coefficient (minADC) from DWI and the maximal normalized cerebral blood flow (nCBF) from 3D-ASL were measured in each tumour. Diagnosis was confirmed by histology. Results MinADC was significantly lower and nCBF significantly higher in meningioma ( n = 19) than cavernous haemangioma ( n = 15). There was a significant negative correlation between minADC and nCBF ( r = −0.605). Conclusion DWI and 3D-ASL are useful in differentiating cavernous haemangiomas from parasellar meningiomas, particularly in situations when the appearance on conventional MRI sequences is otherwise ambiguous.
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Affiliation(s)
- Hua-Feng Xiao
- Department of Radiology, PLA General Hospital, Beijing, China
| | - Xin Lou
- Department of Radiology, PLA General Hospital, Beijing, China
| | - Meng-Yu Liu
- Department of Radiology, PLA General Hospital, Beijing, China
| | - Yu-Lin Wang
- Department of Radiology, PLA General Hospital, Beijing, China
| | - Yan Wang
- Department of Radiology, PLA General Hospital, Beijing, China
| | - Zhi-Ye Chen
- Department of Radiology, PLA General Hospital, Beijing, China
| | - Kai-Ning Shi
- General Electric Company GE (China) Co., Ltd, Healthcare, Beijing, China
| | - Lin Ma
- Department of Radiology, PLA General Hospital, Beijing, China
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Clinical evaluation of an arterial-spin-labeling product sequence in steno-occlusive disease of the brain. PLoS One 2014; 9:e87143. [PMID: 24516546 PMCID: PMC3916330 DOI: 10.1371/journal.pone.0087143] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 12/18/2013] [Indexed: 11/28/2022] Open
Abstract
Introduction In brain perfusion imaging, arterial spin labeling (ASL) is a noninvasive alternative to dynamic susceptibility contrast-magnetic resonance imaging (DSC-MRI). For clinical imaging, only product sequences can be used. We therefore analyzed the performance of a product sequence (PICORE-PASL) included in an MRI software-package compared with DSC-MRI in patients with steno-occlusion of the MCA or ICA >70%. Methods Images were acquired on a 3T MRI system and qualitatively analyzed by 3 raters. For a quantitative analysis, cortical ROIs were placed in co-registered ASL and DSC images. Pooled data for ASL-cerebral blood flow (CBF) and DSC-CBF were analyzed by Spearman’s correlation and the Bland-Altman (BA)-plot. Results In 28 patients, 11 ASL studies were uninterpretable due to patient motion. Of the remaining patients, 71% showed signs of delayed tracer arrival. A weak correlation for DSC-relCBF vs ASL-relCBF (r = 0.24) and a large spread of values in the BA-plot owing to unreliable CBF-measurement was found. Conclusion The PICORE ASL product sequence is sensitive for estimation of delayed tracer arrival, but cannot be recommended to measure CBF in steno-occlusive disease. ASL-sequences that are less sensitive to patient motion and correcting for delayed blood flow should be available in the clinical setting.
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Fussell D, Young RJ. Role of MRI perfusion in improving the treatment of brain tumors. ACTA ACUST UNITED AC 2013. [DOI: 10.2217/iim.13.50] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Watts JM, Whitlow CT, Maldjian JA. Clinical applications of arterial spin labeling. NMR IN BIOMEDICINE 2013; 26:892-900. [PMID: 23378178 DOI: 10.1002/nbm.2904] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 10/23/2012] [Accepted: 11/12/2012] [Indexed: 06/01/2023]
Abstract
MR arterial spin labeling is primarily applied as a neuroimaging method to measure cerebral blood flow. As this technique becomes more widely available, a basic understanding of the clinical applications is necessary for optimal utilization in the setting of patient care. This review focuses on the use of arterial spin labeling imaging for the evaluation of cerebrovascular disease, brain tumors and neuropsychiatric illness.
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Affiliation(s)
- Jonathan M Watts
- Wake Forest School of Medicine, Department of Radiology, Winston Salem, NC, USA
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Differentiating primary CNS lymphoma from glioblastoma multiforme: assessment using arterial spin labeling, diffusion-weighted imaging, and ¹⁸F-fluorodeoxyglucose positron emission tomography. Neuroradiology 2012; 55:135-43. [PMID: 22961074 DOI: 10.1007/s00234-012-1089-6] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 08/27/2012] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Our purpose was to evaluate the diagnostic performance of arterial spin labeling (ASL) perfusion imaging, diffusion-weighted imaging (DWI), and (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) in differentiating primary central nervous system lymphomas (PCNSLs) from glioblastoma multiformes (GBMs). METHODS Fifty-six patients including 19 with PCNSL and 37 with GBM were retrospectively studied. From the ASL data, an absolute tumor blood flow (aTBF) and a relative tumor blood flow (rTBF) were obtained within the enhancing portion of each tumor. In addition, the minimum apparent diffusion coefficient (ADCmin) and the maximum standard uptake value (SUVmax) were obtained from DWI and FDG-PET data, respectively. Each of the four parameters was compared between PCNSLs and GBMs using Kruskal-Wallis test. The performance in discriminating between PCNSLs and GBMs was evaluated using the receiver-operating characteristics analysis. Area-under-the-curve (AUC) values were compared among the four parameters using a nonparametric method. RESULTS The aTBF, rTBF, and ADCmin were significantly higher in GBMs (mean aTBF ± SD = 91.6 ± 56.0 mL/100 g/min, mean rTBF ± SD = 2.61 ± 1.61, mean ADCmin ± SD = 0.78 ± 0.19 × 10(-3) mm(2)/s) than in PCNSLs (mean aTBF ± SD = 37.3 ± 10.5 mL/100 g/min, mean rTBF ± SD = 1.24 ± 0.37, mean ADCmin ± SD = 0.61 ± 0.13 × 10(-3) mm(2)/s) (p < 0.005, respectively). In addition, SUVmax was significantly lower in GBMs (mean ± SD = 13.1 ± 6.34) than in PCNSLs (mean ± SD = 22.5 ± 7.83) (p < 0.005). The AUC for aTBF (0.888) was higher than those for rTBF (0.810), ADCmin (0.768), and SUVmax (0.848), although their difference was not statistically significant. CONCLUSION ASL perfusion imaging is useful for differentiating PCNSLs from GBMs as well as DWI and FDG-PET.
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Lefranc M, Monet P, Desenclos C, Peltier J, Fichten A, Toussaint P, Sevestre H, Deramond H, Le Gars D. Perfusion MRI as a neurosurgical tool for improved targeting in stereotactic tumor biopsies. Stereotact Funct Neurosurg 2012; 90:240-7. [PMID: 22699810 DOI: 10.1159/000338092] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Accepted: 02/27/2012] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Stereotactic biopsies are subject to sampling errors (essentially due to target selection). The presence of contrast enhancement is not a reliable marker of malignancy. The goal of the present study was to determine whether perfusion-weighted imaging can improve target selection in stereotactic biopsies. METHODS We studied 21 consecutive stereotactic biopsies between June 2009 and March 2010. Perfusion-weighted magnetic resonance imaging (MRI) was integrated into our neuronavigator. Perfusion-weighted imaging was used as an adjunct to conventional MRI data for target determination. Conventional MRI alone was used to determine the trajectory. RESULTS We found a linear correlation between regional cerebral blood volume (rCBV) and vessel density (number of vessels per mm(2); R = 0.64; p < 0.001). Perfusion-weighted imaging facilitated target determination in 11 cases (52.4%), all of which were histopathologically diagnosed as glial tumors. For glial tumors, which presented with contrast enhancement, perfusion-weighted imaging identified a more precisely delimited target in 9 cases, a different target in 1 case, and exactly the same target in 1 other case. In all cases, perfusion-selected sampling provided information on cellular features and tumor grading. rCBV was significantly associated with grading (p < 0.01), endothelial proliferation (p < 0.01), and vessel density (p < 0.01). For lesions with rCBV values ≤1, perfusion-weighted MRI did not help to determine the target but was useful for surgical management. CONCLUSIONS For stereotactic biopsies, targeting based on perfusion-weighted imaging is a feasible method for reducing the sampling error and improving target selection in the histopathological diagnosis of tumors with high rCBVs.
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Affiliation(s)
- M Lefranc
- Department of Neurosurgery, Amiens University Hospital, Amiens, France.
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White CM, Pope WB, Zaw T, Qiao J, Naeini KM, Lai A, Nghiemphu PL, Wang JJ, Cloughesy TF, Ellingson BM. Regional and voxel-wise comparisons of blood flow measurements between dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) and arterial spin labeling (ASL) in brain tumors. J Neuroimaging 2012; 24:23-30. [PMID: 22672084 DOI: 10.1111/j.1552-6569.2012.00703.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 11/04/2011] [Accepted: 12/15/2011] [Indexed: 11/30/2022] Open
Abstract
The objective of the current study was to evaluate the regional and voxel-wise correlation between dynamic susceptibility contrast (DSC) and arterial spin labeling (ASL) perfusion magnetic resonance imaging (MRI) measurement of cerebral blood flow (CBF) in patients with brain tumors. Thirty patients with histologically verified brain tumors were evaluated in the current study. DSC-MRI was performed by first using a preload dose of gadolinium contrast, then collecting a dynamic image acquisition during a bolus of contrast, followed by posthoc contrast agent leakage correction. Pseudocontinuous ASL was collected using 30 pairs of tag and control acquisition using a 3-dimensional gradient-echo spin-echo (GRASE) acquisition. All images were registered to a high-resolution anatomical atlas. Average CBF measurements within regions of contrast-enhancement and T2 hyperintensity were evaluated between the two modalities. Additionally, voxel-wise correlation between CBF measurements obtained with DSC and ASL were assessed. Results demonstrated a positive linear correlation between DSC and ASL measurements of CBF when regional average values were compared; however, a statistically significant voxel-wise correlation was only observed in around 30-40% of patients. These results suggest DSC and ASL may provide regionally similar, but spatially different measurements of CBF.
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Affiliation(s)
- Carissa M White
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095
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Diffusion tensor and perfusion imaging of brain tumors in high-field MR imaging. Neuroimaging Clin N Am 2012; 22:123-34, ix. [PMID: 22548924 DOI: 10.1016/j.nic.2012.02.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Diffusion tensor imaging (DTI) and perfusion-weighted imaging (PWI) are essential tools for diagnosing, differentiating, and monitoring brain tumors. High-field MRI provides higher signal-to-noise ratio, shorter scan time, and better image quality. One-stop multiparametric study, including DTI and PWI, is possible with high-field MRI in brain tumors. DTI can be used for assessing spatial relationship between major white matter tract and tumor, differentiating gliomas from nonglial tumors, and postoperative evaluation. PWI provides reliable biomarkers for glioma grading, therapeutic responses, and differential diagnosis of various brain tumors. With higher field strength, better-quality DTI and PWI can raise the diagnostic accuracy in brain tumors.
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Yamashita K, Yoshiura T, Hiwatashi A, Togao O, Yoshimoto K, Suzuki SO, Kikuchi K, Mizoguchi M, Iwaki T, Honda H. Arterial spin labeling of hemangioblastoma: differentiation from metastatic brain tumors based on quantitative blood flow measurement. Neuroradiology 2011; 54:809-13. [DOI: 10.1007/s00234-011-0977-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Accepted: 10/26/2011] [Indexed: 10/15/2022]
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