Arterial Spin Labeling for Glioma Grade Discrimination: Correlations with IDH1 Genotype and 1p/19q Status

Abstract

Since accurate grading of gliomas has important clinical value, the aim of this study is to evaluate the diagnostic efficacy of perfusion values derived from arterial spin labeling (ASL) to grade gliomas. In addition, the correlation between perfusion and isocitrate dehydrogenase 1 (IDH1) genotypes and chromosome arms 1p and 19q (1p/19q) status of gliomas was assessed. A total of 52 cases of supratentorial gliomas in adults who received ASL imaging were enrolled in this retrospective study. The cerebral blood flow (CBF) images derived from ASL and anatomical maps were normalized to the Montreal Neurological Institute coordinate system and matched. The mean CBF (meanCBF), the maximum CBF (maxCBF), and their relative values (rmeanCBF and rmaxCBF, respectively) were assessed in each case. The tumor grades, IDH1 genotypes, and 1p/19q status were diagnosed according to the 2016 WHO criteria. Receiver operating characteristic curves were performed to assess the efficacy of perfusion parameters for grading. Qualitatively, all gliomas were divided into high- and low-perfusion groups. The crosstabs chi-square test of independence was performed to calculate contingency coefficient (C) and Cramer V coefficient to assess the correlation between perfusion and IDH1 genotypes and 1p/19q status of gliomas. The rmaxCBF showed the best diagnostic efficacy; meanwhile, rmeanCBF had the best specificity for grade discrimination. In astrocytoma, there was a mild correlation between IDH1 genotypes and tumor perfusion with the Cramer's V coefficient of 0.378. There was no significant association between 1p/19q codeletion and perfusion in grade II and III gliomas.

Three-Dimensional Pseudo-Continuous Arterial Spin Labeling Parameters Distinguish Pediatric Medulloblastoma and Pilocytic Astrocytoma

“…They also concluded that CBF values had excellent diagnostic accuracy for the differentiation between high-grade and lowgrade gliomas owing to cost-effectiveness, lack of adverse events, and high acceptibility (18). Thus, our findings were in agreement with these previous reports (18,20).…”

“…Wang et al studied 52 patients with glioma, divide into two groups: low-grade glioma ( n = 16) and high-grade glioma ( n = 36). Their results showed that maxCBF, rmaxCBF, meanCBF, and rmeanCBF values for the low-grade group were significantly lower than those for the high-grade group ( 20 ). A meta-analysis by Kong et al, including 305 glioma patients, also showed that the ASL perfusion values of the high-grade glioma group, including aCBFmax, aCBFmean, rCBFmax, and rCBFmean, were significantly higher than those of low-grade glioma group.…”

“…Wang et al suggested an optimal cut-off rmaxCBF value of 1.25, which provided a sensitivity of 86.5%, a specificity of 73.3%, and an AUC of 79.8%, whereas an optimal cut-off rmeanCBF value of 0.89 yielded a sensitivity of 70.3%, a specificity of 86.7%, and an AUC of 74.4%. The rmaxCBF value showed the best diagnostic efficacy, whereas the rmeanCBF value had the best specificity for grade discrimination ( 20 ). In a meta-analysis examining 15 previous studies, involving 505 glioma patients, Falk Delgado et al found that the diagnostic performance of CBF values for glioma grading was 0.90, with a sensitivity of 0.89 (0.79–0.90) and a specificity of 0.80 (0.72–0.89).…”

ASL-Perfusion for Intrinsic Brain Tumor Diagnosis. Analysis of 253 Patients.

“…Zeng et al (2017) [25] revealed a signi cant difference in TBF and nTBF values for these groups of patients, but they did not present ROC-analysis results and thus to evaluate ASL-perfusion effectiveness in differentiating cerebral gliomas grade III and grade IV. Wang et al (2019) did not nd any signi cant difference for TBF and nTBF in these two groups of patients.…”

Can High b Value Diffusion Be a Surrogate Marker for PET—A MR/PET Study in Neurooncology Set Up

“…Many MR/PET studies correlate with multiple advanced imaging parameters like diffusion-weighted imaging (DWI) and Perfusion weighted imaging (PWI) studies on the grading of gliomas, enabling the prediction of recurrence. It is possible to differentiate recurrence vs. radiation necrosis and the false negative in each modality is known (3)(4)(5)(6). PET also has many tracers, each with its specificity and sensitivity (7)(8)(9)(10).…”