Differentiation between recurrent gliomas and radiation necrosis using arterial spin labeling perfusion imaging

Abstract

Arterial spin labeling (ASL) magnetic resonance (MR) perfusion imaging has been proposed as an effective method to measure brain tumor perfusion. The aim of the present study was to evaluate the utility of this technique in the differentiation of recurrent gliomas from radiation necrosis. Twenty-one patients with surgically treated primary gliomas, including 16 cases of recurrent glioma and 5 of radiation necrosis were examined using 3.0T MR imaging (MRI). ASL and dynamic susceptibility contrast-weighted (DSC) perfusion MRI scans were performed. Maps of normalized cerebral blood flow (CBF) in ASL imaging and cerebral blood volume (CBV) in DSC imaging were computed and analyzed in the regions of interest. In cases of glioma recurrence, the normalized ASL-CBF ratio (4.45±2.72) was higher than that in cases of radiation injury (1.22±0.61) (P<0.01). The normalized DSC-relative CBV ratio was also significantly higher in glioma recurrence (3.38±2.08) than it was in radiation injury (1.09±0.55) (P<0.05). A close linear correlation was found between the ASL and DSC MRI techniques (linear regression coefficient, R=0.85; P=0.005) in the differentiation of recurrent glioma from radiation injury. The results indicate that ASL perfusion is an accurate method of distinguishing between glioma recurrence and radiation necrosis.

The Study&nbsp;of&nbsp;Cerebral Blood Flow Variations&nbsp;Following Radiation Dose Gradients for Brain Metastasis&nbsp;Patients During&nbsp;Radiotherapy

“…The results are in good agreement with traditional perfusion imaging, and the combination with conventional MR images is widely used in the diagnosis and differential diagnosis of cranio-cerebral diseases [13,15,40]. In cases of glioma recurrence, the normalized ASL-CBF ratio was 74.83% higher than that of radiation-induced brain injury [41]. Current research on gliomas shows that ASL can be used to evaluate tumor microcirculation perfusion.…”

Optimizing Texture Retrieving Model for Multimodal MR Image‐Based Support Vector Machine for Classifying Glioma

“…Both conventional (including T 1 ‐ and T 2 ‐weighted images) and advanced sequences, including dynamic contrast imaging (DCE), diffusion‐weighted imaging (DWI), and arterial spinal labeling (ASL) have been applied to preoperatively classify glioma. Although it is generally reported that advanced sequences are superior to conventional ones in classifying glioma grades, controversies still exist about the diagnostic accuracy of MRI . The major reason is that only a small number of MRI attributes from the limited MRI modalities were utilized, leaving a huge amount of valuable multimodal image information unused, not to mention reflecting the heterogeneity of gliomas.…”

“…MRI is a commonly used noninvasive technique for glioma diagnosis. Both conventional (including T 1and T 2 -weighted images) 4 and advanced sequences, including dynamic contrast imaging (DCE), diffusion-weighted imaging (DWI), 5,6 and arterial spinal labeling (ASL) 7 have been applied to preoperatively classify glioma. Although it is generally reported that advanced sequences are superior to conventional ones in classifying glioma grades, controversies still exist about the diagnostic accuracy of MRI.…”

“…Although it is generally reported that advanced sequences are superior to conventional ones in classifying glioma grades, controversies still exist about the diagnostic accuracy of MRI. [5][6][7][8][9] The major reason is that only a small number of MRI attributes from the limited MRI modalities were utilized, leaving a huge amount of valuable multimodal image information unused, not to mention reflecting the heterogeneity of gliomas.…”

Perfusion of surgical cavity wall enhancement in early post-treatment MR imaging may stratify the time-to-progression in glioblastoma

“…Pseudoprogression is diagnosed when a post-radiation MRI indicates an increase in contrast enhancement that subsides with time, without any change in therapy, and may therefore have represented radiation change [1, 29]. However, pseudoprogression has also shown decreased perfusion on ASL in previous studies [10, 11] and its possible confounding effect of pseudoprogression is unlikely to have caused the association between decreased perfusion and shorter TTP in our current study.…”