Pseudo-continuous arterial spin labeling reflects vascular density and differentiates angiomatous meningiomas from non-angiomatous meningiomas

Koizumi, Shinichiro; Sakai, Naoto; Kawaji, Hiroshi; Takehara, Yasuo; Yamashita, Shuhei; Sakahara, Harumi; Baba, Satoshi; Hiramatsu, Hisaya; Sameshima, Tetsuro; Namba, Hiroki

doi:10.1007/s11060-014-1666-0

Cited by 28 publications

(15 citation statements)

References 21 publications

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“…ASL CBF measurements have been shown to correlate with DSC metrics in meningiomas as well as microvessel area on his-tologic specimens [19]. There also is a relationship between mengin-gioma subtype (angiomatous, meningo-epithelial, fibrous) and perfusion [9]. In that report the authors do not specify whether their method of continuous ASL could be used to differentiate meningioma grade.…”

Section: Discussionmentioning

confidence: 99%

“…ASL has proven reliable and reproducible in the assessment of CBF in various pathological states. Correlation has been established between DSC- and ASL-derived metrics, including rCBV and CBF [8], and ASL perfusion ima-ging has been correlated with tumor blood vessel density in me-ningiomas [9]. However, the role of ASL-derived metrics as an imaging marker for differentiating benign from malignant meningiomas has not been studied in detail.…”

Section: Introductionmentioning

confidence: 99%

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Application of arterial spin labeling perfusion MRI to differentiate benign from malignant intracranial meningiomas

Qiao

Kim

Wang

et al. 2017

European Journal of Radiology

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Purpose: Differentiating WHO grade I–III of meningioma by non-invasive imaging is challenging. This study investigated the potential of MR arterial spin labeling (ASL) to establish tumor grade in meningioma patients. Material and methods: Pseudo-continuous ASL with 3D background suppressed gradient and spin echo (GRASE) was acquired on 54 patients with newly diagnosed or recurrent intracranial meningioma. Perfusion patterns characterized in CBF color maps were independently evaluated by three neuroradiologists blinded to patient history, and correlated with tumor grade from histo-pathological review. Results: Three perfusion patterns could be discerned by visual evaluation of CBF maps. Pattern 1 consisted of homogeneous hyper-perfusion of the entire tumor; pattern 2 demonstrated heterogeneous hyper-perfusion; pattern 3 showed no substantial hyper-perfusion. Evaluation of the perfusion patterns was highly concordant among the three readers (Kendall W = 0.9458, P < 0.0001). Pattern 1 was associated with WHO Grade I meningioma of (P < 0.0001). Patterns 2 and 3 were predictive of WHO Grade II and III meningioma (P < 0.0001), with an odds ratio (OR, versus pattern 1) of 49.6 (P < 0.01) in a univariate analysis, and an OR of 186.4 (P < 0.01) in a multivariate analysis. Conclusion: Qualitative evaluation of ASL CBF maps can help differentiate benign (WHO Grade I) from higher grade (WHO Grade II and III) intracranial meningiomas, potentially impacting therapeutic strategy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Application of arterial spin labeling perfusion MRI to differentiate benign from malignant intracranial meningiomas

Qiao

Kim

Wang

et al. 2017

European Journal of Radiology

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“…In their study, both the mean and maximum absolute CBF values were shown to have significant positive correlations with microvascular density. 11 In this study, we investigated whether the nCBF from pseudocontinuous ASL maps could serve as a reliable imaging biomarker for angiographic vascularity of meningiomas. Our study demonstrated a significant positive correlation between the nCBF and angiographic vascularity, in keeping with the finding of the previous study, in which normalized cerebral blood volume obtained from dynamic susceptibility contrast-enhanced PWI was used.…”

Section: Discussionmentioning

confidence: 99%

Utility of arterial spin labeling perfusion magnetic resonance imaging in prediction of angiographic vascularity of meningiomas

Yoo

Yun

Cho

et al. 2016

JNS

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OBJECTIVE Arterial spin labeling perfusion-weighted imaging (ASL-PWI) enables quantification of tissue perfusion without contrast media administration. The aim of this study was to explore whether cerebral blood flow (CBF) from ASL-PWI can reliably predict angiographic vascularity of meningiomas. METHODS Twenty-seven patients with intracranial meningiomas, who had undergone preoperative ASL-PWI and digital subtraction angiography prior to resection, were included. Angiographic vascularity was assessed using a 4-point grading scale and meningiomas were classified into 2 groups: low vascularity (Grades 0 and 1; n = 11) and high vascularity (Grades 2 and 3; n = 16). Absolute CBF, measured at the largest section of the tumor, was normalized to the contralateral gray matter. Correlation between the mean normalized CBF (nCBF) and angiographic vascularity was determined and the mean nCBF values of the 2 groups were compared. Diagnostic performance of the nCBF for differentiating between the 2 groups was assessed. RESULTS The nCBF had a significant positive correlation with angiographic vascularity (ρ = 0.718; p < 0.001). The high-vascularity group had a significantly higher nCBF than the low-vascularity group (3.334 ± 2.768 and 0.909 ± 0.468, respectively; p = 0.003). At the optimal nCBF cutoff value of 1.733, sensitivity and specificity for the differential diagnosis of the 2 groups were 69% (95% CI 41%-89%) and 100% (95% CI 72%-100%), respectively. The area under the receiver operating characteristic curve was 0.875 (p < 0.001). CONCLUSIONS ASL-PWI may provide a reliable and noninvasive means of predicting angiographic vascularity of meningiomas. It may thus assist in selecting potential candidates for preoperative digital subtraction angiography and embolization in clinical practice.

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“…pCASL was used by Koizumi et al 18 to differentiate angiomatous from nonangiomatous meningiomas in a study of 25 patients. The investigators found a significant correlation between the microvascular density of the meningioma and the mean and maximum total tumor blood flow.…”

Section: Tumor Meningiomasmentioning

confidence: 99%

Clinical utility of arterial spin labeling imaging in disorders of the nervous system

Soldozy¹,

Galindo²,

Snyder³

et al. 2019

Neurosurgical Focus

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Neuroimaging is an indispensable tool in the workup and management of patients with neurological disorders. Arterial spin labeling (ASL) is an imaging modality that permits the examination of blood flow and perfusion without the need for contrast injection. Noninvasive in nature, ASL provides a feasible alternative to existing vascular imaging techniques, including angiography and perfusion imaging. While promising, ASL has yet to be fully incorporated into the diagnosis and management of neurological disorders. This article presents a review of the most recent literature on ASL, with a special focus on its use in moyamoya disease, brain neoplasms, seizures, and migraines and a commentary on recent advances in ASL that make the imaging technique more attractive as a clinically useful tool.

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Pseudo-continuous arterial spin labeling reflects vascular density and differentiates angiomatous meningiomas from non-angiomatous meningiomas

Cited by 28 publications

References 21 publications

Application of arterial spin labeling perfusion MRI to differentiate benign from malignant intracranial meningiomas

Application of arterial spin labeling perfusion MRI to differentiate benign from malignant intracranial meningiomas

Utility of arterial spin labeling perfusion magnetic resonance imaging in prediction of angiographic vascularity of meningiomas

Clinical utility of arterial spin labeling imaging in disorders of the nervous system

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