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

Abstract

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.

Differentiation of Glioblastoma from Brain Metastasis: Qualitative and Quantitative Analysis Using Arterial Spin Labeling MR Imaging

“…On the other hand, Noguchi et al have proposed that ASL-driven CBF may predict histopathologic vascular densities of brain tumors [16]. Recently, Yoo et al have demonstrated that ASL may predict the angiographic vascularity of meningiomas [22]. Thus, elevated intratumoral CBF in GBM compared to brain metastasis in our study may reflect the difference in vascular density, although the exact pathologic mechanisms remain unclear.…”

“…Because it is very hard to designate a specific MR scanner for certain target patients before knowing their diagnosis in clinical practice, it may be reasonable to find a way to handle such inter-scanner variation. To minimize possible bias associated with different magnetic strengths, we analyzed the data with a normalized CBF [16, 20–22]. The effect of different magnetic strengths to perfusion parameters was not significant, except for nCBF peritumoral in brain metastasis group.…”

“…To minimize inter-individual differences in perfusion, signal intensities of intratumoral and peritumoral ROIs for each subject were normalized by dividing the values by those of contralateral normal gray matter (nCBF intratumoral and nCBF peritumoral , respectively) [16, 20–22]. A Mann-Whitney test was used to compare parameters from GBMs with those from metastases.…”

Non-invasive qualitative and semiquantitative presurgical investigation of the feeding vasculature to intracranial meningiomas using superselective arterial spin labeling

“…ASL has also been used to perform meningioma grading and identify high grade aggressive forms [15]. Non selective ASL was used by Yoo et al to assess meningioma vascularity in comparison to DSA and found a high positive correlation between the two modalities [16]. Kikichi et al investigated the added values of ASL as an additional tool to detect recurrent meningioma and found an increased detection rate among non-specialists [17].…”

Added Value of Arterial Spin-Labeling MR Imaging for the Differentiation of Cerebellar Hemangioblastoma from Metastasis

“…The utility of ASL perfusion imaging in the evaluation of the vascularity of brain tumors has been explored in several recent studies. [11][12][13][14] One prior study differentiated hemangioblastomas from metastases on the basis of quantitative blood flow measurements using ASL. 15 The authors reported that tumor blood flow was significantly higher in hemangioblastomas than in metastases.…”