Arterial spin labeling: Pathologically proven superiority over conventional MRI for detection of high-grade glioma progression after treatment

• Published in: The neuroradiology journal 2016-10, Vol.29 (5), p.377-383
• Main Authors: Nyberg, Eric, Honce, Justin, Kleinschmidt-DeMasters, Bette K, Shukri, Brian, Kreidler, Sarah, Nagae, Lidia
• Format: Article
• Language: English
• Subjects: Brain Diseases
• ISSN: 1971-4009; 2385-1996
• DOI: 10.1177/1971400916665375

Background Standard of care for high-grade gliomas (HGGs) includes surgical debulking and adjuvant chemotherapy and radiation. Patients under treatment require frequent clinical and imaging monitoring for therapy modulation. Differentiating tumor progression from treatment-related changes can be challenging on conventional MRI, resulting in delayed recognition of tumor progression. Arterial spin labeling (ASL) may be more sensitive for tumor progression. Materials and methods ASL and associated conventional MR images obtained in patients previously treated for HGGs and before biopsy or re-resection were reviewed by three neuroradiologists who were blinded to the histopathologic results. Regions of interest (ROIs) of greatest perfusion were chosen by consensus, and mirror-image contralateral ROIs were also placed. Sensitivity of ASL for tumor progression was compared with those of contrast-enhanced T1-weighted (T1W-CE) and fluid-attenuated inversion recovery (FLAIR) images using McNemar’s test. We tested for an association between cerebral blood flow (CBF) and apparent diffusion correlation (ADC) using a Hotelling–Lawley trace. Finally, we used a Pearson’s analysis to test for a correlation between CBF and percentage of tumor within each resection. Results Twenty-two patients were studied. ASL demonstrated hyperperfusion in all cases with mean CBF ratio 3.37 (±1.71). T1W-CE and FLAIR images were positive in 15 (p = 0.0233) and 16 (p = 0.0412) cases, respectively. There was no association between ADC and CBF (p = 0.687). There was a correlation between CBF and percentage of tumor (p = 0.048). Conclusion ASL may be more sensitive than conventional MR sequences for the detection of tumor progression in patients treated for HGGs.