Application of MRS- and ASL-guided navigation for biopsy of intracranial tumors

Abstract

Background The diagnosis of a tumor depends on accurate identification of the target area for biopsy. However, tumor heterogeneity and the inability of conventional structural data for identifying the most malignant areas can reduce this accuracy. Purpose To evaluate the feasibility and practicality of magnetic resonance spectroscopy (MRS)- and arterial spin labeling (ASL)-guided MRI navigation for needle biopsy of intracranial tumors. Material and Methods Thirty patients with intracranial tumors who underwent intraoperative stereotactic biopsy were retrospectively analyzed. Contrast-enhanced 3D-BRAVO or 3D-T2FLAIR structural data, combined with MRS and ASL data, were used to identify the target area for biopsy. High-choline or high-perfusion sites were chosen preferentially, and then the puncture trajectory was optimized to obtain specimens for histopathologic examination. Results Twenty-two specimens were collected from 20 glioma patients (two specimens each were collected from two patients) and ten specimens were collected from ten lymphoma patients. The diagnosis rate after the biopsy was 93.3% (28/30). Two gliomas were initially diagnosed as gliosis and subsequently diagnosed correctly after the collection of a second biopsy specimen. Combined MRS and ASL helped target selection in 23 cases (76.7%), including three cases each of low-enhancing and non-enhancing gliomas. In two cases, the target selection decision was changed because the areas initially chosen on the basis of positron emission tomography data did not match the high-perfusion areas identified with ASL. Conclusion Compared with conventional MRI, combined MRS and ASL improved the accuracy of target selection for the stereotactic biopsy of intracranial tumors.

A Study of Dose Painting Radiotherapy Guided by Three-Dimensional Arterial Spin labeling Perfusion Magnetic Resonance Imaging for Non-Enhancing Low-Grade Gliomas

“…Teng et al showed that glioma puncture guided by 3D-ASL had a higher success rate than conventional MRI. In this study, 6 cases of low-enhancing or non-enhancing gliomas were successfully punctured, indicating that 3D-ASL has great potential in guiding the determination of tumor targets for NE-LGGs [9]. 3D-ASL is widely used in the diagnosis, grading and e cacy evaluation of gliomas [8, 10,11], while its application in guiding NE-LGG radiotherapy has rarely been reported.…”

The potential of advanced MR techniques for precision radiotherapy of glioblastoma

“…In a biopsy study, ASL guidance was found to improve the accuracy of target selection for stereotaxic biopsies when combined with MRS [ 55 ]. A conclusive diagnosis could be made for 28 out of 30 patients (93.3%).…”

Multiparametric MRI: practical approach and pictorial review of a useful tool in the evaluation of brain tumours and tumour-like lesions

“…There is substantial risk of inaccuracy in stereotactic biopsy, with under-grading of WHO grade III tumours reported in 28% of cases [26]. The successful stereotactic biopsy diagnosis rate utilising multiparametric MRI techniques has shown to be more than 93% [27]. To get a .…”

“…There is substantial risk of inaccuracy in stereotactic biopsy, with under-grading of WHO grade III tumours reported in 28% of cases [ 26 ]. The successful stereotactic biopsy diagnosis rate utilising multiparametric MRI techniques has shown to be more than 93% [ 27 ]. To get a better biopsy yield and to avoid sampling error for non-enhancing tumours, the target of biopsy can be selected from a high choline, high rCBV or low ADC location.…”