Diagnostic Accuracy of Arterial Spin Labeling in Comparison With Dynamic Susceptibility Contrast-Enhanced Perfusion for Brain Tumor Surveillance at 3T MRI

Abstract

PurposeWe aimed to compare arterial spin labeling (ASL) with dynamic susceptibility contrast (DSC) enhanced perfusion MRI for the surveillance of primary and metastatic brain tumors at 3T, both in terms of lesion perfusion metrics and diagnostic accuracy.MethodsIn this retrospective study, we included 115 patients, who underwent both ASL and DSC perfusion in the same 3T MRI scanning session between 1 January and 31 December 2019. ASL-derived cerebral blood flow (CBF) maps and DSC-derived relative cerebral blood volume (rCBV) maps, both uncorrected and corrected for leakage, were created with commercially available software. Lesions were identified as T2-/T2-FLAIR hyperintensity with or without contrast enhancement. Measurements were done by placing a region of interest in the visually determined area of highest perfusion, copying to the contralateral normal appearing white matter (NAWM), and then propagating to the other perfusion maps. Pearson’s correlation coefficients were calculated between the CBF and rCBV ratios of tumor versus NAWM. Accuracy for diagnosing tumor progression was calculated as the area under the receiver operating characteristics (ROC) curve (AUC) for the ASL-CBF and leakage corrected DSC-rCBV ratios.ResultsWe identified 178 lesions, 119 with and 59 without contrast enhancement. Correlation coefficients between ASL-derived CBF versus DSC-derived rCBV ratios were 0.60–0.67 without and 0.72–0.78 with leakage correction in all lesions (n = 178); these were 0.65–0.80 in enhancing glioma (n = 80), 0.58–0.73 in non-enhancing glioma, and 0.14–0.40 in enhancing metastasis (n = 31). No significant correlation was found in enhancing (n = 8) or non-enhancing (n = 7) lymphomas. The areas under the ROC curves (AUCs) for all patients were similar for ASL and DSC (0.73–0.78), and were higher for enhancing glioma (AUC = 0.78–0.80) than for non-enhancing glioma (AUC = 0.56–0.62). In brain metastasis, the AUC was lower for ASL-derived CBF (AUC = 0.72) than for DSC-derived rCBV ratios (AUC = 0.87–0.93).ConclusionWe found that ASL and DSC have more or less the same diagnostic accuracy. Our findings suggest that ASL can be used as an alternative to DSC to measure perfusion in enhancing and non-enhancing gliomas and brain metastasis at 3T. For lymphoma, this should be further investigated in a larger population.

Arterial spin labelling MRI for brain tumour surveillance: do we really need cerebral blood flow maps?

“…This study shows that when a lesion is hyperintense (compared to the normal cortex), the average ASL-CBF ratio could be expected to be around 3 (3.00 ± 1.80), which is associated with tumour progression as previously described by Seeger et al [ 22 ]. This is in line with previously published data on the comparison between ASL-derived CBF and DSC-derived rCBV [ 20 ]. Diagnostic performance to determine tumour progression using visual assessment showed moderate diagnostic accuracy of 0.72, for both thresholds.…”

“…Although this is slightly higher than reported here in this study, it is in line with the diagnostic accuracy we have found. Also a comparison of ASL and DSC previously reported by this group provides a comparable diagnostic accuracy of ASL (AUC = 0.73) and DSC (AUC = 0.78) [ 20 ].…”

The value of arterial spin labelling (ASL) perfusion MRI in the assessment of post-treatment progression in adult glioma: A systematic review and meta-analysis.

“…The usefulness of ASL has been previously studied through several comparisons with other advanced imaging techniques, such as diffusion-weighted imaging (DWI), 20 , 24 magnetic resonance spectroscopy (MRS), 19 , 24 and more frequently with the well-established contrast-based perfusion methods, DSC and DCE. 3 , 13 , 18 , 19 , 21–23 , 57 This was primarily achieved in terms of the quantitative measurements derived from both techniques which were closely correlatedand the diagnostic accuracy. However, these studies were performed on somewhat small cohorts, and the impact of the utilized software package and postprocessing method were not considered.…”

“…Glioblastomas are associated with limited survival, 2 despite improvements in treatment plans in recent years. 3 Presently, maximal debulking surgery, followed by radiotherapy with concomitant temozolomide, and further by adjuvant temozolomide, is the standard care regimen. 4 …”

Arterial Spin Labeling (ASL) in Neuroradiological Diagnostics – Methodological Overview and Use Cases

“…Furthermore, compared to DSC-MRI, ASL-based perfusion measurements should not be biased by blood-brain barrier (BBB) permeability effects, given that water is a freely diffusible tracer. In contrast, DSC-MRI relies on gadolinium-based contrast agents, which are intravascular tracers and therefore, even after leakage corrections, DSC-MRI-based perfusion estimates may be deteriorated by BBB leakage [106].…”