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

Abstract

Background Intracranial meningiomas may be amenable to presurgical embolization to reduce bleeding complications. Detailed information usually obtained by digital subtraction angiography (DSA) on the contribution of blood supply from internal and external carotid artery branches is required to prevent non-target embolization and is helpful for pre-surgical planning. Purpose To investigate the contribution of the feeding vasculature to intracranial meningiomas with superselective arterial spin labelling (sASL) as an alternative to DSA. Material and methods Consecutive patients presenting for meningioma resection were prospectively included. sASL perfusion images acquired on a clinical 3T MRI scanner were independently rated by two readers. Contribution of the external carotid artery (ECA), internal carotid artery (ICA) and vertebral/basilar artery (VA/BA) was rated as none, <50% or >50%. Correlation of sASL was performed in two patients undergoing DSA. Results 32 patients (61 ± 13 years) harboring 42 meningiomas could be included. sASL was technically successful in all patients. 19 meningiomas had ICA dominant supply, 19 had ECA dominant supply. One meningioma had mixed supply and in three meningiomas a perfusion signal could not be detected. While exclusive unilateral ECA supply was common (n = 14) and exclusive unilateral ICA was rare (n = 4), mixed supply from multiple vessels (n = 20) was a frequent finding. Interrater agreement was substantial (κ = 0.73). Agreement with DSA was perfect within our predefined categories. Conclusion sASL is able to identify the presence and extent of the feeding vasculature in intracranial meningiomas.

Effectiveness of Super-selective Embolization for Parasagittal Meningiomas and Its Effect on the Level of Inflammatory Factors

“…To this end, preoperative embolization of tumors with abnormal blood supply is encouraged when necessary to reduce intraoperative bleeding and facilitate the surgery. Super-selective embolization of intratumoral vessels [ 12 ] refers to the delivery of a microcatheter into the blood supply artery of a meningioma patient, through which an embolic agent is injected to block the blood flow, prevent intraoperative bleeding, and soften the tumor, thereby reducing the difficulty of surgical resection and facilitating surgical resection [ 13 , 14 ]. However, due to the paucity of related clinical studies, the clinical effectiveness of this procedure has not been fully clarified.…”

Superselective pseudocontinuous arterial spin labeling in patients with meningioma: utility in prediction of feeding arteries and preoperative embolization feasibility

“…These labeling spots, generated by rotating gradients with phase changes in radiofrequency pulses of pCASL labeling trains, are flexibly positioned, adapting to individual vessel geometries. 12,15 As in previous studies, 15,18 we successfully placed labeling spots on ICAs, ECAs, and the VA without much difficulty, even in patients with tortuous vessels. However, labeling is reliant on preacquired TOF-MRA images, so even slight interim shifts in patient positions (between TOF-MRA and labeling) may interfere, leading to partial or no overlay of targeted arterial labeling spots.…”

“…[11][12][13] A number of studies have shown the merit of this technique in certain cerebrovascular disorders such as arteriovenous malformations and carotid artery stenosis, 14,15 but the few efforts to date exploring its applicability to meningioma have lacked full comparisons with DSA. [16][17][18] The present study provides a comparative analysis of superselective pseudocontinuous ASL (ss-pCASL) 12 and DSA in patients with meningiomas, each used to define feeding vessels and gauge preoperative embolization feasibility. We hypothesized that ss-pCASL would reliably predict feeding vasculature of meningiomas.…”