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

Abstract

OBJECTIVESuperselective pseudocontinuous arterial spin labeling (ss-pCASL) is an MRI technique in which individual vessels are labeled to trace their perfusion territories. In this study, the authors assessed its merit in defining feeding vessels and gauging preoperative embolization feasibility for patients with meningioma, using digital subtraction angiography (DSA) as the reference method.METHODSThirty-one consecutive patients with meningiomas were prospectively recruited, each undergoing DSA (and embolization, if feasible) before resection. All ss-pCASL imaging studies were performed 1 day prior to DSA. Two neuroradiologists independently reviewed ss-pCASL images, rating the contribution of each labeled vessel to tumor blood supply as none, minor, or major. Two neuroradiologists also gauged the feasibility of embolization in each patient, based on ss-pCASL images. Interobserver and intermodality agreement were determined using Cohen’s kappa statistic. The diagnostic performance of ss-pCASL was assessed in terms of discerning tumor blood supply and the potential for embolization.RESULTSInterobserver agreement in the rating of blood supply by ss-pCASL was very good (κ = 0.817, 95% CI 0.771–0.863), and intermodality agreement (consensus ss-pCASL readings vs DSA findings) was good (κ = 0.688, 95% CI 0.632–0.744). In delineating tumor blood supply, ss-pCASL showed high sensitivity (87.1%) and specificity (87.2%). The positive and negative predictive values for embolization feasibility were 85.2% and 100%, respectively.CONCLUSIONSIn patients with meningiomas, feeding vessels are reliably predicted by ss-pCASL. This noninvasive approach, involving no iodinated contrast or radiation exposure, is particularly beneficial if there are no prospects of embolization.

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.…”

Arterial Spin Labeling for Pediatric Central Nervous System Diseases: Techniques and Clinical Applications

“…ASL-based studies have shown promising results for the assessment of pediatric brain tumors, including stratification of malignant and/or high-grade brain tumors, outcome prediction, and vascularity. [57][58][59][60][61][62][63] Kikuchi et al compared the tumor blood flow derived from ASL and the histopathological vascular density in pediatric brain tumors and found that the histopathological vascular density had a significant positive correlation with tumor blood flow, which correlated with the • Combining ADC and CBF measurements can be correctly classified as either low-or high-grade tumors. • ADC and CBF of diffuse midline glioma were similar to those of low-grade tumors.…”

“…In particular, for the pre-treatment assessment of tumor vascularity and the feeding arteries, ASL may assist in selecting potential candidates for preoperative DSA and embolization in clinical practice, which may reduce radiation exposure. 63 Acute Encephalopathy with Biphasic Seizure and Late Reduces Diffusion: AESD Acute encephalopathy with biphasic seizure and late reduced diffusion (AESD) is the major etiology of acute infectious encephalopathy in Japanese children (approximately 200 patients per year), and the most common causative pathogen of AESD was human herpesvirus 6. 68 AESD is clinically characterized by biphasic seizures and characteristic diffusion-weighted image (DWI) findings.…”

“…ASL-based studies have shown promising results for the assessment of pediatric brain tumors, including stratification of malignant and/or high-grade brain tumors, outcome prediction, and vascularity. 57 – 63 Kikuchi et al compared the tumor blood flow derived from ASL and the histopathological vascular density in pediatric brain tumors and found that the histopathological vascular density had a significant positive correlation with tumor blood flow, which correlated with the tumor grade. 57 Dangouloff-Ros et al evaluated ASL-derived CBF in 129 pediatric patients with brain tumors for differentiating low- from high-grade neoplasms and assessing the correlation between CBF and the quantitative histological microvascular density.…”

“…In particular, for the pre-treatment assessment of tumor vascularity and the feeding arteries, ASL may assist in selecting potential candidates for preoperative DSA and embolization in clinical practice, which may reduce radiation exposure. 63 …”