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Research ArticleAdult Brain

Diagnostic Accuracy of Arterial Spin-Labeling, Dynamic Contrast-Enhanced, and DSC Perfusion Imaging in the Diagnosis of Recurrent High-Grade Gliomas: A Prospective Study

T.B. Nguyen, N. Zakhari, S. Velasco Sandoval, A. Guarnizo-Capera, M. Alexios Gulak, J. Woulfe, G. Jansen, R. Thornhill, N. Majtenyi and G.O. Cron
American Journal of Neuroradiology February 2023, 44 (2) 134-142; DOI: https://doi.org/10.3174/ajnr.A7771
T.B. Nguyen
aFrom the Department of Radiology (T.B.N., N.Z., R.T.), Radiation Oncology and Medical Physics
cUniversity of Ottawa (T.B.N., N.Z., J.W., G.J., R.T.), Ottawa, Ontario, Canada
dThe Ottawa Hospital Research Institute (T.B.N., J.W., G.J., R.T.), Ottawa, Ontario, Canada
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N. Zakhari
aFrom the Department of Radiology (T.B.N., N.Z., R.T.), Radiation Oncology and Medical Physics
cUniversity of Ottawa (T.B.N., N.Z., J.W., G.J., R.T.), Ottawa, Ontario, Canada
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S. Velasco Sandoval
eDivision of Neuroradiology (S.V.S., A.G.-C.), Department of Radiology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, D.C., Colombia
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A. Guarnizo-Capera
eDivision of Neuroradiology (S.V.S., A.G.-C.), Department of Radiology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, D.C., Colombia
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M. Alexios Gulak
fDepartment of Anesthesiology and Pain Medicine (M.A.G.), University of Toronto, Toronto, Ontario, Canada
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J. Woulfe
bDepartment of Pathology and Laboratory Medicine (J.W., G.J.), The Ottawa Hospital, Ottawa, Ontario, Canada
cUniversity of Ottawa (T.B.N., N.Z., J.W., G.J., R.T.), Ottawa, Ontario, Canada
dThe Ottawa Hospital Research Institute (T.B.N., J.W., G.J., R.T.), Ottawa, Ontario, Canada
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G. Jansen
bDepartment of Pathology and Laboratory Medicine (J.W., G.J.), The Ottawa Hospital, Ottawa, Ontario, Canada
cUniversity of Ottawa (T.B.N., N.Z., J.W., G.J., R.T.), Ottawa, Ontario, Canada
dThe Ottawa Hospital Research Institute (T.B.N., J.W., G.J., R.T.), Ottawa, Ontario, Canada
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R. Thornhill
aFrom the Department of Radiology (T.B.N., N.Z., R.T.), Radiation Oncology and Medical Physics
cUniversity of Ottawa (T.B.N., N.Z., J.W., G.J., R.T.), Ottawa, Ontario, Canada
dThe Ottawa Hospital Research Institute (T.B.N., J.W., G.J., R.T.), Ottawa, Ontario, Canada
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N. Majtenyi
gDepartment of Medical Physics (N.M.), Grand River Regional Cancer Centre, Kitchener, Ontario, Canada
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G.O. Cron
hStanford University (G.O.C.), Stanford, California
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Abstract

BACKGROUND AND PURPOSE: For patients with high-grade gliomas, the appearance of a new, enhancing lesion after surgery and chemoradiation represents a diagnostic dilemma. We hypothesized that MR perfusion without and with contrast can differentiate tumor recurrence from radiation necrosis.

MATERIALS AND METHODS: In this prospective study, we performed 3 MR perfusion methods: arterial spin-labeling, DSC, and dynamic contrast enhancement. For each lesion, we measured CBF from arterial spin-labeling, uncorrected relative CBV, and leakage-corrected relative CBV from DSC imaging. The volume transfer constant and plasma volume were obtained from dynamic contrast-enhanced imaging without and with T1 mapping using modified Look-Locker inversion recovery (MOLLI). The diagnosis of tumor recurrence or radiation necrosis was determined by either histopathology for patients who underwent re-resection or radiologic follow-up for patients who did not have re-resection.

RESULTS: There were 26 patients with 32 lesions, 19 lesions with tumor recurrence and 13 lesions with radiation necrosis. Compared with radiation necrosis, lesions with tumor recurrence had higher CBF (P = .033), leakage-corrected relative CBV (P = .048), and plasma volume using MOLLI T1 mapping (P = .012). For differentiating tumor recurrence from radiation necrosis, the areas under the curve were 0.81 for CBF, 0.80 for plasma volume using MOLLI T1 mapping, and 0.71 for leakage-corrected relative CBV. A correlation was found between CBF and leakage-corrected relative CBV (rs = 0.54), volume transfer constant, and plasma volume (0.50 < rs< 0.77) but not with uncorrected relative CBV (rs = 0.20, P = .29).

CONCLUSIONS: In the differentiation of tumor recurrence from radiation necrosis in a newly enhancing lesion, the diagnostic value of arterial spin-labeling–derived CBF is similar to that of DSC and dynamic contrast-enhancement–derived blood volume.

ABBREVIATIONS:

ASL
arterial spin-labeling
AUC
area under the curve
DCE
dynamic contrast-enhanced
Ktrans
volume transfer constant
MOLLI
modified Look-Locker inversion recovery
pCASL
pseudocontinuous pulse ASL
rCBV
relative CBV (CBV lesion/CBV normal contralateral white matter)
ROC
receiver operating characteristic
SI
signal intensity
SMART1Map
saturation method using adaptive recovery times for cardiac T1 mapping
Vp
plasma volume
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American Journal of Neuroradiology: 44 (2)
American Journal of Neuroradiology
Vol. 44, Issue 2
1 Feb 2023
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Diagnostic Accuracy of Arterial Spin-Labeling, Dynamic Contrast-Enhanced, and DSC Perfusion Imaging in the Diagnosis of Recurrent High-Grade Gliomas: A Prospective Study
T.B. Nguyen, N. Zakhari, S. Velasco Sandoval, A. Guarnizo-Capera, M. Alexios Gulak, J. Woulfe, G. Jansen, R. Thornhill, N. Majtenyi, G.O. Cron
American Journal of Neuroradiology Feb 2023, 44 (2) 134-142; DOI: 10.3174/ajnr.A7771

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Diagnostic Accuracy of Arterial Spin-Labeling, Dynamic Contrast-Enhanced, and DSC Perfusion Imaging in the Diagnosis of Recurrent High-Grade Gliomas: A Prospective Study
T.B. Nguyen, N. Zakhari, S. Velasco Sandoval, A. Guarnizo-Capera, M. Alexios Gulak, J. Woulfe, G. Jansen, R. Thornhill, N. Majtenyi, G.O. Cron
American Journal of Neuroradiology Feb 2023, 44 (2) 134-142; DOI: 10.3174/ajnr.A7771
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