PT  - JOURNAL ARTICLE
AU  - Nguyen, T.B.
AU  - Zakhari, N.
AU  - Velasco Sandoval, S.
AU  - Guarnizo-Capera, A.
AU  - Alexios Gulak, M.
AU  - Woulfe, J.
AU  - Jansen, G.
AU  - Thornhill, R.
AU  - Majtenyi, N.
AU  - Cron, G.O.
TI  - Diagnostic Accuracy of Arterial Spin-Labeling, Dynamic Contrast-Enhanced, and DSC Perfusion Imaging in the Diagnosis of Recurrent High-Grade Gliomas: A Prospective Study
AID  - 10.3174/ajnr.A7771
DP  - 2023 Jan 26
TA  - American Journal of Neuroradiology
4099  - http://www.ajnr.org/content/early/2023/01/25/ajnr.A7771.short
4100  - http://www.ajnr.org/content/early/2023/01/25/ajnr.A7771.full
AB  - 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.ASLarterial spin-labelingAUCarea under the curveDCEdynamic contrast-enhancedKtransvolume transfer constantMOLLImodified Look-Locker inversion recoverypCASLpseudocontinuous pulse ASLrCBVrelative CBV (CBV lesion/CBV normal contralateral white matter)ROCreceiver operating characteristicSIsignal intensitySMART1Mapsaturation method using adaptive recovery times for cardiac T1 mappingVpplasma volume