Application Of Arterial Spin Labeling And Dynamic Susceptibility Contrast-enhanced MR Imaging In The Pre-operation Evaluation Of Brain Gliomas At 3.0T

ObjectiveTo explore the potential clinical application of arterial spin labeling (ASL) technique in the pre-operation of brain gliomas by comparing ASL with dynamic susceptibility contrast-enhanced (DSC)MR imaging.Materials and MethodsThirty-one patients with gliomas were performed by 3.0T MRI, including ASL and DSC before operation.All the cases were verified histologically,including 12 patients of low-grade gliomas,19 patients of high-grade gliomas.The maximal cerebral blood flow of solid regions of tumor(TBFmax) and the cerebral blood flow of opposite white matter,opposite grey matter and opposite hemisphere were measured on maps. Use the ratio of maximal tumor blood flow(TBFmax)/opposite white matter CBF, TBFmax/opposite grey matter CBF,TBFmax/opposite hemisphere CBF as the perfusion parameters.MR perfusion parameters obtained by DSC and ASL were analyzed between high-grade and low-grade gliomas. Receiver operating characteristic curve (ROC curve) was used to find the best classification threshold,and then calculating its sensitivity,specificity and accuracy.ResultsAll of 31 cases demonstrated agreement between ASL and DSC MR imagings. The ratio of maximal tumor blood flow(TBFmax)/opposite white matter CBF,TBFmax/opposite grey matter CBF and TBFmax/opposite hemisphere CBF revealed no statistically significant between the two techniques(P>0.05).But there was statistical difference between high-grade and low-grade gliomas(P<0.01).Analysis of ROC curve: The threshold of TBFmax/opposite white matter CBF,TBFmax/opposite grey matter CBF and TBFmax/opposite hemisphere CBF were 4.67,0.68 and1.39 respectively,the diagnosis sensibility were 84.2%,84.2%and 100% respectively,the specificity were 83.3%,83.3%and 91.7% respectively,and the accuracy were 83.9%,83.9% and 96.8% respectively by ASL technique. With DSC ,the threshold of TBFmax/opposite white matter CBF,TBFmax/opposite grey matter CBF and TBFmax/opposite hemisphere CBF were 4.61,0.51 and1.25 respectively,the diagnosis sensibility were 89.5%,100%and 100% respectively,the specificity were 91.7%,83.3%and 91.7% respectively,and the accuracy were 90.3%,96.8% and 96.8% respectively. The threshold of TBVmax/opposite white matter CBV,TBVmax/opposite grey matter CBV and TBVmax/opposite hemisphere CBV were 4.62,0.57 and1.54 respectively,the diagnosis sensibility were 94.7%,100%and 94.7% respectively,the specificity were 91.7%,91.7%and 91.7% respectively,and the accuracy were 93.5%,96.8% and 93.5% respectively.Conclusion1,Both ASL and DSC can be used to evaluate tumor angiogenesis and obtained hemodynamic information of tumor. There were no statistically significant differences between the two techniques(P>0.05).ASL was almost as sensitive as DSC technique in detecting brain gliomas perfusing abnormalities.2,Both ASL and DSC techniques showed the statistically significant differences existed between high-grade and low-grade gliomas(P<0.01).ROC curve can give the best classification threshold, it is helpful to give the gradation of gliomas before operation.3,ASL is a kind of MR perfusion imaging method to evaluate the hemodynamic information of brain gliomas.It is simple and can be carried out without injection of contrast medium.ASL can be a suitable candidate as a conventional sequence for the pre-operation assessment of brain gliomas.