Arterial Spin-Labeling Assessment of Normalized Vascular Intratumoral Signal Intensity as a Predictor of Histologic Grade of Astrocytic Neoplasms

BACKGROUND AND PURPOSE: Pulsed arterial spin-labeling is a noninvasive MR imaging perfusion method performed with the use of water in the arterial blood as an endogenous contrast agent. The purpose of this study was to determine the inversion time with the largest difference in normalized intratumoral signal intensity between high-grade and low-grade astrocytomas. MATERIALS AND METHODS: Thirty-three patients with gliomas, histologically classified as low-grade (n = 7) or high-grade astrocytomas (n = 26) according to the World Health Organization brain tumor classification, were included. A 3T MR scanner was used to perform pulsed arterial spin-labeling measurements at 8 different inversion times (370 ms, 614 ms, 864 ms, 1114 ms, 1364 ms, 1614 ms, 1864 ms, and 2114 ms). Normalized intratumoral signal intensity was calculated, which was defined by the signal intensity ratio of the tumor and the contralateral normal brain tissue for all fixed inversion times. A 3-way mixed ANOVA was used to reveal potential differences in the normalized vascular intratumoral signal intensity between high-grade and low-grade astrocytomas. RESULTS: The difference in normalized vascular intratumoral signal intensity between high-grade and low-grade astrocytomas obtained the most statistically significant results at 370 ms (P = .003, other P values ranged from .012–.955). CONCLUSIONS: The inversion time by which to differentiate high-grade and low-grade astrocytomas by use of normalized vascular intratumoral signal intensity was 370 ms in our study. The normalized vascular intratumoral signal intensity values at this inversion time mainly reflect the labeled intra-arterial blood bolus and therefore could be referred to as normalized vascular intratumoral signal intensity. Our data indicate that the use of normalized vascular intratumoral signal intensity values allows differentiation between low-grade and high-grade astrocytomas and thus may serve as a new, noninvasive marker for astrocytoma grading.

[1]  T. Hirai,et al.  Quantitative Blood Flow Measurements in Gliomas Using Arterial Spin-Labeling at 3T: Intermodality Agreement and Inter- and Intraobserver Reproducibility Study , 2011, American Journal of Neuroradiology.

[2]  Yufen Chen,et al.  Test–retest reliability of arterial spin labeling with common labeling strategies , 2011, Journal of magnetic resonance imaging : JMRI.

[3]  Peiying Liu,et al.  Determination of spin compartment in arterial spin labeling MRI , 2011, Magnetic resonance in medicine.

[4]  Bram Stieltjes,et al.  Biopsy Targeting Gliomas: Do Functional Imaging Techniques Identify Similar Target Areas? , 2010, Investigative radiology.

[5]  Susan M. Chang,et al.  Updated response assessment criteria for high-grade gliomas: response assessment in neuro-oncology working group. , 2010, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[6]  David C. Alsop,et al.  Perfusion MRI of brain tumours: a comparative study of pseudo-continuous arterial spin labelling and dynamic susceptibility contrast imaging , 2010, Neuroradiology.

[7]  Peter Jezzard,et al.  Assessment of arterial arrival times derived from multiple inversion time pulsed arterial spin labeling MRI , 2010, Magnetic resonance in medicine.

[8]  T. Paine,et al.  Optimized Preload Leakage-Correction Methods to Improve the Diagnostic Accuracy of Dynamic Susceptibility-Weighted Contrast-Enhanced Perfusion MR Imaging in Posttreatment Gliomas , 2010, American Journal of Neuroradiology.

[9]  T. Mikkelsen,et al.  Bevacizumab alone and in combination with irinotecan in recurrent glioblastoma. , 2009, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[10]  H. Heinzl,et al.  The Austrian Brain Tumour Registry: a cooperative way to establish a population-based brain tumour registry , 2009, Journal of Neuro-Oncology.

[11]  R. Kraft,et al.  Arterial Spin-Labeling in Routine Clinical Practice, Part 1: Technique and Artifacts , 2008, American Journal of Neuroradiology.

[12]  Ting-Yim Lee,et al.  Validation study of a pulsed arterial spin labeling technique by comparison to perfusion computed tomography. , 2008, Magnetic resonance imaging.

[13]  S. Y. Kim,et al.  Diagnostic accuracy and interobserver variability of pulsed arterial spin labeling for glioma grading , 2008, Acta radiologica.

[14]  John Sampson,et al.  Bevacizumab plus irinotecan in recurrent glioblastoma multiforme. , 2007, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[15]  E. Melhem,et al.  Arterial Spin-Labeling and MR Spectroscopy in the Differentiation of Gliomas , 2007, American Journal of Neuroradiology.

[16]  Xavier Golay,et al.  Arterial spin labeling: benefits and pitfalls of high magnetic field. , 2006, Neuroimaging clinics of North America.

[17]  Paul S Mischel,et al.  MR imaging correlates of survival in patients with high-grade gliomas. , 2005, AJNR. American journal of neuroradiology.

[18]  J. Detre,et al.  Grading of CNS neoplasms using continuous arterial spin labeled perfusion MR imaging at 3 Tesla , 2005, Journal of magnetic resonance imaging : JMRI.

[19]  Jeroen van der Grond,et al.  Internal carotid artery occlusion assessed at pulsed arterial spin-labeling perfusion MR imaging at multiple delay times. , 2004, Radiology.

[20]  Xavier Golay,et al.  Determining the longitudinal relaxation time (T1) of blood at 3.0 Tesla , 2004, Magnetic resonance in medicine.

[21]  Glyn Johnson,et al.  Comparison of cerebral blood volume and vascular permeability from dynamic susceptibility contrast-enhanced perfusion MR imaging with glioma grade. , 2004, AJNR. American journal of neuroradiology.

[22]  Michael H Lev,et al.  Glial tumor grading and outcome prediction using dynamic spin-echo MR susceptibility mapping compared with conventional contrast-enhanced MR: confounding effect of elevated rCBV of oligodendrogliomas [corrected]. , 2004, AJNR. American journal of neuroradiology.

[23]  Matthias Günther,et al.  Comparison of Arterial Spin-Labeling Techniques and Dynamic Susceptibility-Weighted Contrast-Enhanced MRI in Perfusion Imaging of Normal Brain Tissue , 2003, Investigative radiology.

[24]  Glyn Johnson,et al.  Glioma grading: sensitivity, specificity, and predictive values of perfusion MR imaging and proton MR spectroscopic imaging compared with conventional MR imaging. , 2003, AJNR. American journal of neuroradiology.

[25]  C. Zimmer,et al.  Quantification of blood flow in brain tumors: comparison of arterial spin labeling and dynamic susceptibility-weighted contrast-enhanced MR imaging. , 2003, Radiology.

[26]  G Johnson,et al.  Glial neoplasms: dynamic contrast-enhanced T2*-weighted MR imaging. , 1999, Radiology.

[27]  Susan M. Chang,et al.  Age and the risk of anaplasia in magnetic resonance‐nonenhancing supratentorial cerebral tumors , 1997, Cancer.

[28]  R. Buxton,et al.  Implementation of quantitative perfusion imaging techniques for functional brain mapping using pulsed arterial spin labeling , 1997, NMR in biomedicine.

[29]  P. Kelly,et al.  Grading of astrocytomas: A simple and reproducible method , 1988, Cancer.

[30]  J. Bruner,et al.  Descriptive epidemiology of primary brain and CNS tumors: results from the Central Brain Tumor Registry of the United States, 1990-1994. , 1999, Neuro-oncology.