Subscribe to RSS
Brain Tumor Vascularity Estimation by Arterial Spin Label Perfusion MRI—A Preoperative Tool for Patient Prognostication
Introduction Brain tumors remain a significant cause of morbidity and mortality around the globe. Preoperative estimation of tumor vascularity is of great significance for a neurosurgeon. Aim of our study was to correlate tumor blood flow (TBF) using arterial spin labeling perfusion imaging (ASL-PI) with microvessel density (MVD), tumor grade, and preoperative prognostication of brain tumors.
Materials and Methods This was a prospective observational cross-sectional study conducted in 63 patients of primary brain tumors already referred for magnetic resonance imaging. Absolute and relative mean and maximum TBF were calculated using ASL-PI and correlated with tumor grade and MVD at 10x and 40x magnificantion; thereby stydying the role of ASL-PI in brain tumor prognostication.
Results The mean of maxTBF values (mL/min/100 g) in the gliomas group, meningiomas group, schwannoma group, craniopharyngioma group, and hemangioblastoma group was 147.15, 251.55, 96.43, 43.3, and 578.3, respectively. The median of maxTBF value in the gliomas group, meningiomas group, schwannoma group, craniopharyngioma group, and hemangioblastoma group was 131.5, 158.63, 94.5, 43.4, and 578.3, respectively.
Discussion Significant correlation between meanTBF and MVD at 10X magnification (p-value < 0.001, rho =0.88) and a positive correlation between meanTBF and MVD at 40X magnification (p-value < 0.001) were seen. Significant correlation was also seen between maxTBF and MVD at 10X magnification (p-value < 0.001, rho = 0.91) and between maxTBF and MVD at 40X magnification. TBF in case of the hemangioblastoma was higher than other types of brain tumors (gliomas, meningiomas, and schwannomas). HighTBF value was seen in high-grade gliomas compared with low-grade gliomas with worse prognosis. TBF was high in typical meningiomas whereas low in atypical meningioma.
Conclusion TBF by ASL-PI can be considered a noninvasive in vivo marker in predicting the grade of brain tumors and further assist in envisaging prognosis of the patients with brain tumors.
KeywordsArterial spin labelled perfusion imaging (ASL-PI) - brain tumors - preoperative prognostication - tumor blood flow (TBF) estimation - tumor microvessel density
J.G. and R.J. contributed in conceptualization, reviewing, and editing of draft. N.R. collected data and formulated initial draft. B.P.S. provided surgical details and reviewed the draft. K.B.S. provided surgical details. S.Z. performed histopathological analysis.
Article published online:
14 April 2023
© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
- 1 Dasgupta A, Gupta T, Jalali R. Indian data on central nervous tumors: a summary of published work. South Asian J Cancer 2016; 5 (03) 147-153
- 2 Jensen RL, Mumert ML, Gillespie DL, Kinney AY, Schabel MC, Salzman KL. Preoperative dynamic contrast-enhanced MRI correlates with molecular markers of hypoxia and vascularity in specific areas of intratumoral microenvironment and is predictive of patient outcome. Neuro-oncol 2014; 16 (02) 280-291
- 3 James RF, Kramer DR, Page PS, Gaughen Jr JR, Martin LB, Mack WJ. Strategic and technical considerations for the endovascular embolization of intracranial meningiomas. Neurosurg Clin N Am 2016; 27 (02) 155-166
- 4 Villanueva-Meyer JE, Mabray MC, Cha S. Current clinical brain tumor imaging. Neurosurgery 2017; 81 (03) 397-415
- 5 Jahng GH, Li KL, Ostergaard L, Calamante F. Perfusion magnetic resonance imaging: a comprehensive update on principles and techniques. Korean J Radiol 2014; 15 (05) 554-577
- 6 Fussell D, Young RJ. Role of MRI perfusion in improving the treatment of brain tumors. Imaging Med 2013; 5: 407-426
- 7 Wolf RL, Detre JA. Clinical neuroimaging using arterial spin-labeled perfusion magnetic resonance imaging. Neurotherapeutics 2007; 4 (03) 346-359
- 8 Noguchi T, Yoshiura T, Hiwatashi A. et al. Perfusion imaging of brain tumors using arterial spin-labeling: correlation with histopathologic vascular density. AJNR Am J Neuroradiol 2008; 29 (04) 688-693
- 9 Koizumi S, Sakai N, Kawaji H. et al. Pseudo-continuous arterial spin labeling reflects vascular density and differentiates angiomatous meningiomas from non-angiomatous meningiomas. J Neurooncol 2015; 121 (03) 549-556
- 10 Kikuchi K, Hiwatashi A, Togao O. et al. Correlation between arterial spin-labeling perfusion and histopathological vascular density of pediatric intracranial tumors. J Neurooncol 2017; 135 (03) 561-569
- 11 Kimura H, Takeuchi H, Koshimoto Y. et al. Perfusion imaging of meningioma by using continuous arterial spin-labeling: comparison with dynamic susceptibility-weighted contrast-enhanced MR images and histopathologic features. AJNR Am J Neuroradiol 2006; 27 (01) 85-93
- 12 Wang N, Xie SY, Liu HM, Chen GQ, Zhang WD. Arterial spin labeling for glioma grade discrimination: correlations with IDH1 genotype and 1p/19q Status. Transl Oncol 2019; 12 (05) 749-756
- 13 Yeom KW, Mitchell LA, Lober RM. et al. Arterial spin-labeled perfusion of pediatric brain tumors. AJNR Am J Neuroradiol 2014; 35 (02) 395-401
- 14 Abdel Razek AAK, Talaat M, El-Serougy L, Gaballa G, Abdelsalam M. Clinical applications of arterial spin labeling in brain tumors. J Comput Assist Tomogr 2019; 43 (04) 525-532
- 15 Arisawa A, Watanabe Y, Tanaka H. et al. Comparative study of pulsed-continuous arterial spin labeling and dynamic susceptibility contrast imaging by histogram analysis in evaluation of glial tumors. Neuroradiology 2018; 60 (06) 599-608
- 16 Khashbat D, Harada M, Abe T. et al. Diagnostic performance of arterial spin labeling for grading non enhancing astrocytic tumors. Magn Reson Med Sci 2018; 17 (04) 277-282
- 17 Qiao XJ, Kim HG, Wang DJJ. et al. Application of arterial spin labeling perfusion MRI to differentiate benign from malignant intracranial meningiomas. Eur J Radiol 2017; 97: 31-36
- 18 ElBeheiry A, Fayed AA, Alkassas AH, Emara D. Can magnetic resonance imaging predict preoperative consistency and vascularity of intracranial meningioma?. Egypt J Radiol Nucl Med 2022; 53: 31
- 19 van Westen D, Petersen ET, Wirestam R. et al. Correlation between arterial blood volume obtained by arterial spin labelling and cerebral blood volume in intracranial tumours. Magn Reson Mater Biol Phys Med 2011; 24 (04) 211-223
- 20 Wu WC, St Lawrence KS, Licht DJ, Wang DJ. Quantification issues in arterial spin labeling perfusion magnetic resonance imaging. Top Magn Reson Imaging 2010; 21 (02) 65-73