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. 2023 Jul 3;9(7):e17615.
doi: 10.1016/j.heliyon.2023.e17615. eCollection 2023 Jul.

The utility of arterial spin labelled perfusion-weighted magnetic resonance imaging in measuring the vascularity of high grade gliomas - A prospective study

Gurkirat Chatha  1 , Tarundeep Dhaliwal  1 , Mendel David Castle-Kirszbaum  1   2 , Shalini Amukotuwa  3 , Leon Lai  1   2 , Edward Kwan  4
Affiliations

The utility of arterial spin labelled perfusion-weighted magnetic resonance imaging in measuring the vascularity of high grade gliomas - A prospective study

Gurkirat Chatha et al. Heliyon. .

Abstract

Background: Dynamic susceptibility contrast (DSC) perfusion weighted imaging (PWI) currently remains the gold standard technique for measuring cerebral perfusion in glioma diagnosis and surveillance. Arterial spin labelling (ASL) PWI is a non-invasive alternative that does not require gadolinium contrast administration, although it is yet to be applied in widespread clinical practice. This study aims to assess the utility of measuring signal intensity in ASL PWI in predicting glioma vascularity by measuring maximal tumour signal intensity in patients based on pre-operative imaging and comparing this to maximal vessel density on histopathology.

Methods: Pseudocontinuous ASL (pCASL) and DSC images were acquired pre-operatively in 21 patients with high grade gliomas. The maximal signal intensity within the gliomas over a region of interest of 100 mm2 was measured and also normalised to the contralateral cerebral cortex (nTBF-C), and cerebellum (nTBF-Cb). Maximal vessel density per 1 mm2 was determined on histopathology using CD31 and CD34 immunostaining on all participants.

Results: Using ASL, statistically significant correlation was observed between maximal signal intensity (p < 0.05) and nTBF-C (p < 0.05) to maximal vessel density based on histopathology. Although a positive trend was also observed nTBF-Cb, this did not reach statistical significance. Using DSC, no statistically significant correlation was found between signal intensity, nTBF-C and nTBF-Cb. There was no correlation between maximal signal intensity between ASL and DSC. Average vessel density did not correlate with age, sex, previous treatment, or IDH status.

Conclusions: ASL PWI imaging is a reliable marker of evaluating the vascularity of high grade gliomas and may be used as an adjunct to DSC PWI.

Keywords: Arterial spin labelling (ASL); Cerebral blood flow (CBF); Cerebral blood volume (CBV); Dynamic susceptibility contrast (DSC); Glioma; Magnetic resonance imaging (MRI); Perfusion weighted imaging (PWI).

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Conflict of interest statement

The authors declare that they do not have any competing financial or other interests pertaining to this study.

Figures

Fig. 1
Fig. 1
A) ASL sequence measuring signal intensity over an area of 100 mm2 in a patient with a right parietal GBM; B) ASL sequence measuring signal intensity over 100 mm2 in the contralateral temporal grey matter cortex in the same patient; C) ASL sequence measuring signal intensity over an area of 100 mm2 in the contralateral cerebellar hemisphere in the same patient.
Fig. 2
Fig. 2
A) DSC sequence measuring signal intensity over an area of 100 mm2 in a patient with a right parietal GBM; B) DSC sequence measuring signal intensity over 100 mm2 in the contralateral temporal grey matter cortex in the same patient; C) DSC sequence measuring signal intensity over an area of 100 mm2 in the contralateral cerebellar hemisphere in the same patient.
Fig. 3
Fig. 3
Scatter plot values of maximal average signal intensity using ASL PWI compared to vessel density on histopathology. Linear regression analysis also revealed a statistically significant positive correlation (r = 0.52, p = 0.02).
Fig. 4
Fig. 4
Scatter plot values of nTBF-C using ASL PWI compared to vessel density on histopathology. Linear regression analysis also revealed a statistically significant positive correlation (r = 0.44, p = 0.04).
Fig. 5
Fig. 5
Scatter plot values of average maximal signal intensity using DSC PWI compared to vessel density on histopathology. Linear regression analysis did not demonstrate a correlation (r = 0.31, p = 0.17).
Fig. 6
Fig. 6
Average maximal signal intensity on ASL PWI compared to DSC PWI. Linear regression analysis did not demonstrate a correlation (r = 0.30, p = 0.17).
Fig. 7
Fig. 7
Flow chart summarising workflow process for ASL and DSC analysis and comparison.
See this image and copyright information in PMC

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