Neuroradiology Unit, Istituto Giannina Gaslini, via Gerolamo Gaslini 5, 16147, Genoa, Italy.
Radiology Department, Fondazione Policlinico Universitario "A. Gemelli", Università Cattolica del Sacro Cuore, Rome, Italy.
Neuroradiology. 2018 Apr;60(4):437-446. doi: 10.1007/s00234-018-1992-6. Epub 2018 Feb 16.
The aim of this study was to compare arterial spin labeling (ASL) and dynamic susceptibility contrast (DSC) MRI perfusion with respect to diagnostic performance in tumor grading in pediatric patients with low- and high-grade astrocytic tumors (AT).
We retrospectively analyzed 37 children with histologically proven treatment naive low- and high-grade AT who underwent concomitant pre-operative ASL and DSC MRI perfusion. Studies were performed on a 1.5 T scanner, and a pulsed technique was used for ASL. DSC data were post-processed with a leakage correction software. Normalization of tumor perfusion parameters was performed with contralateral normal appearing gray matter. Normalized cerebral blood volume (nCBV) values in the most perfused area of each neoplasm were compared with normalized DSC-derived cerebral blood flow (nDSC-CBF) and ASL-derived cerebral blood flow (nASL-CBF) data, and correlated with WHO tumor grade. Statistics included Pearson's chi-square and Mann-Whitney U tests, Spearman's rank correlation, and receiver operating characteristic (ROC) analysis.
A significant correlation was demonstrated between DSC and ASL data (p < 0.001). Significant differences in terms of DSC and ASL data were found between low- and high-grade AT (p < 0.001). ROC analysis demonstrated similar performances between all parameters in predicting tumor grade (nCBV: AUC 0.96, p < 0.001; nDSC-CBF: AUC 0.98, p < 0.001; nASL-CBF: AUC 0.96, p < 0.001).
Normalized pulsed ASL performed with a 1.5 T scanner provides comparable results to DSC MRI perfusion in pediatric AT and may allow distinction between high- and low-grade AT.
本研究旨在比较动脉自旋标记（ASL）和动态对比磁共振灌注成像（DSC）在儿童低级别和高级别星形细胞瘤（AT）肿瘤分级诊断中的性能。
我们回顾性分析了 37 例经组织学证实的初治低级别和高级别 AT 患儿，这些患儿均在术前接受了 ASL 和 DSC 磁共振灌注检查。研究在 1.5T 扫描仪上进行，ASL 采用脉冲技术。DSC 数据使用漏液校正软件进行后处理。通过对侧正常灰质对肿瘤灌注参数进行归一化。对每个肿瘤最灌注区域的归一化脑血容量（nCBV）值与归一化 DSC 衍生脑血流（nDSC-CBF）和 ASL 衍生脑血流（nASL-CBF）数据进行比较，并与 WHO 肿瘤分级相关。统计分析包括 Pearson χ²检验和 Mann-Whitney U 检验、Spearman 秩相关和受试者工作特征（ROC）分析。
DSC 和 ASL 数据之间存在显著相关性（p<0.001）。低级别和高级别 AT 之间在 DSC 和 ASL 数据方面存在显著差异（p<0.001）。ROC 分析表明，所有参数在预测肿瘤分级方面均具有相似的性能（nCBV：AUC 0.96，p<0.001；nDSC-CBF：AUC 0.98，p<0.001；nASL-CBF：AUC 0.96，p<0.001）。
在 1.5T 扫描仪上进行的归一化脉冲 ASL 与 DSC MRI 灌注在儿童 AT 中提供了可比的结果，并可能有助于区分高级别和低级别 AT。
