Diffuse glioma molecular profiling with arterial spin labeling and dynamic susceptibility contrast perfusion MRI: A comparative study.

BACKGROUND

Evaluation of molecular markers (, p, 1p/19q codeletion, and ) in adult diffuse gliomas is crucial for accurate diagnosis and optimal treatment planning. Dynamic Susceptibility Contrast (DSC) and Arterial Spin Labeling (ASL) perfusion MRI techniques have both shown good performance in classifying molecular markers, however, their performance has not been compared side-by-side.

METHODS

Pretreatment MRI data from 90 patients diagnosed with diffuse glioma (54 men/36 female, 53.1 ± 15.5 years, grades 2-4) were retrospectively analyzed. DSC-derived normalized cerebral blood flow/volume (nCBF/nCBV) and ASL-derived nCBF in tumor and perifocal edema were analyzed in patients with available -mutation ( = 67), p-mutation ( = 39), 1p/19q codeletion ( = 33), and promoter methylation ( = 31) status. Cross-validated uni- and multivariate logistic regression models assessed perfusion parameters' performance in molecular marker detection.

RESULTS

ASL and DSC perfusion parameters in tumor and edema distinguished -wildtype (wt) and pwt tumors from mutated ones. Univariate classification performance was comparable for ASL-nCBF and DSC-nCBV in (maximum AUROCC 0.82 and 0.83, respectively) and p (maximum AUROCC 0.70 and 0.81, respectively) status differentiation. The multivariate approach improved (DSC-nCBV AUROCC 0.89) and p (ASL-nCBF AUROCC 0.8 and DSC-nCBV AUROCC 0.86) classification. However, ASL and DSC parameters could not differentiate 1p/19q codeletion or promoter methylation status. Positive correlations were found between ASL-nCBF and DSC-nCBV/-nCBF in tumor and edema.

CONCLUSIONS

ASL is a viable gadolinium-free replacement for DSC for molecular characterization of adult diffuse gliomas.