Velocity-Selective arterial spin labeling (VSASL) for cerebral blood volume assessment in gliomas: comparison with VSASL based cerebral blood flow and dynamic susceptibility contrast MRI.

PURPOSE

Cerebral blood volume (CBV) maps created using dynamic susceptibility contrast-enhanced perfusion weighted imaging (DSC-PWI) are valuable but may be limited by gadolinium contraindications in certain clinical scenarios. A noninvasive perfusion method for CBV assessment based on velocity-selective (VS) ASL has emerged. This study is to evaluate the performance of VSASL-derived CBV among glioma patients in clinical practice, comparing with the VSASL-based cerebral blood flow (CBF) and DSC-PWI.

METHODS

Forty-eight patients with pathologically confirmed gliomas (mean age: 45 ± 13 years; 25 males; 25 in low-grade) underwent preoperative VSASL-CBV MRI. Lesion conspicuity on VSASL-CBV maps was visually scored (1-3) relative to surrounding parenchyma by two neuroradiologists. Relative maximum tumor blood volume (rTBV) and flow (rTBF) from VSASL and DSC-PWI were compared between low- and high-grade gliomas. Correlation and agreement between VSASL- and DSC-PWI-derived rTBV were assessed via linear regression and Bland-Altman analysis. Diagnostic performance for glioma grading was evaluated using ROC curves.

RESULTS

VSASL-CBV maps demonstrated good lesion conspicuity (mean score: 2.26 ± 0.76; inter-reader weighted κ = 0.8). VSASL-rTBV strongly correlated with DSC-PWI-rTBV (R²=0.83, p < 0.001). Both VSASL and DSC-PWI metrics significantly distinguished low- from high-grade gliomas (p < 0.001). ROC analysis revealed that VSASL-rTBV achieved excellent diagnostic accuracy in glioma grading (AUC = 0.94), outperforming VSASL-rTBF (AUC = 0.89) and matching DSC-PWI-rTBV (AUC = 0.93). Sensitivity, predictive values, and accuracy of VSASL-rTBV were superior to VSASL-rTBF.

CONCLUSION

VSASL provides accurate, noninvasive CBV quantification for glioma stratification, demonstrating diagnostic performance comparable to DSC-PWI. It offers a viable alternative in clinical settings where gadolinium contrast is contraindicated.