Qu Yaoming, Ma Andong, Yan Xinran, Ou Xiaochan, Zou Xia, Rui Qihong, Wen Haitao, Wang Xianlong, Zhu Dan, Qin Qin, Wen Zhibo
Department of Radiology, Zhujiang Hospital of Southern Medical University, Guangzhou, China.
Department of Radiology, The First People's Hospital of FoShan, FoShan, China.
Neuroradiology. 2025 Sep 2. doi: 10.1007/s00234-025-03751-6.
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.
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.
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.
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.
利用动态磁敏感对比增强灌注加权成像（DSC-PWI）创建的脑血容量（CBV）图很有价值，但在某些临床情况下可能会受到钆剂禁忌证的限制。一种基于速度选择（VS）动脉自旋标记（ASL）的用于CBV评估的非侵入性灌注方法已经出现。本研究旨在评估在临床实践中VSASL衍生的CBV在胶质瘤患者中的性能，并与基于VSASL的脑血流量（CBF）和DSC-PWI进行比较。
48例经病理证实的胶质瘤患者（平均年龄：45±13岁；男性25例；低级别25例）接受术前VSASL-CBV MRI检查。两名神经放射科医生根据VSASL-CBV图上病变相对于周围实质的清晰度进行视觉评分（1-3分）。比较低级别和高级别胶质瘤中VSASL和DSC-PWI得出的相对最大肿瘤血容量（rTBV）和血流量（rTBF）。通过线性回归和Bland-Altman分析评估VSASL和DSC-PWI衍生的rTBV之间的相关性和一致性。使用ROC曲线评估胶质瘤分级的诊断性能。
VSASL-CBV图显示出良好的病变清晰度（平均评分：2.26±0.76；阅片者间加权κ=0.8）。VSASL-rTBV与DSC-PWI-rTBV高度相关（R²=0.83，p<0.001）。VSASL和DSC-PWI指标均能显著区分低级别和高级别胶质瘤（p<0.001）。ROC分析显示，VSASL-rTBV在胶质瘤分级中具有出色的诊断准确性（AUC=0.94），优于VSASL-rTBF（AUC=0.89），与DSC-PWI-rTBV相当（AUC=0.93）。VSASL-rTBV的敏感性、预测值和准确性均优于VSASL-rTBF。
VSASL为胶质瘤分层提供了准确的、非侵入性的CBV定量，其诊断性能与DSC-PWI相当。在钆剂造影禁忌的临床环境中，它提供了一种可行的替代方法。
