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Purpose <p>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.</p> Methods <p>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.</p> Results <p>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, <i>p</i> &lt; 0.001). Both VSASL and DSC-PWI metrics significantly distinguished low- from high-grade gliomas (<i>p</i> &lt; 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.</p> Conclusion <p>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.</p>

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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.

  • 期刊论文

  • 发表日期：

    2025年9月2日

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  • Yaoming Qu,
  • Andong Ma,
  • Xinran Yan,
  • Xiaochan Ou,
  • Xia Zou,
  • Qihong Rui,
  • Haitao Wen,
  • Xianlong Wang,
  • Dan Zhu,
  • Qin Qin,
  • Zhibo Wen

摘要

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.