Multi-modality perfusion imaging in gliomas: quantitative and visual comparison between ASL, DSC, and [15O]H20 PET


Multi-modality perfusion imaging in gliomas: quantitative and visual comparison between ASL, DSC, and [15O]H20 PET

Petr, J.; Verburg, N.; Koopman, T.; Kuijer, J. P.; Barkhof, F.; van den Hoff, J.; Boellaard, R.; de Witt Hamer, P. C.; Mutsaerts, H. J.

Purpose/Introduction
Glioma vascularization and perfusion are important factors for tumor diagnostics. Dynamic Susceptibility Contrast (DSC) provides a proxy of perfusion by measuring mean transit time and blood volume and is sensitive to blood-brain-barrier breakdown. Arterial spin labeling (ASL) measures true tissue perfusion and can thus provide complementary information to DSC that may aid in tumor grading and in imaging the treatment response to, e.g., antiangiogenic drugs. Agreement of ASL and PET was shown in volunteers 1 .
However, ASL can also partly show intravascular signal making ASL imaging of tumors challenging especially in the presence of vascular shunting. We compared ASL and DSC to the gold-standard for perfusion, [ 15 O]H 2 0 PET, to understand their limits as a surrogate of true regional perfusion.

Subjects and Methods
As part of the FRONTIER study, 8 glioma patients underwent multiple biopsies before scanning using Philips 3T Achieva MR and Gemini PET-CT 2 . PET (10min, 370 MBq of [ 15 O]H 2 0, simultaneous arterial blood sampling), ASL (pCASL 2D EPI, post-labeling delay and labeling duration 1800ms, 3x3x5 mm 3 ), DSC (TR 1.9s, TE 30ms, 1.7x2.4x3.6mm 3 , preloaded contrast) images were acquired. Cerebral blood flow (CBF) was quantified for ASL with ExploreASL, for DSC with Olea Sphere 3.0 with AIF obtained manually from MCA 3 . CBF images were aligned to PET and downsampled 6x6x6mm 3 resolution. Mean and voxel-wise CBF was compared between modalities in tumors and in contralateral-hemisphere gray matter (GM). Absolute and relative CBF (divided by subject’s mean whole-hemisphere contralateral GM CBF) were assessed.

Results
Mean hemispheric and voxelwise GM CBF values in the contralateral hemisphere were compared before and after normalization to global GM mean. For relative CBF, we observed a linear relationship between modalities in the tumor maximum values. Voxelwise analysis shows good agreement of PET and ASL for CBF ratio<1.5. For higher values ASL overestimated CBF, however, the relation was monotonic. DSC and ASL differed due to ASL overestimation in shunting vessels or low DSC signal in non-enhancing
gliomas.

Discussion/Conclusion
CBF normalization to contralateral GM improves the agreement of ASL and PET in tumors, after which a linear relationship in tumor-maximum was observed between all three modalities. The voxel-wise analysis, however, showed that ASL overestimates CBF in the presence of vascular shunting offering a different type of contrast than perfusion. We also observed increased CBF in both PET and ASL in non-enhancing tumors where CBF was underestimated by DSC. ASL presents a viable alternative to DSC with a monotonic relation to PET CBF, can present complementary information to DSC and thus warrants further research in its utility for glioma assessment.

  • Lecture (Conference)
    ESMRMB 2019, 36th Annual Scientific Meeting, 05.10.2019, Rotterdam, Netherlands

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Publ.-Id: 29977