Arterial spin labeling imaging correlates with the angiographic and clinical vascularity of vestibular schwannomas



Hypervascular vestibular schwannomas (HVSs) are a type of the vestibular schwannomas (VSs) that are extremely difficult to remove. We examined whether HVSs can be predicted by using arterial spin labeling (ASL) imaging.


A total of 103 patients with VSs underwent ASL imaging and digital subtraction angiography (DSA) before surgery. Regional cerebral blood flow (CBF) of gray matter and regional tumor blood flow (TBF) were calculated from ASL imaging, and we defined the ratio of TBF to CBF as the relative TBF (rTBF = TBF/CBF). Angiographic vascularity was evaluated by DSA, and clinical vascularity was evaluated by the degree of intraoperative tumor bleeding. Based on the angiographic and clinical vascularity, the VSs were divided into two categories: HVS and non-HVS. We compared rTBF with angiographic and clinical vascularities, retrospectively.


The mean rTBFs of angiographic non-HVSs and HVSs were 1.29 and 2.58, respectively (p < 0.0001). At a cutoff value of 1.55, the sensitivity and specificity were 93.9% and 72.9%, respectively. The mean rTBFs of clinical non-HVS and HVSs were 1.45 and 2.22, respectively (p = 0.0002). At a cutoff value of 1.55, the sensitivity and specificity were 79.4% and 66.7%, respectively.


The rTBF calculated from ASL imaging correlates well with tumor vascularity and may be useful for predicting HVSs before surgery.

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  1. 1.

    Teranishi Y, Kohno M, Sora S, Sato H, Nagata O (2018) Hypervascular vestibular schwannomas: clinical characteristics, angiographical classification, and surgical considerations. Oper Neurosurg 15:251–261.

  2. 2.

    Abe T, Izumiyama H, Imaizumi Y, Kobayashi S, Shimazu M, Sasaki K, Matsumoto K, Kushima M (2001) Staged resection of large hypervascular vestibular schwannomas in young adults. Skull Base 11:199–206

  3. 3.

    Allcutt DA, Hoffman HJ, Isla A, Becker LE, Humphreys RP (1991) Acoustic schwannomas in children. Neurosurgery 29:14–18.

  4. 4.

    Lemay DR, Sun JK, Fishback D, Locke GE, Giannotta SL (1998) Hypervascular acoustic neuroma. Neurol Res 20:748–750

  5. 5.

    Ikeda K, Ito H, Kashihara K, Fujihara H, Yamamoto S (1988) Effective preoperative irradiation of highly vascular cerebellopontine angle neurinomas. Neurosurgery 22:566–573.

  6. 6.

    Yamakami I, Kobayashi E, Iwadate Y, Saeki N, Yamaura A (2002) Hypervascular vestibular schwannomas. Surg Neurol 57:105–112.

  7. 7.

    Falk Delgado A, De Luca F, van Westen D, Falk Delgado A (2018) Arterial spin labeling MR imaging for differentiation between high- and low-grade glioma-a meta-analysis. Neuro-Oncology 20:1450–1461.

  8. 8.

    Kimura H, Takeuchi H, Koshimoto Y, Arishima H, Uematsu H, Kawamura Y, Kubota T, Itoh H (2006) Perfusion imaging of meningioma by using continuous arterial spin-labeling: comparison with dynamic susceptibility-weighted contrast-enhanced MR images and histopathologic features. Am J Neuroradiol 27:85–93

  9. 9.

    Razek AAKA, El-Serougy L, Abdelsalam M, Gaballa G, Talaat M (2018) Differentiation of residual/recurrent gliomas from postradiation necrosis with arterial spin labeling and diffusion tensor magnetic resonance imaging-derived metrics. Neuroradiology 60:169–177.

  10. 10.

    Warmuth C, Gunther M, Zimmer C (2003) Quantification of blood flow in brain tumors: comparison of arterial spin labeling and dynamic susceptibility-weighted contrast-enhanced MR imaging. Radiology 228:523–532.

  11. 11.

    Yoo RE, Yun TJ, Cho YD, Rhim JH, Kang KM, Choi SH, Kim JH, Kim JE, Kang HS, Sohn CH, Park SW, Han MH (2016) Utility of arterial spin labeling perfusion magnetic resonance imaging in prediction of angiographic vascularity of meningiomas. J Neurosurg 125:536–543.

  12. 12.

    Mayercik V, Ma M, Holdsworth S, Heit J, Iv M (2019) Arterial spin-labeling MRI identifies hypervacular meningiomas. Am J Roentgenol 213:1–5.

  13. 13.

    Zaharchuk G, El Mogy IS, Fischbein NJ, Albers GW (2012) Comparison of arterial spin labeling and bolus perfusion-weighted imaging for detecting mismatch in acute stroke. Stroke 43:1843–1848.

  14. 14.

    Wolf RL, Wang J, Wang S, Melhem ER, O’Rourke DM, Judy KD et al (2005) Grading of CNS neoplasms using continuous arterial spin labeled perfusion MR imaging at 3 tesla. J Magn Reson Imaging 22:475–482.

  15. 15.

    Lawrence KS, Frank JA, McLaughlin AC (2000) Effect of restricted water exchange on cerebral blood flow values calculated with arterial spin tagging: a theoretical investigation. Magn Reson Med 44:440–449.<440::AID-MRM15>3.0.CO;2-6

  16. 16.

    Koizumi S, Sakai N, Kawaji H, Takehara Y, Yamashita S, Namba H et al (2015) Pseudo-continuous arterial spin labeling reflects vascular density and differentiates angiomatous meningiomas from non-angiomatous meningiomas. J Neuro-Oncol 121:549–556.

  17. 17.

    Luh WM, Wong EC, Bandettini PA, Hyde JS (1999) QUIPSS II with thin-slice TI1 periodic saturation: a method for improving accuracy of quantitative perfusion imaging using pulsed arterial spin labeling. Magn Reson Med 41:1246–1254.;2-n

  18. 18.

    Amano M, Kohno M, Nagata O, Taniguchi M, Sora S, Sato H (2011) Intraoperative continuous monitoring of evoked facial nerve electromyograms in acoustic neuroma surgery. Acta Neurochir 153:1059–1067.

  19. 19.

    Bartko JJ (1966) The intraclass correlation coefficient as a measure of reliability. Psychol Rep 19:3–11.

  20. 20.

    Fleiss JL (1981) Statistical methods for rates and proportions. 2nd ed. Wiley, New York, pp 38–46

  21. 21.

    Caye-Thomasen P, Baandrup L, Jacobsen GK, Thomsen J, Stangerup SE (2003) Immunohistochemical demonstration of vascular endothelial growth factor in vestibular schwannomas correlates to tumor growth rate. Laryngoscope 113:2129–2134.

  22. 22.

    Caye-Thomasen P, Werther K, Nalla A, Bog-Hansen TC, Nielsen HJ, Stangerup SE et al (2005) VEGF and VEGF receptor-1 concentration in vestibular schwannoma homogenates correlates to tumor growth rate. Otol Neurotol 26:98–101

  23. 23.

    Koutsimpelas D, Bjelopavlovic M, Yetis R, Frauenknecht K, Adryan B, Schmidtmann I (2012) The VEGF/VEGF-R axis in sporadic vestibular schwannomas correlates with irradiation and disease recurrence. ORL J Otorhinolaryngol Relat Spec 74:330–338.

  24. 24.

    Koutsimpelas D, Stripf T, Heinrich UR, Mann WJ, Brieger J (2007) Expression of vascular endothelial growth factor and basic fibroblast growth factor in sporadic vestibular schwannomas correlates to growth characteristics. Otol Neurotol 28:1094–1099.

  25. 25.

    Noguchi T, Yoshiura T, Hiwatashi A, Togao O, Yamashita K, Honda H (2008) Perfusion imaging of brain tumors using arterial spin-labeling: correlation with histopathologic vascular density. Am J Neuroradiol 29:688–693.

  26. 26.

    Sakai N, Koizumi S, Yamashita S, Takehara Y, Sakahara H, Namba H (2013) Arterial spin-labeled perfusion imaging reflects vascular density in nonfunctioning pituitary macroadenomas. Am J Neuroradiol 34:2139–2143.

  27. 27.

    Kikuchi K, Hiwatashi A, Togao O, Yamashita K, Yoshimoto K, Mizoguchi M, Suzuki SO, Iwaki T, Suzuki Y, Honda H (2017) Correlation between arterial spin-labeling perfusion and histopathological vascular density of pediatric intracranial tumors. J Neuro-Oncol 135:561–569.

  28. 28.

    Weber MA, Zoubaa S, Schlieter M, Juttler E, Huttner HB, Geletneky K et al (2006) Diagnostic performance of spectroscopic and perfusion MRI for distinction of brain tumors. Neurology 66:1899–1906.

  29. 29.

    Rushworth RG, Sorby WA, Smith SF (1984) Acoustic neuroma in a child treated with the aid of preoperative arterial embolization. Case report. J Neurosurg 61:396–398.

  30. 30.

    Shuto T, Inomori S, Matsunaga S, Fujino H (2008) Microsurgery for vestibular schwannoma after gamma knife radiosurgery. Acta Neurochir (Wien) 150:229–234.

  31. 31.

    Kai Y, Hamada JI, Morioka M, Yano S, Nakamura H, Makino K (2006) Clinical evaluation of cellulose porous beads for the therapeutic embolization of meningiomas. Am J Neuroradiol 27:1146–1150

  32. 32.

    Lee CC, Wu HM, Chung WY, Chen CJ, Pan DH, Hsu SP (2014) Microsurgery for vestibular schwannoma after gamma knife surgery: challenges and treatment strategies. J Neurosurg 121(Suppl):150–159.

  33. 33.

    Pollock BE, Lunsford LD, Kondziolka D, Sekula R, Subach BR, Foote RL (1998) Vestibular schwannoma management: Part II. Failed radiosurgery and the role of delayed microsurgery. J Neurosurg 89:949–955.

  34. 34.

    Bendszus M, Warmuth-Metz M, Klein R, Bartsch AJ, Krone A, Tonn JC, Solymosi L (2002) Sequential MRI and MR spectroscopy in embolized meningiomas: correlation with surgical and histopathological findings. Neuroradiology 44:77–82.

  35. 35.

    Tanaka Y, Hashimoto T, Watanabe D, Okada H, Akimoto J, Kohno M (2018) Post-embolization neurological syndrome after embolization for intracranial and skull base tumors: transient exacerbation of neurological symptoms with inflammatory responses. Neuroradiology 60:843–851.

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The authors would like to thank Enago ( for the English language review.

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Correspondence to Yujiro Tanaka.

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Tanaka, Y., Kohno, M., Hashimoto, T. et al. Arterial spin labeling imaging correlates with the angiographic and clinical vascularity of vestibular schwannomas. Neuroradiology (2020).

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  • Hypervascular vestibular schwannoma
  • Arterial spin labeling
  • Tumor blood flow
  • Angioraphic vascularity
  • Clinical vascularity