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Pseudo-continuous arterial spin labelling shows high diagnostic performance in the detection of postoperative residual lesion in hyper-vascularised adult brain tumours

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Abstract

Objectives

Our aim was to evaluate the contribution of pseudo-continuous arterial spin labelling (pCASL) in the detection of a postoperative residual lesion in adult brain tumours.

Methods

Seventy-five patients were prospectively included. Following the results of preoperative DSC-PWI assessment, intra-axial lesions, including high-grade gliomas (n = 43) and certain metastases (n = 14), were classified as hyper-vascular (HV+ group, n = 57); other lesions, including low-grade gliomas and certain metastases, were classified as non-hyper-vascular (HV− group, n = 18). To confirm the absence/presence of a residual lesion or disease progression, postoperative MRI including pCASL sequence and follow-up-MRI were performed within 72 h and 1–6 months after the resection, respectively. Two raters evaluated the images. Mean and maximal ASL cerebral blood flow (CBF) values were measured in the perioperative region and normalised to the contralateral tissue. The pCASL-CBF maps and post-contrast T1WI were visually assessed for residual lesion. Quantitative data were analysed with unpaired Student t and Mann-Whitney U tests and the visual diagnostic performance with the McNemar test.

Results

In the HV+ group, the mean normalised CBF was 1.97 ± 0.59 and 0.97 ± 0.29 (p < 0.0001, AUC = 0.964, cut-off = 1.27) for patients with or without residual tumours, respectively. The mean normalised CBF was not discriminative for assessing residual tumours in the HV− group (p = 0.454). Visual CBF evaluation allowed 92.98% patients belonging to the HV+ group to be correctly classified (sensitivity 93.02%, specificity 92.86%, p < 0.001). Visual evaluation was correlated with contrast enhancement evaluation and with the mean normalised CBF values (r = 0.505, p < 0.0001 and 0.838, p < 0.0001, respectively).

Conclusion

Qualitative and quantitative ASL evaluation shows high diagnostic performance in postoperative assessment of hyper-perfused tumours. In this case, postoperative pCASL may be useful, especially if contrast injection cannot be performed or when contrast enhancement is doubtful.

Key Points

• Evaluation of postoperative residual lesion in the case of brain tumours is an imaging challenge.

• This prospective monocentric study showed that increased normalised cerebral blood flow assessed by pseudo-continuous arterial spin labelling (pCASL) correlates well with the presence of a residual tumour in the case of hyper-vascular tumour diagnosed on preoperative MRI.

• Qualitative and quantitative pCASL is an informative sequence for hyper-vascular residual tumour, especially if acquired more than 48 h after brain tumour surgery, when contrast enhancement can give ambiguous results due to blood-brain barrier disruption.

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Abbreviations

CBF:

Cerebral blood flow

CE-T1WI:

Contrast-enhanced T1-weighted imaging

CInd:

Confidence index

maxrCBF:

Normalised ratio for the maximal CBF values

meanrCBF:

Normalised ratio for the mean CBF values

PRL:

Postoperative residual lesion

visualCBF:

Visually assessed CBF

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Authors and Affiliations

  1. Neuroradiology Department, Centre Hospitalo-Universitaire de Tours, 2 boulevard Tonnellé, 37000, Tours, France

    Clara Cohen

  2. Neuroradiology Department, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, F-75013, Paris, France

    Bruno Law-Ye, Didier Dormont, Delphine Leclercq, Damien Galanaud & Nadya Pyatigorskaya

  3. Sorbonne Université, UPMC Univ Paris 06, F-75013, Paris, France

    Didier Dormont, Damien Galanaud & Nadya Pyatigorskaya

  4. Neurosurgery Department, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, F-75013, Paris, France

    Laurent Capelle

  5. Neurooncology Department, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, F-75013, Paris, France

    Marc Sanson

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  1. Clara Cohen
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Cohen, C., Law-Ye, B., Dormont, D. et al. Pseudo-continuous arterial spin labelling shows high diagnostic performance in the detection of postoperative residual lesion in hyper-vascularised adult brain tumours. Eur Radiol 30, 2809–2820 (2020). https://doi.org/10.1007/s00330-019-06474-4

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