4180

Perfusion imaging of brain gliomas using arterial spin labeling: Correlation with histopathological vascular density in MRI-guided biopsies
Haopeng Pang1, Ningning Di1, Chengjun Yao2, Yan Ren1, Jingsong Wu 3, Yong Zhang4, Jianxun Qu 4, and Zhenwei Yao 1

1Radiology, Huashan Hospital, Shanghai, People's Republic of China, 2Glioma Surgery Division, Huashan Hospital, Shanghai, People's Republic of China, 3Neurosurgery, Huashan Hospital, Shanghai, People's Republic of China, 4MR Research China, GE Healthcare, Shanghai, People's Republic of China

Synopsis

This study was designed to determine if CBF derived from ASL perfusion imaging could be used to quantitatively evaluate the MVD of brain gliomas on a “point-to-point” basis. The study enrolled 47 patients with treatment-naive brain gliomas who underwent preoperative ASL before stereotactic surgery. We histologically quantified MVD from CD34-stained sections of stereotactic biopsies and co-registered biopsy locations with localized CBF measurements. CBF showed a statistically significant positive correlation with MVD. ASL can be a quantitative and noninvasive perfusion MR method for evaluating the MVD of brain gliomas, and may reflect the microvascularity of gliomas.

Purpose

ASL can reflect the brain tumor angiogenesis proved by the correlation between CBF and MVD.1-4 However, the mismatch between radiology and histopathology leaves the conclusion open to question. This study was designed to determine if CBF derived from ASL perfusion imaging could be used to quantitatively evaluate the MVD of brain gliomas on a “point-to-point” basis (Fig1).

Methods

The study enrolled 47 patients with treatment-naive brain gliomas who underwent preoperative ASL before stereotactic surgery. We histologically quantified MVD from CD34-stained sections of stereotactic biopsies and co-registered biopsy locations with localized CBF measurements (Fig 2). The correlation between CBF and MVD was determined using Spearman correlation coefficient. P ≤ .05 was considered statistically significant.

Results

Of the 47 patients enrolled in the study, 6 were excluded from the analysis because of brain shift or poor co-registration and localization of the biopsy site during surgery. Finally, 84 biopsies form 41 subjects were included in the analysis. CBF showed a statistically significant positive correlation with MVD (ρ=0.567, P = .029, Fig3).

Discussion and Conclusion

ASL can be a quantitative and noninvasive perfusion MR method for evaluating the MVD of brain gliomas, and may reflect the microvascularity of gliomas.

Acknowledgements

No acknowledgement found.

References

1. Provenzale JM, Mukundan S, Barboriak DP. Diffusion weighted and perfusion MR imaging for brain tumor characterization and assessment of treatment response. Radiology 2006;239:632–49

2. Detre JA, Rao H, Wang DJ, et al. Applications of arterial spin labeled MRI in the brain. J Magn Reson Imaging 2012;35:1026–37

3. Kuo PH, Kanal E, Abu-Alfa AK, et al. Gadolinium-based MR contrast agents and nephrogenic systemic fibrosis. Radiology 2007;242:647–49

4. Warmuth C, Gunther M , Zimmer C. Quantification of blood flow in brain tumors: comparison of arterial spin labeling and dynamic susceptibility-weighted contrast-enhanced MR imaging. Radiology 2003;228:523–32

Figures

WHO grade II glioma in a 43-year-old woman. A, Intraoperative screen captures from the neuronavigation system show two biopsy trajectories are projected into T2 FLAIR with high signal in the right thalamus. B-C, Two ROIs corresponding to biopsy targets, labeled by 1 and 2, are defined on axial CBF map (B), and axial T2 FLAIR image (C). D-G, Pathologic biopsy samples corresponding to ROI 2 (D, E) and for ROI 1 (F, G). Anti-CD34 immunostain (original magnification ×200 for all stains) (D, F). Computer-assisted quantification is used to outline vascular profiles in green (E, G). Arrows show microvascular stained with CD34.

WHO grade III glioma in a 56-year-old man. A, Intraoperative screen captures from the neuronavigation system show the biopsy trajectory is projected into 3D T1C+ with enhancing lesion in the left parietal lobe. B-D, ROI corresponding to biopsy target is defined on axial CBF map (B), axial T2 FLAIR image (C), and postcontrast T1-weighted MR image (D). E-F, Pathologic biopsy sample corresponding to the region of interest. Anti-CD34 immunostain (original magnification ×200 for all stains) (E). Computer-assisted quantification is used to outline vascular profiles in green (F). Arrows show microvascular stained with CD34.

Graph shows positive correlation between CBF and microvascular density measured with CD34 immunostaining. Spearman correlation: ρ= 0.567 (P<0.05).

Proc. Intl. Soc. Mag. Reson. Med. 25 (2017)
4180