Korean J Radiol.  2019 Feb;20(2):275-282. 10.3348/kjr.2018.0300.

Evaluation of Tumor Blood Flow Using Alternate Ascending/Descending Directional Navigation in Primary Brain Tumors: A Comparison Study with Dynamic Susceptibility Contrast Magnetic Resonance Imaging

• Park H
• Lee J
• Park SH
• Choi SH

• KMID: 2438258
• DOI: http://doi.org/10.3348/kjr.2018.0300

Abstract

OBJECTIVE
Alternate ascending/descending directional navigation (ALADDIN) is a novel arterial spin labeling technique that does not require a separate spin preparation pulse. We sought to compare the normalized cerebral blood flow (nCBF) values obtained by ALADDIN and dynamic susceptibility contrast (DSC) perfusion magnetic resonance imaging (MRI) in patients with primary brain tumors.
MATERIALS AND METHODS
Sixteen patients with primary brain tumors underwent MRI scans including contrast-enhanced T1-weighted imaging, DSC perfusion MRI, and ALADDIN. The nCBF values of normal gray matter (GM) and tumor areas were measured by both DSC perfusion MRI and ALADDIN, which were compared by the Wilcoxon signed rank test. Subgroup analyses according to pathology were performed with the Wilcoxon signed rank test.
RESULTS
Higher mean nCBF values of GM regions in the bilateral frontal lobe, temporal lobe, and caudate were detected by ALADDIN than by DSC perfusion MRI (p <0.05). In terms of the mean or median nCBF values and the mean of the top 10% nCBF values from tumors, DSC perfusion MRI and ALADDIN did not statistically significantly differ either overall or in each tumor group.
CONCLUSION
ALADDIN tended to detect higher nCBF values in normal GM, as well as higher perfusion portions of primary brain tumors, than did DSC perfusion MRI. We believe that the high perfusion signal on ALADDIN can be beneficial in lesion detection and characterization.

Keyword

MRI; Arterial spin labeling (ASL); Dynamic susceptibility contrast (DSC); Brain tumor; Glioma

MeSH Terms

Brain Neoplasms*
Cerebrovascular Circulation
Frontal Lobe
Glioma
Gray Matter
Humans
Magnetic Resonance Angiography
Magnetic Resonance Imaging*
Pathology
Perfusion
Temporal Lobe

Figure

• 

  Fig. 1 Flowchart for selecting study population.

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  Fig. 2 Normal GM of frontal lobe, parietal lobe, temporal lobe, occipital lobe, thalamus, and caudate head from DSC perfusion MRI and ALADDIN (arrows).Region of interest in normal GM was selected in specific regions in each lobe for consistency as follows: precentral gyrus above central sulcus for frontal lobe, postcentral gyrus below central sulcus for parietal lobe, middle temporal gyrus for temporal lobe, and occipital pole. ALADDIN = alternate ascending/descending directional navigation, DSC = dynamic susceptibility contrast, GM = gray matter, MRI = magnetic resonance imaging

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  Fig. 3 Representative cases of high-grade glioma (A), low-grade glioma (B), lymphoma (C) in CE T1WI, DSC perfusion MRI, and ALADDIN.A. 83-year-old woman with multifocal glioblastoma (mean nCBF from DSC perfusion MRI and ALADDIN was 2.06 and 3.09, respectively). B. 41-year-old woman with oligodendroglioma in right parietal lobe that locally recurred after surgery (mean nCBF from DSC perfusion MRI and ALADDIN was 1.01 and 4.46, respectively). C. 63-year-old woman with diffuse large B cell lymphoma in right frontal lobe (mean nCBF from DSC perfusion MRI and ALADDIN was 2.15 and 1.70, respectively). CE = contrast-enhanced, nCBF = normalized cerebral blood flow, T1WI = T1-weighted imaging

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  Fig. 4 78-year-old woman with glioblastoma in right frontal lobe.CE T1WI (A) and ALADDIN ascending (B), descending (C), ascending + descending (D) acquisition indicated that lesion had higher signal intensity in descending and ascending + descending acquisitions, but lower signal intensity in ascending acquisition.

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