Three-dimensional arterial spin labeling imaging and dynamic susceptibility contrast perfusion-weighted imaging value in diagnosing glioma grade prior to surgery

The current study aimed to investigate whole-brain three-dimensional arterial spin labeling imaging (3D ASL) and dynamic susceptibility contrast perfusion‑weighted imaging (DSC‑PWI), in regards to their diagnostic value of preoperative glioma grade. The parameter values obtained after correction will be correlated with the diagnostic value of 3D ASL and DSC‑PWI perfusion. In the current study, 50 patients with gliomas confirmed by pathology were used, including 27 low‑grade gliomas (LGGs) and 23 high‑grade gliomas (HGGs). Prior to surgery all patients underwent 3 Tesla magnetic resonance imaging (MRI), 3D ASL, DSC‑PWI and conventional enhanced MRI scans to obtain original 3D ASL and DSC‑PWI images, and the tumor regions with the most obvious parenchyma perfusion and contralateral normal white matter were selected. In these areas, the ASL‑relative cerebral blood flow (ASL‑rCBF), DSC‑relative cerebral blood flow (DSC-rCBF) and DSC-relative cerebral blood volume (DSC-rCBV) parameter values were then obtained after correction for individual differences. The results of the present study show that ASL‑CBF, DSC‑CBF, DSC‑CBV values and ASL‑rCBF, DSC-rCBF, DSC-rCBV values increased as the grade of the glioma being imaged increased, and there was a marked difference between the HGGs and the LGGs. ASL-rCBF was significantly positively correlated with DSC‑rCBF (r=0.580, P<0.01). In addition, ASL‑rCBF was significantly positively correlated with DSC‑rCBV (r=0.431, P<0.01). Receiver operating characteristic (ROC) curves were applied to compare the two perfusion parameters of DSC‑PWI and 3D ASL in the diagnosis of glioma grade. ASL‑rCBF had the highest area value under the ROC curve (0.836). The areas under the ROC curve of DSC‑rCBF and DSC‑rCBV were analyzed using the Z test, but the difference was not statistically significant. When ASL‑rCBF, DSC‑rCBF and DSC‑rCBV were cutoff at 2.24, 1.85 and 1.68, the sensitivity of HGG diagnosis was 83.2, 91.3 and 91.3%, and the specificity was 77.7, 63.9 and 66.7%, respectively.