rd Annual Meeting
ASNR 54rd
Arterial Spin Labeling Perfusion in
Differentiation of Primary and Secondary
Glioblastomas
A. Tonoyan, T. Ovcharenko, L. Shishkina, I. Pronin.
Burdenko Neurosurgery Institute, Moscow, Russia
rd Annual Meeting
ASNR 54Disclosure
The study was funded by the
RSF (РНФ) grant № 14-15-00197
Brain
gliomas
Brain gliomas
Treatment protocols and prognosis in gliomas depend
on:
• Glioma malignancy grade
• Glioma proliferative activity
• Genetic alterations
• …
Brain GBMs
• Most frequent malignant primary brain tumor
• Proliferative activity (Ki-67/MIB-1 LI)
• Genetic alterations (IDH, etc)
Louis DN, Perry A, Burger P, et al. International Society of Neuropathology-Haarlem
Consensus Guidelines for Nervous System Tumor Classification and Grading. Brain
Pathology 2014;24(5):429-35
Brain GBMs
Primary GBMs
Secondary
GBMs
IDH1 -
IDH1 +
All solid tumor
demonstrates
contrast
enhancement
Tumor solid
regions
without any
contrast
enhancement
are present
Poor
prognosis
Better
prognosis
Primary GBM Secondary GBM
IDH1+
IDH1-
Perfusion
(CBF, CBV)
Perfusion in gliomas
Grade I-II

Grade III

Grade IV
Liu X et al. 2011; Prager AJ et al. 2015; Falk A et al. 2014
Purpose
Purpose:
Тo assess:
1. the efficacy of CBF (ASL-perfusion) in differentiation of
primary
(IDH1-)
and
secondary
(IDH1+)
GBMs.
2. the correlation between CBF (ASL-perfusion) and Ki-67/MIB-1
LI of GBMs.
3. to compare Ki-67/MIB-1 LI between primary (IDH1-) and
secondary (IDH1+) GBMs.
Methods
Materials
Methods and
and Materials:
37 patients with newly diagnosed brain GBMs (without any
treatment before).
• 14 Secondary GBMs (IDH1+)
• 23 Primary GBMs (IDH1-)
Diagnosis confirmation – tumor removal in all patients.
Methods and Materials
• 3T MR-scanner
• T2, T2-FLAIR, T1, DWI, T1+Gd, ASL.
• ASL perfusion parameters:
• TR = 4639 ms
• TE = 9,8 ms
• NEX = 3
• Slice thickness = 4 mm
• FOV = 240 mm
• Matrix = 518x518
• Post-labeling delay 1525 ms
Methods and Materials
TBF – tumor
blood flow
mean-TBF
• n-TBF (normalization) = TBF/CBF
• No necrosis in ROIs
• ROIs were delineated in
accordance with T2, T2-FLAIR, T1
and T1+Gd
max-TBF
CBF in contralateral
white matter
Methods and Materials
Statistical analysis
• TBF-max, n-TBF-max
• TBF-mean, n-TBF-mean
• TBF-max, n-TBF-max
• TBF-mean, n-TBF-mean
between IDH1+ and IDH1GBMs
correlation with
Ki-67/MIB-1 LI of GBMs
• Comparison of Ki-67/MIB-1 Li between IDH1+ and IDH1- GBMs
• Mann-Whitney test (p < 0,05)
• Spearman correlation
Results
ASL in differentiation of IDH mutation in GBMs
200
150
100
GBM IDH-1 GBM IDH-1 +
50
0
TBF-max,
(p=0,62)
n-TBF-max (x0,1),
(p=0,71)
TBF-mean,
(p=0,57)
n-TBF-mean
(x0,1), (p=0,97)
No statistically significant differences of TBF-max, TBF-mean, n-TBFmax, n-TBF-mean values between IDH1- and IDH1+ GBMs.
Results
CBF correlation with Ki-67 LI in GBMs (Spearman correlaion)
TBF-max &
Ki-67/MIB-1 LI
P value of
correlation
n-TBF-max & Ki67/MIB-1 LI
p = 0,44
p = 0,72
TBF-mean &
Ki-67/MIB-1 LI
n-TBF-mean &
Ki-67/MIB-1 LI
p = 0,64
Ki-67 LI differences between IDH+ and IDH- GBMs
20
15
10
± 14,7
± 6,3
P>0,05
GBM IDH-1 GBM IDH-1 +
5
0
Ki-67/MIB-1 LI
p = 0,70
Conclusion
In spite of the fact that there is a number of studies
presenting a significant increase of perfusion metrics (CBV
and CBF) of gliomas with higher tumor malignancy,
according to our results, there are
• no significant differences of CBF (ASL) between «IDH1+»
and «IDH1-» GBMs
• no significant correlation between CBF (ASL) and KI67/MIB-1 LI in GBMs
• no significant differences of Ki-67/MIB-1 LI between IDHand IDH+ GBMs
Burdenko Neurosurgery Institute
Moscow, Russia
Thank you very much!
E-mail: [email protected]