Superselective pseudocontinuous arterial spin labeling in patients with meningioma: utility in prediction of feeding arteries and preoperative embolization feasibility

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  • 1 Departments of Radiology and
  • 2 Neurosurgery, Seoul National University Hospital, Seoul; and
  • 3 Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
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OBJECTIVE

Superselective pseudocontinuous arterial spin labeling (ss-pCASL) is an MRI technique in which individual vessels are labeled to trace their perfusion territories. In this study, the authors assessed its merit in defining feeding vessels and gauging preoperative embolization feasibility for patients with meningioma, using digital subtraction angiography (DSA) as the reference method.

METHODS

Thirty-one consecutive patients with meningiomas were prospectively recruited, each undergoing DSA (and embolization, if feasible) before resection. All ss-pCASL imaging studies were performed 1 day prior to DSA. Two neuroradiologists independently reviewed ss-pCASL images, rating the contribution of each labeled vessel to tumor blood supply as none, minor, or major. Two neuroradiologists also gauged the feasibility of embolization in each patient, based on ss-pCASL images. Interobserver and intermodality agreement were determined using Cohen’s kappa statistic. The diagnostic performance of ss-pCASL was assessed in terms of discerning tumor blood supply and the potential for embolization.

RESULTS

Interobserver agreement in the rating of blood supply by ss-pCASL was very good (κ = 0.817, 95% CI 0.771–0.863), and intermodality agreement (consensus ss-pCASL readings vs DSA findings) was good (κ = 0.688, 95% CI 0.632–0.744). In delineating tumor blood supply, ss-pCASL showed high sensitivity (87.1%) and specificity (87.2%). The positive and negative predictive values for embolization feasibility were 85.2% and 100%, respectively.

CONCLUSIONS

In patients with meningiomas, feeding vessels are reliably predicted by ss-pCASL. This noninvasive approach, involving no iodinated contrast or radiation exposure, is particularly beneficial if there are no prospects of embolization.

ABBREVIATIONS ASL = arterial spin labeling; DSA = digital subtraction angiography; ECA = external carotid artery; ICA = internal carotid artery; MMA = middle meningeal artery; NPV = negative predictive value; OA = occipital artery; PPV = positive predictive value; SNR = signal-to-noise ratio; ss-pCASL = superselective pseudocontinuous ASL; STA = superficial temporal artery; TOF-MRA = time-of-flight magnetic resonance angiography; VA = vertebral artery.

Supplementary Materials

    • Supplementary Figure (PDF 1.5 MB)

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Contributor Notes

Correspondence Chul-Ho Sohn: Seoul National University Hospital, Seoul, Korea. neurorad63@gmail.com.

INCLUDE WHEN CITING Published online November 13, 2020; DOI: 10.3171/2020.7.JNS201915.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Wiemels J, Wrensch M, Claus EB. Epidemiology and etiology of meningioma. J Neurooncol. 2010;99(3):307314.

  • 2

    Bitzer M, Wöckel L, Luft AR, The importance of pial blood supply to the development of peritumoral brain edema in meningiomas. J Neurosurg. 1997;87(3):368373.

    • Search Google Scholar
    • Export Citation
  • 3

    Bendszus M, Rao G, Burger R, Is there a benefit of preoperative meningioma embolization? Neurosurgery. 2000;47(6):13061312.

  • 4

    Dowd CF, Halbach VV, Higashida RT. Meningiomas: the role of preoperative angiography and embolization. Neurosurg Focus. 2003;15(1):E10.

  • 5

    Shah AH, Patel N, Raper DM, The role of preoperative embolization for intracranial meningiomas. J Neurosurg. 2013;119(2):364372.

  • 6

    Raper DM, Starke RM, Henderson F Jr, Preoperative embolization of intracranial meningiomas: efficacy, technical considerations, and complications. AJNR Am J Neuroradiol. 2014;35(9):17981804.

    • Search Google Scholar
    • Export Citation
  • 7

    Adler JR, Upton J, Wallman J, Winston KR. Management and prevention of necrosis of the scalp after embolization and surgery for meningioma. Surg Neurol. 1986;25(4):357360.

    • Search Google Scholar
    • Export Citation
  • 8

    Dubel GJ, Ahn SH, Soares GM. Contemporary endovascular embolotherapy for meningioma. Semin Intervent Radiol. 2013;30(3):263277.

  • 9

    Willinsky RA, Taylor SM, TerBrugge K, Neurologic complications of cerebral angiography: prospective analysis of 2,899 procedures and review of the literature. Radiology. 2003;227(2):522528.

    • Search Google Scholar
    • Export Citation
  • 10

    Haller S, Zaharchuk G, Thomas DL, Arterial spin labeling perfusion of the brain: emerging clinical applications. Radiology. 2016;281(2):337356.

    • Search Google Scholar
    • Export Citation
  • 11

    Wong EC. Vessel-encoded arterial spin-labeling using pseudocontinuous tagging. Magn Reson Med. 2007;58(6):10861091.

  • 12

    Helle M, Norris DG, Rüfer S, Superselective pseudocontinuous arterial spin labeling. Magn Reson Med. 2010;64(3):777786.

  • 13

    Lindner T, Helle M, Jansen O. A short introduction to arterial spin labeling and its application to flow territory mapping. Clin Neuroradiol. 2015;25(suppl 2):211218.

    • Search Google Scholar
    • Export Citation
  • 14

    Yu SL, Wang R, Wang R, Accuracy of vessel-encoded pseudocontinuous arterial spin-labeling in identification of feeding arteries in patients with intracranial arteriovenous malformations. AJNR Am J Neuroradiol. 2014;35(1):6571.

    • Search Google Scholar
    • Export Citation
  • 15

    Richter V, Helle M, van Osch MJ, MR imaging of individual perfusion reorganization using superselective pseudocontinuous arterial spin-labeling in patients with complex extracranial steno-occlusive disease. AJNR Am J Neuroradiol. 2017;38(4):703711.

    • Search Google Scholar
    • Export Citation
  • 16

    Sasao A, Hirai T, Nishimura S, Assessment of vascular supply of hypervascular extra-axial brain tumors with 3T MR regional perfusion imaging. AJNR Am J Neuroradiol. 2010;31(3):554558.

    • Search Google Scholar
    • Export Citation
  • 17

    Lu Y, Luan S, Liu L, Evaluation of the applicability of territorial arterial spin labeling in meningiomas for presurgical assessments compared with 3-dimensional time-of-flight magnetic resonance angiography. Eur Radiol. 2017;27(10):40724081.

    • Search Google Scholar
    • Export Citation
  • 18

    Jensen-Kondering U, Helle M, Lindner T, Non-invasive qualitative and semiquantitative presurgical investigation of the feeding vasculature to intracranial meningiomas using superselective arterial spin labeling. PLoS One. 2019;14(4):e0215145.

    • Search Google Scholar
    • Export Citation
  • 19

    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(2):523532.

    • Search Google Scholar
    • Export Citation
  • 20

    Noguchi T, Yoshiura T, Hiwatashi A, Perfusion imaging of brain tumors using arterial spin-labeling: correlation with histopathologic vascular density. AJNR Am J Neuroradiol. 2008;29(4):688693.

    • Search Google Scholar
    • Export Citation
  • 21

    Kong L, Chen H, Yang Y, Chen L. A meta-analysis of arterial spin labelling perfusion values for the prediction of glioma grade. Clin Radiol. 2017;72(3):255261.

    • Search Google Scholar
    • Export Citation
  • 22

    Kimura H, Takeuchi H, Koshimoto Y, Perfusion imaging of meningioma by using continuous arterial spin-labeling: comparison with dynamic susceptibility-weighted contrast-enhanced MR images and histopathologic features. AJNR Am J Neuroradiol. 2006;27(1):8593.

    • Search Google Scholar
    • Export Citation
  • 23

    Koizumi S, Sakai N, Kawaji H, Pseudo-continuous arterial spin labeling reflects vascular density and differentiates angiomatous meningiomas from non-angiomatous meningiomas. J Neurooncol. 2015;121(3):549556.

    • Search Google Scholar
    • Export Citation
  • 24

    Lu Y, Xiong J, Yin B, The role of three-dimensional pseudo-continuous arterial spin labelling in grading and differentiating histological subgroups of meningiomas. Clin Radiol. 2018;73(2):176184.

    • Search Google Scholar
    • Export Citation
  • 25

    Yoo RE, Yun TJ, Cho YD, Utility of arterial spin labeling perfusion magnetic resonance imaging in prediction of angiographic vascularity of meningiomas. J Neurosurg. 2016;125(3):536543.

    • Search Google Scholar
    • Export Citation
  • 26

    Mayercik V, Ma M, Holdsworth S, Arterial spin-labeling MRI identifies hypervascular meningiomas. AJR Am J Roentgenol. 2019;213(5):11241128.

    • Search Google Scholar
    • Export Citation
  • 27

    Wood ML, Henkelman RM. MR image artifacts from periodic motion. Med Phys. 1985;12(2):143151.

  • 28

    Uetani H, Akter M, Hirai T, Can 3T MR angiography replace DSA for the identification of arteries feeding intracranial meningiomas? AJNR Am J Neuroradiol. 2013;34(4):765772.

    • Search Google Scholar
    • Export Citation
  • 29

    Hirohata M, Abe T, Fujimura N, Preoperative embolization of brain tumor with pial artery or dural branch of internal carotid artery as feeding artery. Interv Neuroradiol. 2006;12(1)(suppl 1):246251.

    • Search Google Scholar
    • Export Citation

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