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Updated: Feb 22, 2026
Diffusion Tensor Magnetic Resonance Imaging in the Analysis of Neurodegenerative Diseases
Published on: July 28, 2013
Differentiation between progression and pseudoprogresion by arterial spin labeling MRI in patients with glioblastoma
Marija Jovanovic1, Sandra Radenkovic, Tatjana Stosic-Opincal
1Clinical Center of Serbia, Radiology and MRI Center, Belgrade, Serbia.
Purpose:
To compare arterial spin labeling (ASL) perfusion technique with the clinically established dynamic susceptibility contrast-enhanced (DSC) perfusion weighted-imaging (PWI), and to determine its value in routine MRI evaluation of disease progression in patients with glioblastoma multiforme (GBM).
Methods:
A prospective intraindividual study was performed in 31 patients with histologically proven GBM who had clinical and/or radiological deterioration after treatment, including surgery, radiotherapy and therapy with temozolomide. Conventional brain protocol with ASL and DSC techniques was performed on 3T MRI unit. Cerebral blood flow (CBF) and cerebral blood volume (CBV) maps were analyzed by means of regions of interest (ROI). Each ROI average value was normalized to the contralateral normal brain parenchyma ROI value. Neuroradiologists analyzed CBF and CBV maps separately, and classified patients into progression or pseudoprogression group. Radiological diagnosis was confirmed by clinical-radiological follow-up for at least three months after patient deterioration.
Results:
High linear correlation existed between DSC-PWI and ASL in the tumor ROI (r=0.733; p<0.001). 92% of ASL CBF maps were informative. ASL detected all lesions as well as DSC MRI. Both techniques provided perfusion values closely correlated.
Conclusion:
ASL allows distinction between GBM progression and pseudoprogression, and it can be used as reliable alternative to DSC-PWI.
Insights
Arterial spin labeling (ASL) is a reliable alternative to dynamic susceptibility contrast-enhanced (DSC) perfusion weighted-imaging (PWI) for evaluating glioblastoma multiforme (GBM) progression. ASL effectively distinguishes between tumor progression and pseudoprogression in GBM patients.
Area of Science:
- Neuroimaging
- Radiology
- Oncology
Background:
- Glioblastoma multiforme (GBM) requires accurate monitoring for treatment response and disease progression.
- Dynamic susceptibility contrast-enhanced perfusion weighted-imaging (DSC-PWI) is the established method for assessing GBM perfusion.
- Arterial spin labeling (ASL) is an emerging perfusion technique with potential advantages.
Purpose of the Study:
- To compare the efficacy of ASL perfusion technique against the established DSC-PWI.
- To evaluate the utility of ASL in the routine MRI assessment of disease progression in GBM patients.
Main Methods:
- A prospective intraindividual study involving 31 GBM patients with clinical deterioration post-treatment.
- Conventional brain MRI with both ASL and DSC techniques on a 3T unit.
- Analysis of cerebral blood flow (CBF) and cerebral blood volume (CBV) maps using normalized regions of interest (ROIs).
Main Results:
- A high linear correlation (r=0.733; p<0.001) was observed between ASL and DSC-PWI in tumor ROIs.
- ASL CBF maps were informative in 92% of cases and detected all lesions identified by DSC MRI.
- Both techniques yielded closely correlated perfusion values.
Conclusions:
- ASL perfusion imaging is a reliable alternative to DSC-PWI for GBM evaluation.
- ASL effectively differentiates between true GBM progression and pseudoprogression.
- ASL can be integrated into routine MRI protocols for monitoring GBM patients.
