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Updated: Feb 18, 2026
Author Spotlight: Noninvasive Cerebral Blood Flow Determination in Human Functional Brain Region for Diagnosis of Neurological Disorders
Published on: May 31, 2024
Application of arterial spin labeling perfusion MRI to differentiate benign from malignant intracranial meningiomas
Xin J Qiao1, Hyun Grace Kim1, Danny J J Wang2
1Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.
Purpose:
Differentiating WHO grade I-III of meningioma by non-invasive imaging is challenging. This study investigated the potential of MR arterial spin labeling (ASL) to establish tumor grade in meningioma patients.
Material And Methods:
Pseudo-continuous ASL with 3D background suppressed gradient and spin echo (GRASE) was acquired on 54 patients with newly diagnosed or recurrent intracranial meningioma. Perfusion patterns characterized in CBF color maps were independently evaluated by three neuroradiologists blinded to patient history, and correlated with tumor grade from histo-pathological review.
Results:
Three perfusion patterns could be discerned by visual evaluation of CBF maps. Pattern 1 consisted of homogeneous hyper-perfusion of the entire tumor; pattern 2 demonstrated heterogeneous hyper-perfusion; pattern 3 showed no substantial hyper-perfusion. Evaluation of the perfusion patterns was highly concordant among the three readers (Kendall W=0.9458, P<0.0001). Pattern 1 was associated with WHO Grade I meningioma of (P<0.0001). Patterns 2 and 3 were predictive of WHO Grade II and III meningioma (P<0.0001), with an odds ratio (OR, versus pattern 1) of 49.6 (P<0.01) in a univariate analysis, and an OR of 186.4 (P<0.01) in a multivariate analysis.
Conclusion:
Qualitative evaluation of ASL CBF maps can help differentiate benign (WHO Grade I) from higher grade (WHO Grade II and III) intracranial meningiomas, potentially impacting therapeutic strategy.
Insights
Arterial spin labeling (ASL) MRI can differentiate meningioma grades. Homogeneous hyper-perfusion indicates benign (WHO Grade I) tumors, while heterogeneous or absent hyper-perfusion suggests higher grades (WHO II-III).
Area of Science:
- Neuroradiology
- Medical Imaging
- Oncology
Background:
- Meningiomas are common primary brain tumors.
- Accurate grading of meningiomas (WHO Grade I-III) is crucial for treatment planning.
- Non-invasive methods to distinguish meningioma grades are needed.
Purpose of the Study:
- To evaluate the potential of Magnetic Resonance (MR) arterial spin labeling (ASL) for differentiating meningioma grades.
- To correlate ASL-derived perfusion patterns with histopathological tumor grading.
Main Methods:
- Pseudo-continuous ASL with 3D background suppressed gradient and spin echo (GRASE) was performed on 54 meningioma patients.
- Cerebral Blood Flow (CBF) color maps were visually assessed for perfusion patterns.
- Patterns were correlated with WHO histopathological grades.
Main Results:
- Three distinct perfusion patterns were identified: homogeneous hyper-perfusion (Pattern 1), heterogeneous hyper-perfusion (Pattern 2), and no substantial hyper-perfusion (Pattern 3).
- Pattern 1 strongly correlated with WHO Grade I meningiomas (P<0.0001).
- Patterns 2 and 3 were predictive of higher-grade (WHO II-III) meningiomas with high odds ratios (OR=49.6 univariate, OR=186.4 multivariate).
Conclusions:
- Qualitative assessment of ASL CBF maps can effectively distinguish between benign (WHO Grade I) and higher-grade (WHO Grade II-III) intracranial meningiomas.
- ASL imaging may aid in non-invasively determining tumor grade, potentially influencing therapeutic strategies.
