Usefulness of Superselective Arterial Spin Labeling for Evaluating Feeding Arteries and Brain Invasion in Meningiomas
Takashi Katsube1, Aiko Gobara2, Hiroya Asou2
1From the Department of Radiology (T.K., A.G., Y.K.), Neurosurgery (T.Y., K.H.), Shimane University Faculty of Medicine, Izumo, Shimane, Japan, Department of Radiology (H.A.), Shimane University Hospital, Izumo, Shimane, Japan and Philips Japan (M.O.), Tokyo, Japan. katsube@med.shimane-u.ac.jp.
Background And Purpose:
This study aimed to assess the utility of superselective arterial spin labeling (SS-ASL) in identifying the feeding arteries of meningiomas and in predicting brain invasion.
Materials And Methods:
A prospective study was conducted with 26 patients with meningiomas. Preoperative SS-ASL was used to selectively label the external carotid artery, ICA, or vertebral artery. Two board-certified radiologists evaluated the accuracy of feeding artery identification by comparing SS-ASL findings with conventional angiography. Perfusion patterns at the tumor-parenchyma interface were further evaluated as a potential surrogate marker for predicting brain invasion.
Results:
SS-ASL identification of feeding arteries corresponded with angiography in over 93% of images and more than 80% of cases. Surgical and pathological evaluation confirmed brain invasion in 6 cases. SS-ASL correctly identified all 6 cases (sensitivity: 100%) but showed internal carotid artery/vertebral artery signals in 7 additional cases without pathological evidence of invasion (specificity: 65%), yielding a negative predictive value (NPV) of 100%.
Conclusions:
SS-ASL is a noninvasive and reliable technique for identifying meningioma feeding arteries. It also shows strong potential for preoperative screening of brain invasion; its high NPV suggests it may be useful for ruling out invasion and aiding surgical planning.
