Arterial spin labeling (ASL) is a noninvasive neuroimaging technique that allows for quantifying cerebral blood flow without intravenous contrast. Various neurovascular disorders and tumors have cerebral blood flow alterations. Identifying these perfusion changes through ASL can aid in the diagnosis, especially in entities with normal structural imaging. In addition, complications of tumor treatment and tumor progression can also be monitored using ASL. In this case-based review, we demonstrate the clinical applications of ASL in diagnosing and monitoring brain tumors and treatment complications.
TelischakNADetreJAZaharchukG, et al.Arterial spin labeling MRI: clinical applications in the brain. J Magn Reson Imaging2015; 41: 1165–1180, DOI: 10.1002/jmri.24751
5.
HuangRYNeaguMRReardonDA, et al.Pitfalls in the neuroimaging of glioblastoma in the era of antiangiogenic and immuno/targeted therapy – detecting illusive disease, defining response. Front Neurol2015; 6: 33. DOI: 10.3389/fneur.2015.00033
6.
ChoiYJKimHSJahngG-H, et al.Pseudoprogression in patients with glioblastoma: added value of arterial spin labeling to dynamic susceptibility contrast perfusion MR imaging. Acta Radiologica2013; 54: 448–454. DOI: 10.1177/0284185112474916
7.
ZhouLWangYPinhoMC, et al.Intrasession reliability of arterial spin-labeled MRI–measured noncontrast perfusion in glioblastoma at 3 T. Tomography2020; 6: 139–147. DOI: 10.18383/j.tom.2020.00010
8.
GrandeFDSubhawongTWeberK, et al.Detection of soft-tissue sarcoma recurrence: added value of functional MR imaging techniques at 3.0 T. Radiology2014; 271: 499–511. DOI: 10.1148/radiol.13130844
9.
WeberMAThilmannCLichyMP, et al.Assessment of irradiated brain metastases by means of arterial spin-labeling and dynamic susceptibility-weighted contrast-enhanced perfusion MRI: initial results. Invest Radiol2004; 39: 277–287. DOI: 10.1097/01.rli.0000119195.50515.04
10.
BalañaCCapelladesJPinedaE, et al.Pseudoprogression as an adverse event of glioblastoma therapy. Cancer Med2017; 6: 2858–2866. DOI: 10.1002/cam4.1242
11.
ChoiYJKimHSJahngG-H, et al.Pseudoprogression in patients with glioblastoma: added value of arterial spin labeling to dynamic susceptibility contrast perfusion MR imaging. Acta Radiologica2013; 54: 448–454. DOI: 10.1177/0284185112474916
12.
WolfRLWangJWangS, et al.Grading of CNS neoplasms using continuous arterial spin labeled perfusion MR imaging at 3 Tesla. J Magn Reson Imaging2005; 22: 475–482. DOI: 10.1002/jmri.20415
13.
SilvaACKimSGGarwoodM, et al.Imaging blood flow in brain tumors using arterial spin labeling. Magn Reson Med2000; 44: 169–173. DOI: 10.1002/1522-2594(200008)44:2<169::aid-mrm1>3.0.co;2-u
14.
LuanJWuMWangX, et al.The diagnostic value of quantitative analysis of ASL, DSC-MRI and DKI in the grading of cerebral gliomas: a meta-analysis. Radiat Oncol2020; 15: 204. DOI: 10.1186/s13014-020-01643-y
15.
GarianiJHottingerABen AissaA, et al.New patterns of magnetic resonance images in high-grade glioma patients treated with bevacizumab (Avastin®). Clin Translational Neurosci2018; 2: 2514183X17752903. DOI: 10.1177/2514183x17752903
16.
SoniNSrindharanKKumarS, et al.Arterial spin labeling perfusion: prospective MR imaging in differentiating neoplastic from non-neoplastic intra-axial brain lesions. Neuroradiol J2018; 31: 544–553. DOI: 10.1177/1971400918783058
17.
GanboldMHaradaMKhashbatD, et al.Differences in high-intensity signal volume between arterial spin labeling and contrast-enhanced T1-weighted imaging may be useful for differentiating glioblastoma from brain metastasis. J Med Invest2017; 64: 58–63. DOI: 10.2152/jmi.64.58
18.
FuMHanFFengC, et al.Based on arterial spin labeling helps to differentiate high-grade gliomas from brain solitary metastasis: a systematic review and meta-analysis. Medicine2019; 98: e15580. DOI: 10.1097/md.0000000000015580
19.
Aparici-RoblesFDavidhiACarot-SierraJM, et al.Glioblastoma versus solitary brain metastasis: MRI differentiation using the edema perfusion gradient. J Neuroimaging2022; 32: 127–133, DOI: 10.1111/jon.12920
20.
YouS-HYunTJChoiHJ, et al.Differentiation between primary CNS lymphoma and glioblastoma: qualitative and quantitative analysis using arterial spin labeling MR imaging. Eur Radiol2018; 28: 3801–3810. DOI: 10.1007/s00330-018-5359-5
21.
RoserFSainiMMelissR, et al.Apoptosis, vascularity, and proliferation in primary central nervous system lymphomas (PCNSL): a histopathological study. Surg Neurol2004; 62: 393–399. DOI: 10.1016/j.surneu.2003.11.038
22.
KickingerederPSahmFWiestlerB, et al.Evaluation of microvascular permeability with dynamic contrast-enhanced MRI for the differentiation of primary CNS lymphoma and glioblastoma: radiologic-pathologic correlation. Am J Neuroradiology2014; 35: 1503–1508. DOI: 10.3174/ajnr.A3915
23.
YamashitaKYoshiuraTHiwatashiA, et al.Differentiating primary CNS lymphoma from glioblastoma multiforme: assessment using arterial spin labeling, diffusion-weighted imaging, and 18F-fluorodeoxyglucose positron emission tomography. Neuroradiology2013; 55: 135–143. DOI: 10.1007/s00234-012-1089-6
24.
KangKMSohnCHYouSH, et al.Added value of arterial spin-labeling MR imaging for the differentiation of cerebellar hemangioblastoma from metastasis. Am J Neuroradiology2017; 38: 2052–2058. DOI: 10.3174/ajnr.A5363
25.
KhashbatDAbeTGanboldM, et al.Correlation of 3D arterial spin labeling and multi-parametric dynamic susceptibility contrast perfusion MRI in brain tumors. The J Med Invest2016; 63: 175–181. DOI: 10.2152/jmi.63.175
26.
KikuchiKHiwatashiATogaoO, et al.Arterial spin-labeling is useful for the diagnosis of residual or recurrent meningiomas. Eur Radiol2018; 28: 4334–4342. DOI: 10.1007/s00330-018-5404-4
27.
MayercikVMaMHoldsworthS, et al.Arterial spin-labeling MRI identifies hypervascular meningiomas. Am J Roentgenology2019; 213: 1124–1128. DOI: 10.2214/AJR.18.21026
28.
TamraziBShiroishiMSLiuC-SJ, et al.Advanced imaging of intracranial meningiomas. Neurosurg Clin N Am2016; 27: 137–143. DOI: 10.1016/j.nec.2015.11.004
29.
QiaoXJKimHGWangDJJ, et al.Application of arterial spin labeling perfusion MRI to differentiate benign from malignant intracranial meningiomas. Eur J Radiol2017; 97: 31–36. DOI: 10.1016/j.ejrad.2017.10.005
30.
LuYLuanSLiuL, et al.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 Radiol2017; 27: 4072–4081. DOI: 10.1007/s00330-017-4760-9
31.
OkamotoNItokawaHMoriyaM, et al.Efficacy of preoperative radiation therapy in hyper-vascular solitary fibrous tumor. Neurol Surg2009; 37: 189–194.
32.
MaWYinHHuanY, et al.An unusual malignant solitary fibrous tumor of the pineal region: A case report and review of the literature. Eur J Radiol Extra2010; 76: e39–e42, DOI: 10.1016/j.ejrex.2010.07.005
DengFYoonBC. Brachiocephalic vein compression with jugular venous reflux may mimic cavernous dural arteriovenous fistula on arterial spin labeling. Neuroradiology2021; 63: 291–294. DOI: 10.1007/s00234-021-02637-7
35.
ImaiMSunagaAAokiR, et al.Possibility of arterial spin labeling perfusion magnetic resonance imaging sequences with steroid therapy for Tolosa-Hunt syndrome: a case report and review of literature. Surg Neurol Int2022; 13: 27–2022. DOI: 10.25259/sni_969_2021
36.
NoguchiTYakushijiYNishiharaM, et al.Arterial spin-labeling in central nervous system infection. Magn Reson Med Sci2016; 15: 386–394. DOI: 10.2463/mrms.mp.2015-0140
37.
FanEPHeiberGGerardEE, et al.Stroke-like migraine attacks after radiation therapy: a misnomer?Epilepsia2018; 59: 259–268. DOI: 10.1111/epi.13963
38.
BlackDFMorrisJMLindellEP, et al.Stroke-like migraine attacks after radiation therapy (SMART) syndrome is not always completely reversible: a case series. Am J Neuroradiology2013; 34: 2298–2303. DOI: 10.3174/ajnr.A3602
39.
NoguchiTYoshiuraTHiwatashiA, et al.Perfusion imaging of brain tumors using arterial spin-labeling: correlation with histopathologic vascular density. Am J Neuroradiology2008; 29: 688–693. DOI: 10.3174/ajnr.A0903
40.
Mora ÁlvarezMGStobbeRWBeaulieuC, et al.High resolution continuous arterial spin labeling of human cerebral perfusion using a separate neck tagging RF coil. PLoS One2019; 14: e0215998. DOI: 10.1371/journal.pone.0215998
41.
Falk DelgadoAVan WestenDNilssonM, et al.Diagnostic value of alternative techniques to gadolinium-based contrast agents in MR neuroimaging-a comprehensive overview. Insights Imaging2019; 10. DOI: 10.1186/s13244-019-0771-1
42.
MorelloACasseriTAcampaM, et al.Stroke in pregnancy and review of current literature: arterial spin-labeling MRI can identify the presence and intensity of collateral circle. J Stroke Cerebrovasc Dis2018; 27: 3575–3577, DOI: 10.1016/j.jstrokecerebrovasdis.2018.08.027
