ASNR 54rd Annual Meeting ASNR 54rd Annual Meeting Arterial Spin Labeling Perfusion in Differentiation of Primary and Secondary Glioblastomas A. Tonoyan, T. Ovcharenko, L. Shishkina, I. Pronin. Burdenko Neurosurgery Institute, Moscow, Russia

The study was funded by the Disclosure ASNR 54rd Annual Meeting The study was funded by the RSF (РНФ) grant № 14-15-00197

Brain gliomas Brain gliomas Brain GBMs Treatment protocols and prognosis in gliomas depend on: Glioma malignancy grade Glioma proliferative activity Genetic alterations … Brain GBMs Most frequent malignant primary brain tumor Proliferative activity (Ki-67/MIB-1 LI) Genetic alterations (IDH, etc) Louis DN, Perry A, Burger P, et al. International Society of Neuropathology-Haarlem Consensus Guidelines for Nervous System Tumor Classification and Grading. Brain Pathology 2014;24(5):429-35

Brain GBMs Primary GBM IDH1+ Secondary GBM IDH1- Primary GBMs Secondary GBMs IDH1 - IDH1 + All solid tumor demonstrates contrast enhancement Tumor solid regions without any contrast enhancement are present Poor prognosis Better prognosis

Perfusion in gliomas Perfusion (CBF, CBV) Grade I-II  Grade III  Grade IV Liu X et al. 2011; Prager AJ et al. 2015; Falk A et al. 2014

Purpose Purpose: Тo assess: the efficacy of CBF (ASL-perfusion) in differentiation of primary (IDH1-) and secondary (IDH1+) GBMs. the correlation between CBF (ASL-perfusion) and Ki-67/MIB-1 LI of GBMs. to compare Ki-67/MIB-1 LI between primary (IDH1-) and secondary (IDH1+) GBMs.

Methods and Materials: 37 patients with newly diagnosed brain GBMs (without any treatment before). 14 Secondary GBMs (IDH1+) 23 Primary GBMs (IDH1-) Diagnosis confirmation – tumor removal in all patients.

Methods and Materials 3T MR-scanner T2, T2-FLAIR, T1, DWI, T1+Gd, ASL. ASL perfusion parameters: TR = 4639 ms TE = 9,8 ms NEX = 3 Slice thickness = 4 mm FOV = 240 mm Matrix = 518x518 Post-labeling delay 1525 ms

Methods and Materials n-TBF (normalization) = TBF/CBF TBF – tumor blood flow mean-TBF n-TBF (normalization) = TBF/CBF No necrosis in ROIs ROIs were delineated in accordance with T2, T2-FLAIR, T1 and T1+Gd max-TBF CBF in contralateral white matter

Methods and Materials Statistical analysis TBF-max, n-TBF-max TBF-mean, n-TBF-mean Comparison of Ki-67/MIB-1 Li between IDH1+ and IDH1- GBMs Mann-Whitney test (p < 0,05) Spearman correlation between IDH1+ and IDH1- GBMs correlation with Ki-67/MIB-1 LI of GBMs

Results No statistically significant differences of TBF-max, TBF-mean, n-TBF-max, n-TBF-mean values between IDH1- and IDH1+ GBMs.

Results CBF correlation with Ki-67 LI in GBMs (Spearman correlaion) TBF-max & Ki-67/MIB-1 LI n-TBF-max & Ki-67/MIB-1 LI TBF-mean & n-TBF-mean & P value of correlation p = 0,44 p = 0,72 p = 0,64 p = 0,70 Ki-67 LI differences between IDH+ and IDH- GBMs ± 14,7 ± 6,3 P>0,05

Conclusion In spite of the fact that there is a number of studies presenting a significant increase of perfusion metrics (CBV and CBF) of gliomas with higher tumor malignancy, according to our results, there are no significant differences of CBF (ASL) between «IDH1+» and «IDH1-» GBMs no significant correlation between CBF (ASL) and KI-67/MIB-1 LI in GBMs no significant differences of Ki-67/MIB-1 LI between IDH- and IDH+ GBMs

Burdenko Neurosurgery Institute Moscow, Russia Thank you very much! E-mail: atonoyan@nsi.ru