1. 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

2. The study was funded by the
Disclosure
ASNR 54rd Annual Meeting
The study was funded by the
RSF (РНФ) grant №

3. 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

4. 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

5. 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

6. 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.

7. 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.

8. 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

9. 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

10. 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

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

12. 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

13. 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

14. Burdenko Neurosurgery Institute Moscow, Russia
Thank you very much!