The Application Value Of 3D Arterial Spin Labeling And Dynamic Contrast-enhanced MRI In Differential Diagnosis Of High-grade Gliomas And Brain Metastatic Tumors

Objective:The purpose of this study is to explore the quantitative parameters measured by3D-ASL and DCE-MRI in differentiating brain high-grade glioma（HGG）from brain metastatic tumor（MT）,in order to improve the accuracy of preoperative diagnosis.Methods:From June 2019 to January 2021,61 patients diagnosed with histopathological analysis after surgical resection in Qingdao Municipal Hospital Affiliated to Qingdao University,were enrolled（22 high-grade gliomas and 39 brain metastases）.All patients were examined by routine brain MRI,3D-ASL,DCE-MRI and T1WI enhanced scan before surgery.Importing the scanned original images into the GE ADW 4.6 workstation.Post-processing the images of 3D-ASL by Functool software to obtain the cerebral blood flow（CBF）of the tumor parenchyma,peritumoral edema（<1cm）,and contralateral white matter.Calculating the relative cerebral blood flow（r CBF）values（r CBF=CBF of the parenchyma/CBF of the contralateral white matter）to eliminate the influence of individual differences.Post-processing the images of DCE-MRI by Gen-IQ software to obtain the volume transfer constant K^trans and the volume fraction of extravascular space V_e.Comparing the ages,genders,occurrence sites of tumors and permeability parameters(K^trans,V_e,CBF,and r CBF)of patients.In addition,the diagnostic values of each parameter were evaluated by the receiver operating characteristic（ROC）curve analysis,and the optimal cut-off values of each parameter as well as the corresponding sensitivity and specificity were calculated.The difference was statistically significant when P<0.05.Results:1.There were no statistically significant differences in gender and age between HGG and MT（P>0.05）.In the area of the tumor parenchyma,the values of CBF between the two groups were significantly different（P<0.05）.There were no significant differences in K^trans,V_e,and r CBF（P>0.05）.In the area of peritumoral edema,there were significant differences in quantitative parameters of K^trans,V_e,CBF,and r CBF（t values were 4.667,3.280,4.005,3.645,P<0.05）.2.ROC curve showed that the quantitative parameters(r CBF,K^trans,and V_e)of the peritumoral edema were the most effective in the differential diagnosis of HGG and MT.The optimal cut-offs of these quantitative parameters(r CBF,K^trans,and V_e)were 1.092,0.053,and 0.483,the corresponding areas under the curve（AUC）were 0.756,0.798,and0.735.K^trans was more efficient than V_e and r CBF.According to the optimal cut-offs,the sensitivity of r CBF,K^trans,and V_e were 72.70%,90.90%,and 54.50%,and the corresponding specificity of r CBF,K^trans,and V_e were 71.80%,60.00%,and 92.30%.The diagnostic efficiency of combined quantitative parameters was the most significant with the maximum AUC of 0.897,and the corresponding sensitivity and specificity were 71.80%and 95.50%,respectively.Conclusions:1.The quantitative parameters(K^trans,Ve,r CBF)measured by 3D-ASL and DCE-MRI were all helpful in distinguishing high-grade brain gliomas from brain metastases,and K^trans was more efficient than Ve and r CBF.2.The quantitative permeability parameters of peritumoral edema(K^trans,Ve,r CBF)were more valuable than those of tumor parenchyma.3.The combination of K^trans,Ve,and r CBF can further improve the diagnostic efficiency between high-grade glioma and brain metastatic tumor.