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High accuracy of arterial spin labeling perfusion imaging in differentiation of pilomyxoid from pilocytic astrocytoma

  • Paediatric Neuroradiology
  • Published:
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Abstract

Introduction

Pilomyxoid astrocytoma (PMA) is a relatively new tumor entity which has been added to the 2007 WHO Classification of tumors of the central nervous system. The goal of this study is to utilize arterial spin labeling (ASL) perfusion imaging to differentiate PMA from pilocytic astrocytoma (PA).

Methods

Pulsed ASL and conventional MRI sequences of patients with PMA and PA in the past 5 years were retrospectively evaluated. Patients with history of radiation or treatment with anti-angiogenic drugs were excluded.

Results

A total of 24 patients (9 PMA, 15 PA) were included. There were statistically significant differences between PMA and PA in mean tumor/gray matter (GM) cerebral blood flow (CBF) ratios (1.3 vs 0.4, p < 0.001) and maximum tumor/GM CBF ratio (2.3 vs 1, p < 0.001). Area under the receiver operating characteristic (ROC) curves for differentiation of PMA from PA was 0.91 using mean tumor CBF, 0.95 using mean tumor/GM CBF ratios, and 0.89 using maximum tumor/GM CBF. Using a threshold value of 0.91, the mean tumor/GM CBF ratio was able to diagnose PMA with 77 % sensitivity, 100 % specificity, and a threshold value of 0.7, provided 88 % sensitivity and 86 % specificity. There was no statistically significant difference between the two tumors in enhancement pattern (p = 0.33), internal architecture (p = 0.15), or apparent diffusion coefficient (ADC) values (p = 0.07).

Conclusion

ASL imaging has high accuracy in differentiating PMA from PA. The result of this study may have important applications in prognostication and treatment planning especially in patients with less accessible tumors such as hypothalamic-chiasmatic gliomas.

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Ethical standards and patient consent

We declare that all human and animal studies have been approved by the IRB Committee of Children’s Hospital of Philadelphia and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Due to the retrospective nature of study, informed consent was waived.

Conflict of interest

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Department of Radiology, Children’s Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania, 324S 34th Street – Wood 2115, Philadelphia, PA, 19104, USA

    S. A. Nabavizadeh, R. Assadsangabi, M. Hajmomenian & A. Vossough

  2. Department of Pathology, Children’s Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA

    M. Santi

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  1. S. A. Nabavizadeh
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  2. R. Assadsangabi
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  3. M. Hajmomenian
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  4. M. Santi
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  5. A. Vossough
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Correspondence to S. A. Nabavizadeh.

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Nabavizadeh, S.A., Assadsangabi, R., Hajmomenian, M. et al. High accuracy of arterial spin labeling perfusion imaging in differentiation of pilomyxoid from pilocytic astrocytoma. Neuroradiology 57, 527–533 (2015). https://doi.org/10.1007/s00234-015-1497-5

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  • DOI: https://doi.org/10.1007/s00234-015-1497-5

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