Histogram-Based Analysis of Low- and High-Grade Glioma and Its Surrounding Edema Using Arterial Spin Labeling Magnetic Resonance Imaging

A glioma is a type of intra-axial brain tumor originating from the glial cells. Making up about one-third of all brain tumors, a timely diagnosis alongside correct grading and subsequent therapy planning is crucial. Magnetic Resonance Imaging is an established method for the diagnosis of tumors. Arterial Spin Labeling (ASL) Perfusion Imaging allows for the non-contrast enhanced visualization of tumor hyper- or hypoperfusion. Commonly, cell swelling occurs around the tumor that causes edema, which subsequently puts healthy tissue at risk by potentially reducing regional perfusion. The patient collective in this study consists of 495 patients (501 scans) with histopathologically confirmed grade II-IV diffuse gliomas. The aim of this study was to evaluate the potential of histogram analysis of the ASL data to find biomarkers for the pathological diagnosis, grading, MGMT, and mutation status of the tumors as well as the analysis of tumor-surrounding edema. The analysis showed statistically significant results for the pathological diagnosis and grading but not for MGMT status or mutation. The differentiation between tumor and edema showed highly significant results yet did not show differences between edema and perfusion on the contralateral hemisphere.