European Radiology

, Volume 28, Issue 10, pp 4334–4342 | Cite as

Arterial spin-labeling is useful for the diagnosis of residual or recurrent meningiomas

  • Kazufumi Kikuchi
  • Akio HiwatashiEmail author
  • Osamu Togao
  • Koji Yamashita
  • Ryotaro Kamei
  • Koji Yoshimoto
  • Koji Iihara
  • Satoshi O. Suzuki
  • Toru Iwaki
  • Yuriko Suzuki
  • Hiroshi Honda



ASL is useful in evaluating tumour blood flow and in detecting hypervascular tumours. The purpose of this study was to assess the additive value of ASL to non-contrast and contrast-enhanced (NC/CE)-T1WI for diagnosing residual or recurrent meningiomas.


This retrospective study included 25 postoperative patients (20 women, 5 men; median age, 65 [32–85] years) with and 25 gender- and age-matched postoperative patients without residual or recurrent meningiomas. ASL was performed using a pseudocontinuous method. Seven independent observers (two radiology residents, two general radiologists and three neuroradiologists) participated in two reading sessions consisting of only NC/CE-T1WI (first session) or NC/CE-T1WI with ASL (second session). We evaluated the sensitivity and diagnostic performance for the detection of residual or recurrent meningiomas. The diagnostic performance was assessed using a figure of merit (FOM) calculated via jackknife free-response receiver-operating characteristics. Statistical analysis was performed with paired t tests, with a significance level of p < .05.


The sensitivities were as follows (NC/CE-T1WI vs. NC/CE-T1WI with ASL): residents (62.1% vs. 70.7%), general radiologists (75.9% vs. 87.9%), neuroradiologists (97.7% vs. 100%) and all observers (81.3% vs. 88.2%). The FOMs were as follows (NC/CE-T1WI vs. NC/CE-T1WI with ASL): residents (0.76 vs. 0.83), general radiologists (0.83 vs. 0.93), neuroradiologists (0.95 vs. 0.99) and all observers (0.86 vs. 0.93). The addition of ASL significantly improved the diagnostic parameters for all observers except neuroradiologists (p <. 05).


ASL improved the detection rate of residual or recurrent meningiomas on NC/CE-T1WI among both radiology residents and general radiologists.

Key Points

• ASL improved diagnostic performance for residual/recurrent meningioma compare to NC/CE-T1WI alone.

• Diagnostic sensitivity was increased after adding ASL compared with NC/CE-T1WI.

• FOM was increased after adding ASL compared with NC/CE-T1WI.


Perfusion-weighted MRI Residual tumour Local neoplasm recurrence Meningioma Cancer early detection 



Arterial spin-labeling


Cerebral blood flow


Contrast-enhanced T1-weighted imaging


Lesion-to-normal contrast-to-noise ratio


Figure of merit


Non-contrast T1-weighted imaging


Pseudocontinuous arterial spin-labeling


Perfusion-weighted imaging


Tumour blood flow



Part of this work was presented at the 54th Annual Meeting of the American Society of Neuroradiology and Foundation of the ASNR Symposium, May 23–26, 2016; Washington, DC., USA: Number O-377


The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Hiroshi Honda.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the institutional review board.

Ethical approval

Institutional review board approval was obtained.


• Retrospective

• Diagnostic or prognostic study


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Kazufumi Kikuchi
    • 1
  • Akio Hiwatashi
    • 1
    Email author
  • Osamu Togao
    • 1
  • Koji Yamashita
    • 1
  • Ryotaro Kamei
    • 1
  • Koji Yoshimoto
    • 2
  • Koji Iihara
    • 2
  • Satoshi O. Suzuki
    • 3
  • Toru Iwaki
    • 3
  • Yuriko Suzuki
    • 4
  • Hiroshi Honda
    • 1
  1. 1.Department of Clinical Radiology, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
  2. 2.Department of Neurosurgery, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
  3. 3.Department of Neuropathology, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
  4. 4.MR Clinical SciencePhilips Electronics JapanTokyoJapan

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