Arterial spin labeling perfusion-weighted imaging aids in prediction of molecular biomarkers and survival in glioblastomas

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Prediction of progression-free survival (PFS) and overall survival (OS) and early identification of molecular biomarkers with prognostic information are clinically important in glioblastoma (GBM) patients. We aimed to explore the utility of arterial spin labeling perfusion-weighted imaging (ASL-PWI) in the prediction of molecular biomarkers and survival in GBM patients.


We retrospectively analyzed 149 consecutive GBM patients, who had undergone maximal surgical resection or biopsy followed by concurrent chemoradiotherapy and adjuvant chemotherapy using temozolomide between November 2010 and June 2016. On preoperative ASL-PWI, cerebral blood flow (CBF) within contrast-enhancing (CE) and nonenhancing (NE) portions were evaluated both qualitatively (perfusion pattern[CE] and perfusion pattern[NE]) and quantitatively (nCBFCE and nCBFNE). ASL-PWI findings were correlated with molecular biomarkers, including isocitrate dehydrogenase (IDH) and O6-methylguanine-DNA methyltransferase (MGMT) methylation statuses, and survival, using the Mann-Whitney U-test, Spearman rank correlation, Kaplan-Meier analysis, and receiver operating characteristics analysis.


nCBFCE was significantly higher in the IDH wild-type group than in the IDH mutant group (p = .013) and in the MGMT unmethylated group than in the methylated group (p = .047). Areas under the receiver operating characteristic curve were 0.678 for IDH mutation (p = .022) and 0.601 for MGMT promoter methylation (p = .043). Hyperperfusion was associated with the shortest median PFS for both perfusion pattern[CE] (7.6 months) and perfusion pattern[NE] (4.0 months). The perfusion pattern[NE] remained an independent predictor for PFS and OS even after adjusting for clinical and molecular predictors, unlike perfusion pattern[CE].


ASL-PWI can aid to predict survival and molecular biomarkers including IDH mutation and MGMT promoter methylation statuses in GBM patients.

Key Points

• ASL-PWI can aid to predict survival in GBM patients.

• ASL-PWI can aid to predict IDH and MGMT promoter methylation statuses in GBM.

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Fig. 1
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Fig. 3



Arterial spin labeling


Alpha thalassemia/mental retardation syndrome x-linked gene


Cerebral blood flow


Cerebral blood volume


Concurrent chemo- and radiation therapy


Dynamic susceptibility contrast-enhanced


Epidermal growth factor receptor


Fluid-attenuated inversion recovery




Hypoxia-inducible factor 1-alpha


Hazard ratio


Isocitrate dehydrogenase


Interquartile range


Karnofsky performance score


O6-methylguanine-DNA methyltransferase


Overall survival


Progression-free survival


Perfusion-weighted imaging


Response assessment in neuro-oncology




Vascular endothelial growth factor


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Author information

Correspondence to Tae Jin Yun.

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The scientific guarantor of this publication is Tae Jin Yun.

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

One of the authors (R.E.Y.) has significant statistical expertise.

Informed consent

Requirement for informed consent was waived due to its retrospective nature.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Part of the patient population in this study (n = 132) overlaps with those in a previous study (Hong EK, Choi SH, Shin DJ et al (2018) Radiogenomics correlation between MR imaging features and major genetic profiles in glioblastoma. Eur Radiol. The current study differs from the previous study in that we used ASL-PWI to conduct rigorous radiogenomics and survival analyses, focusing on both enhancing and nonenhancing portions of tumors. Moreover, the current study expands on the prior study by having a larger patient number and includes a more in-depth survival analysis using a multivariable survival model based on various imaging, molecular, and clinical predictors.


• retrospective

• diagnostic or prognostic study

• performed at one institution

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Yoo, R., Yun, T.J., Hwang, I. et al. Arterial spin labeling perfusion-weighted imaging aids in prediction of molecular biomarkers and survival in glioblastomas. Eur Radiol 30, 1202–1211 (2020).

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  • Glioblastoma
  • Isocitrate dehydrogenase
  • Perfusion-weighted imaging
  • Progression-free survival
  • Overall survival