动脉自旋标记（ASL）灌注磁共振成像（MRI）是一种用于脑肿瘤监测的先进MRI技术之一。本研究的首要目的是调查定量脑血流（CBF）与非定量灌注加权成像（ASL-PWI）测量结果之间的相关性。其次目的是探究ASL-CBF和ASL-PWI测量以及视觉评估在识别肿瘤进展方面的诊断准确性。使用一组连续的经过治疗的脑肿瘤患者进行了包含ASL的3-Tesla MRI监测。在ASL-CBF地图中的肿瘤代表性区域（ROI）内绘制ROI，并将其复制到ASL-PWI中。计算ASL-CBF比值和ASL-PWI比值与正常外观白质（NAWM）之间的相关性（皮尔逊相关系数），并计算AUC以评估诊断准确性。此外，将病灶在视觉上分类为低信号、等信号或高信号，并在两个阈值上计算准确性：低阈值（低信号-等信号之间）和高阈值（等信号-高信号之间）。173个病变（包括强化和非强化）在115名患者（93例胶质瘤、16例转移瘤和6例淋巴瘤）中测量结果显示，ASL-CBF比值和ASL-PWI比值之间存在很高的相关性（0.96，95% CI：0.88-0.99）。ASL-CBF比值的AUC为0.76（95% CI：0.65-0.88），ASL-PWI比值的AUC为0.72（95% CI：0.58-0.85）。对于强化病灶的视觉评估的诊断准确性为0.72。ASL-PWI比值和ASL-CBF比值显示出很高的相关性和可比较的AUC值，因此可在这些患者中省略ASL-CBF的定量化。视觉分类与ASL-PWI或ASL-CBF比值具有类似的诊断准确性。本研究表明，对于脑肿瘤监测，可以省略ASL灌注MRI的CBF定量化，视觉评估能够提供相同的诊断准确性。这大大简化了ASL在日常临床实践中的使用复杂性。• 动脉自旋标记MRI在临床脑肿瘤监测中被低估和研究不足。• 非定量和定量动脉自旋标记评估显示高相关性和可比较的诊断准确性。• 在日常临床工作流程中可以省略动脉自旋标记MRI的定量化以改进工作效率。©2023. 作者。

Arterial spin labelling (ASL) perfusion MRI is one of the available advanced MRI techniques for brain tumour surveillance. The first aim of this study was to investigate the correlation between quantitative cerebral blood flow (CBF) and non-quantitative perfusion weighted imaging (ASL-PWI) measurements. The second aim was to investigate the diagnostic accuracy of ASL-CBF and ASL-PWI measurements as well as visual assessment for identifying tumour progression.A consecutive cohort of patients who underwent 3-T MRI surveillance containing ASL for treated brain tumours was used. ROIs were drawn in representative parts of tumours in the ASL-CBF maps and copied to the ASL-PWI. ASL-CBF ratios and ASL-PWI ratios of the tumour ROI versus normal appearing white matter (NAWM) were correlated (Pearson correlation) and AUCs were calculated to assess diagnostic accuracy. Additionally, lesions were visually classified as hypointense, isointense, or hyperintense. We calculated accuracy at two thresholds: low threshold (between hypointense-isointense) and high threshold (between isointense-hyperintense).A total of 173 lesions, both enhancing and non-enhancing, measured in 115 patients (93 glioma, 16 metastasis, and 6 lymphoma) showed a very high correlation of 0.96 (95% CI: 0.88-0.99) between ASL-CBF ratios and ASL-PWI ratios. AUC was 0.76 (95%CI: 0.65-0.88) for ASL-CBF ratios and 0.72 (95%CI: 0.58-0.85) for ASL-PWI ratios. Diagnostic accuracy of visual assessment for enhancing lesions was 0.72.ASL-PWI ratios and ASL-CBF ratios showed a high correlation and comparable AUCs; therefore, quantification of ASL-CBF could be omitted in these patients. Visual classification had comparable diagnostic accuracy to the ASL-PWI or ASL-CBF ratios.This study shows that CBF quantification of ASL perfusion MRI could be omitted for brain tumour surveillance and that visual assessment provides the same diagnostic accuracy. This greatly reduces the complexity of the use of ASL in routine clinical practice.• Arterial spin labelling MRI for clinical brain tumour surveillance is undervalued and underinvestigated. • Non-quantitative and quantitative arterial spin labelling assessments show high correlation and comparable diagnostic accuracy. • Quantification of arterial spin labelling MRI could be omitted to improve daily clinical workflow.© 2023. The Author(s).