BACKGROUND: Evaluation of molecular markers (IDH, pTERT, 1p/19q codeletion, and MGMT) in adult diffuse gliomas is crucial for accurate diagnosis and optimal treatment planning. Dynamic Susceptibility Contrast (DSC) and Arterial Spin Labeling (ASL) perfusion MRI techniques have both shown good performance in classifying molecular markers, however, their performance has not been compared side-by-side. METHODS: Pretreatment MRI data from 90 patients diagnosed with diffuse glioma (54 men/36 female, 53.1 ± 15.5 years, grades 2-4) were retrospectively analyzed. DSC-derived normalized cerebral blood flow/volume (nCBF/nCBV) and ASL-derived nCBF in tumor and perifocal edema were analyzed in patients with available IDH-mutation (n = 67), pTERT-mutation (n = 39), 1p/19q codeletion (n = 33), and MGMT promoter methylation (n = 31) status. Cross-validated uni- and multivariate logistic regression models assessed perfusion parameters' performance in molecular marker detection. RESULTS: ASL and DSC perfusion parameters in tumor and edema distinguished IDH-wildtype (wt) and pTERT-wt tumors from mutated ones. Univariate classification performance was comparable for ASL-nCBF and DSC-nCBV in IDH (maximum AUROCC 0.82 and 0.83, respectively) and pTERT (maximum AUROCC 0.70 and 0.81, respectively) status differentiation. The multivariate approach improved IDH (DSC-nCBV AUROCC 0.89) and pTERT (ASL-nCBF AUROCC 0.8 and DSC-nCBV AUROCC 0.86) classification. However, ASL and DSC parameters could not differentiate 1p/19q codeletion or MGMT promoter methylation status. Positive correlations were found between ASL-nCBF and DSC-nCBV/-nCBF in tumor and edema. CONCLUSIONS: ASL is a viable gadolinium-free replacement for DSC for molecular characterization of adult diffuse gliomas.

Biomedical Data Science Laboratory Instituto Universitario de Tecnologías de la Información y Comunicaciones Universitat Politècnica de València València Spain

Center for Lifespan Changes in Brain and Cognition University of Oslo Oslo Norway

Department of Neurosurgery Amsterdam University Medical Center Amsterdam The Netherlands

Department of Neurosurgery Oslo University Hospital Oslo Norway

Department of Oncology Oslo University Hospital Oslo Norway

Department of Pathology Oslo University Hospital Oslo Norway

Department of Pathophysiology 2nd Faculty of Medicine Charles University Prague The Czech Republic

Department of Physics and Computational Radiology Division of Radiology and Nuclear Medicine Oslo University Hospital Oslo Norway

Department of Radiology and Nuclear Medicine Amsterdam Neuroscience Amsterdam University Medical Center Location VUmc Amsterdam The Netherlands

Helmholtz Zentrum Dresden Rossendorf Institute of Radiopharmaceutical Cancer Research Dresden Germany

Institute of Clinical Medicine Faculty of Medicine University of Oslo Oslo Norway

Section for Cancer Cytogenetics Institute for Cancer Genetics and Informatics Oslo University Hospital Oslo Norway

Section of Neuroradiology Department of Radiology and Nuclear Medicine Oslo University Hospital Oslo Norway

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