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Noninvasive blood–brain barrier integrity mapping in patients with high‐grade glioma and metastasis by multi–echo time–encoded arterial spin labeling.

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Title: Noninvasive blood–brain barrier integrity mapping in patients with high‐grade glioma and metastasis by multi–echo time–encoded arterial spin labeling.
Authors: Hoffmann, Gabriel1,2 (AUTHOR) gabriel.hoffmann@tum.de, Preibisch, Christine1,2,3 (AUTHOR), Günther, Matthias4,5,6 (AUTHOR), Mahroo, Amnah4 (AUTHOR), van Osch, Matthias J. P.7,8 (AUTHOR), Václavů, Lena7 (AUTHOR), Metz, Marie‐Christin1 (AUTHOR), Jung, Kirsten1 (AUTHOR), Zimmer, Claus1,2 (AUTHOR), Wiestler, Benedikt1,9 (AUTHOR), Kaczmarz, Stephan1,2,10 (AUTHOR)
Source: Magnetic Resonance in Medicine. May2025, Vol. 93 Issue 5, p2086-2098. 13p.
Subjects: Spin labels, Magnetic resonance imaging, Receiver operating characteristic curves, Brain tumors, Magnetic flux leakage
Abstract: Purpose: In brain tumors, disruption of the blood–brain barrier (BBB) indicates malignancy. Clinical assessment is qualitative; quantitative evaluation is feasible using the K2 leakage parameter from dynamic susceptibility contrast MRI. However, contrast agent–based techniques are limited in patients with renal dysfunction and insensitive to subtle impairments. Assessing water transport times across the BBB (Tex) by multi‐echo arterial spin labeling promises to detect BBB impairments noninvasively and potentially more sensitively. We hypothesized that reduced Tex indicates impaired BBB. Furthermore, we assumed higher sensitivity for Tex than dynamic susceptibility contrast–based K2, because arterial spin labeling uses water as a freely diffusible tracer. Methods: We acquired 3T MRI data from 28 patients with intraparenchymal brain tumors (World Health Organization Grade 3 & 4 gliomas [n = 17] or metastases [n = 11]) and 17 age‐matched healthy controls. The protocol included multi‐echo and single‐echo Hadamard‐encoded arterial spin labeling, dynamic susceptibility contrast, and conventional clinical imaging. Tex was calculated using a T2‐dependent multi‐compartment model. Areas of contrast‐enhancing tissue, edema, and normal‐appearing tissue were automatically segmented, and parameter values were compared across volumes of interest and between patients and healthy controls. Results: Tex was significantly reduced (−20.3%) in contrast‐enhancing tissue compared with normal‐appearing gray matter and correlated well with |K2| (r = −0.347). Compared with healthy controls, Tex was significantly lower in tumor patients' normal‐appearing gray matter (Tex,tumor = 0.141 ± 0.032 s vs. Tex,HC = 0.172 ± 0.036 s) and normal‐appearing white matter (Tex,tumor = 0.116 ± 0.015 vs. Tex,HC = 0.127 ± 0.017 s), whereas |K2| did not differ significantly. Receiver operating characteristic analysis showed a larger area under the curve for Tex (0.784) than K2 (0.604). Conclusion: Tex is sensitive to pathophysiologically impaired BBB. It agrees with contrast agent–based K2 in contrast‐enhancing tissue and indicates sensitivity to subtle leakage. [ABSTRACT FROM AUTHOR]
Copyright of Magnetic Resonance in Medicine is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Label: Title
  Group: Ti
  Data: Noninvasive blood–brain barrier integrity mapping in patients with high‐grade glioma and metastasis by multi–echo time–encoded arterial spin labeling.
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  Data: <searchLink fieldCode="AR" term="%22Hoffmann%2C+Gabriel%22">Hoffmann, Gabriel</searchLink><relatesTo>1,2</relatesTo> (AUTHOR)<i> gabriel.hoffmann@tum.de</i><br /><searchLink fieldCode="AR" term="%22Preibisch%2C+Christine%22">Preibisch, Christine</searchLink><relatesTo>1,2,3</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Günther%2C+Matthias%22">Günther, Matthias</searchLink><relatesTo>4,5,6</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Mahroo%2C+Amnah%22">Mahroo, Amnah</searchLink><relatesTo>4</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22van+Osch%2C+Matthias+J%2E+P%2E%22">van Osch, Matthias J. P.</searchLink><relatesTo>7,8</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Václavů%2C+Lena%22">Václavů, Lena</searchLink><relatesTo>7</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Metz%2C+Marie‐Christin%22">Metz, Marie‐Christin</searchLink><relatesTo>1</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Jung%2C+Kirsten%22">Jung, Kirsten</searchLink><relatesTo>1</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Zimmer%2C+Claus%22">Zimmer, Claus</searchLink><relatesTo>1,2</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Wiestler%2C+Benedikt%22">Wiestler, Benedikt</searchLink><relatesTo>1,9</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Kaczmarz%2C+Stephan%22">Kaczmarz, Stephan</searchLink><relatesTo>1,2,10</relatesTo> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22Magnetic+Resonance+in+Medicine%22">Magnetic Resonance in Medicine</searchLink>. May2025, Vol. 93 Issue 5, p2086-2098. 13p.
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  Data: <searchLink fieldCode="DE" term="%22Spin+labels%22">Spin labels</searchLink><br /><searchLink fieldCode="DE" term="%22Magnetic+resonance+imaging%22">Magnetic resonance imaging</searchLink><br /><searchLink fieldCode="DE" term="%22Receiver+operating+characteristic+curves%22">Receiver operating characteristic curves</searchLink><br /><searchLink fieldCode="DE" term="%22Brain+tumors%22">Brain tumors</searchLink><br /><searchLink fieldCode="DE" term="%22Magnetic+flux+leakage%22">Magnetic flux leakage</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Purpose: In brain tumors, disruption of the blood–brain barrier (BBB) indicates malignancy. Clinical assessment is qualitative; quantitative evaluation is feasible using the K2 leakage parameter from dynamic susceptibility contrast MRI. However, contrast agent–based techniques are limited in patients with renal dysfunction and insensitive to subtle impairments. Assessing water transport times across the BBB (Tex) by multi‐echo arterial spin labeling promises to detect BBB impairments noninvasively and potentially more sensitively. We hypothesized that reduced Tex indicates impaired BBB. Furthermore, we assumed higher sensitivity for Tex than dynamic susceptibility contrast–based K2, because arterial spin labeling uses water as a freely diffusible tracer. Methods: We acquired 3T MRI data from 28 patients with intraparenchymal brain tumors (World Health Organization Grade 3 & 4 gliomas [n = 17] or metastases [n = 11]) and 17 age‐matched healthy controls. The protocol included multi‐echo and single‐echo Hadamard‐encoded arterial spin labeling, dynamic susceptibility contrast, and conventional clinical imaging. Tex was calculated using a T2‐dependent multi‐compartment model. Areas of contrast‐enhancing tissue, edema, and normal‐appearing tissue were automatically segmented, and parameter values were compared across volumes of interest and between patients and healthy controls. Results: Tex was significantly reduced (−20.3%) in contrast‐enhancing tissue compared with normal‐appearing gray matter and correlated well with |K2| (r = −0.347). Compared with healthy controls, Tex was significantly lower in tumor patients' normal‐appearing gray matter (Tex,tumor = 0.141 ± 0.032 s vs. Tex,HC = 0.172 ± 0.036 s) and normal‐appearing white matter (Tex,tumor = 0.116 ± 0.015 vs. Tex,HC = 0.127 ± 0.017 s), whereas |K2| did not differ significantly. Receiver operating characteristic analysis showed a larger area under the curve for Tex (0.784) than K2 (0.604). Conclusion: Tex is sensitive to pathophysiologically impaired BBB. It agrees with contrast agent–based K2 in contrast‐enhancing tissue and indicates sensitivity to subtle leakage. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
  Label:
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  Data: <i>Copyright of Magnetic Resonance in Medicine is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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        Value: 10.1002/mrm.30415
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        Text: English
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              Text: May2025
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