Clinical value of arterial spin labeling in detecting cerebral blood flow in children with pilocytic astrocytoma，hemangioblastoma and medulloblastoma

doi:10.3877/cma.j.issn.1673-5250.2025.01.008

Objective

To explore the application value of arterial spin labeling（ASL）in detecting cerebral blood flow（CBF）in children with three common intracranial tumors，namely pilocytic astrocytoma（PA），hemangioblastoma（HB），and medulloblastoma（MB）.

Methods

A total of 35 children who underwent surgical treatment in Chinese PLA General Hospital from April 2015 to July 2024 and were diagnosed with PA，HB，or MB by histopathological examination of the surgically resected tissues were selected as the research subjects.They were included into the PA group （n=10），HB group ^（n=12），and MB group ^（n=13）by retrospective analysis method.Before surgical treatment，all children in three groups underwent plain MRI scan，enhanced MRI scan，and 3D ASL imaging.The CBF values of the tumor parenchyma，proximal peritumoral area （within 1 cm from the enhanced edge of the tumor），and distal peritumoral area（more than 1 cm from the enhanced edge of the tumor）were measured in the three groups.One-way ANOVA and Kruskal-Wallis H rank sum test were used to statistically compare the CBF values of the tumor parenchyma，proximal and distal peritumoral areas among the three groups.The study protocol complied with the WorldMedical AssociationDeclarationofHelsinki revised in 2013.

Results

In PA group，HB group，and MB group，the median CBF values of the tumor parenchyma were 59.1，255.7，and 32.1 mL/（100 g·min），respectively，and the CBF values of the proximal peritumoral area were（62.3±30.0），（196.3±113.6），and（39.6±17.5）m L/（100 g·min），respectively，and the median CBF values of the distal peritumoral area were 59.2，112.2，and 33.1 m L/（100 g· min），respectively.There were statistically significant differences in the overall comparison of the CBF values of the tumor parenchyma，proximal and distal peritumoral areas among three groups （χ²=25.51，P＜0.001；F=18.00，P＜0.001； χ²=15.26，P＜0.001）.The results of further pairwise comparison showed that the CBF values of the tumor parenchyma and proximal peritumoral area in the HB group were significantly higher than those in PA group and MB group，and the differences were statistically significant（CBF values of the tumor parenchyma：Z=-3.56，-4.13，both P ＜0.001；CBF values of the proximal peritumoral area：both P ＜0.001）.The CBF values of the distal peritumoral area in PA group and HB group were significantly higher than those in MB group，and the differences were statistically s ignificant （P=0.009，＜0.001）.

Conclusions

ASL is a perfusion weight imaging technique，which can quantitatively evaluate the CBF values of three common intracranial tumors such as PA，HB，and MB，providing an auxiliary reference for the clinical differential diagnosis of PA，HB，and MB.

Key words: Magnetic resonance imaging, Arterial spin labeling, Cerebellar neoplasms, Pilocytic astrocytoma, Medulloblastoma, Hemangioblastoma, Child

图1 本研究PA、HB、MB患儿颅脑MRI图像［图1A～1C分别为1例小脑蚓部MB患儿（男性，2岁）颅脑MRI T2WI平扫、T1WI增强扫描和ASL图像，ASL图像显示MB肿瘤病灶呈较低灌注，CBF值为49.2 m L/（100 g·min）；图1D～1F分别为1例小脑半球PA 患儿（男性，15岁）颅脑MRI T2WI平扫、T1WI增强扫描和ASL 图像，ASL 图像显示PA 肿瘤病灶呈低灌注，CBF值为24.2 m L/（100 g·min）；图1G～1I分别为1例右侧小脑半球HB患儿（女性，6岁）颅脑MRI T2WI平扫、T1WI增强扫描和ASL图像，ASL图像显示HB肿瘤病灶呈明显高灌注，CBF值为237.6 m L/（100 g·min）］注：MB为髓母细胞瘤，PA 为毛细胞型星形细胞瘤，HB为血管母细胞瘤。ASL为动脉自旋标记，CBF为脑血流量

表1 本研究PA 组、HB 组、MB 组患儿肿瘤实质CBF 值比较［m L/（100 g·min），M（Q₁，Q₃）］

组别	例数	CBF值
PA组	10	59.1（37.3，96.0）
HB组	12	255.7（207.7，353.4）
MB组	13	32.1（27.0，46.5）
总体比较（χ²值/P值）		21.51/＜0.001
两两比较（Z 值/P值）
PA组vs HB组		-3.56/＜0.001
PA组vs MB组		-1.43/0.154
HB组vs MB组		-4.13/＜0.001

表1 本研究PA 组、HB 组、MB 组患儿肿瘤实质CBF 值比较［m L/（100 g·min），M（Q₁，Q₃）］

组别	例数	CBF值
PA组	10	59.1（37.3，96.0）
HB组	12	255.7（207.7，353.4）
MB组	13	32.1（27.0，46.5）
总体比较（χ²值/P值）		21.51/＜0.001
两两比较（Z 值/P值）
PA组vs HB组		-3.56/＜0.001
PA组vs MB组		-1.43/0.154
HB组vs MB组		-4.13/＜0.001

表2 本研究PA 组、HB组、MB组患儿近侧瘤周区CBF值比较［mL/（100 g·min），±s］

组别	例数	CBF值
PA组	10	62.3±30.0
HB组	12	196.3±113.6
MB组	13	39.6±17.5
总体比较（F值/P值）		18.00/＜0.001
两两比较（P值）^a
PA组vs HB组		＜0.001
PA组vs MB组		0.441
HB组vs MB组		＜0.001

表2 本研究PA 组、HB组、MB组患儿近侧瘤周区CBF值比较［mL/（100 g·min），±s］

组别	例数	CBF值
PA组	10	62.3±30.0
HB组	12	196.3±113.6
MB组	13	39.6±17.5
总体比较（F值/P值）		18.00/＜0.001
两两比较（P值）^a
PA组vs HB组		＜0.001
PA组vs MB组		0.441
HB组vs MB组		＜0.001

表3 本研究PA 组、HB组、MB组患儿远侧瘤周区CBF值比较［mL/（100 g·min），M（Q₁，Q₃）］

组别	例数	CBF值
PA组	10	59.2（50.2，68.8）
HB组	12	112.2（61.2，171.6）
MB组	13	33.1（20.1，46.5）
总体比较（χ²值/P值）		15.26/＜0.001
两两比较（Z值/P值）
PA组vs HB组		-1.91/0.056
PA组vs MB组		-2.61/0.009
HB组vs MB组		-3.48/＜0.001

表3 本研究PA 组、HB组、MB组患儿远侧瘤周区CBF值比较［mL/（100 g·min），M（Q₁，Q₃）］

组别	例数	CBF值
PA组	10	59.2（50.2，68.8）
HB组	12	112.2（61.2，171.6）
MB组	13	33.1（20.1，46.5）
总体比较（χ²值/P值）		15.26/＜0.001
两两比较（Z值/P值）
PA组vs HB组		-1.91/0.056
PA组vs MB组		-2.61/0.009
HB组vs MB组		-3.48/＜0.001

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