Arterial Spin-Labeling and DSC Perfusion Metrics Improve Agreement in Neuroradiologists’ Clinical Interpretations of Posttreatment High-Grade Glioma Surveillance MR Imaging—An Institutional Experience

Example of rater BT-RADS scores in a 61-year-old woman with previously treated GBM and equivocally worsening findings on surveillance MR imaging. The T1 postgadolinium image demonstrates an enhancing lesion in the right temporal lobe. The lesion shows no elevated ASL-CBF or DSC-rCBV, and DSC-FTB shows that the enhancing voxels are in the “low” FTB (blue voxels) category. For two raters, the addition of perfusion metrics to CE-MR imaging resulted in a scoring downgrade from 3b (worsening imaging findings, indeterminate mix of treatment effects and tumor) to 3a (worsening imaging findings, likely treatment effects). For the other raters, perfusion metrics did not influence their assessment. The consensus score in this case was 2 (no change). The discrepancy between the consensus group and the raters was due to differences in opinion as to whether the enhancing lesion had subtly increased in size from the prior MR imaging (not shown).

Clinically meaningful changes in BT-RADS scores following the inclusion of perfusion metrics compared with conventional CE-MR imaging alone. Clinically meaningful upgrades or downgrades were defined as score changes from ≤3a⇆3b or 3b⇆3c/4 and from 3c/4⇆≤3b or 3b⇆≤3a, respectively. The numbers and arrows above the bar graph indicate the number of score upgrades (upward facing arrow) or downgrades (downward facing arrow). The greatest number of score changes was observed with the addition of DSC-FTB.