Comparing the performance of dynamic susceptibility contrast and arterial spin labeling for detecting residual and recurrent glioblastoma with deep learning and multishell diffusion MRI.

Background: Differentiating recurrent tumor from post-treatment changes remains a major challenge in glioblastoma (GBM) patients. In this work, we compared the performance of 2 different MR perfusion techniques, dynamic susceptibility contrast (DSC), and arterial spin labeling (ASL) to differentiate recurrent tumor and post-treatment changes from the volume of cellular tumor segmented from combined Deep Learning and multimodal MRI measurements, including multishell diffusion and perfusion. Methods: In this retrospective study, 137 MRIs from 107 patients with GBM were analyzed. Cellular tumor maps were segmented by 2 radiologists based on imaging, clinical history, and pathology. Multimodal MRI with perfusion and multishell diffusion were inputted into 5 nnU-Net Deep Learning models using either DSC or ASL with combination of multishell diffusion and standard MRI sequences to segment cellular tumor. Models with DSC and ASL were compared using segmentation performance (Dice score) and accuracy to detect recurrent tumor from post-treatment changes (area under the curve [AUC] under the receiver operating characteristic curve). Results: Segmentation performances were similar in both cases, with a median Dice score of 0.75 (IQR: 0.53-0.84) for ASL and 0.76 (IQR: 0.57-0.84). AUC was 0.88 (CI 0.82-0.94) for ASL and 0.86 (CI, 0.80-0.92) for DSC, and this difference was statistically significant (P < .05, n = 10 000 permutation test). In 11 individual cases, recurring disease was detected with ASL but missed with cerebral blood volume, including recurring tumor in the vicinity of a surgical cavity (n = 5), close to the skull base (n = 1), and adjacent to an Ommaya reservoir (n = 2). Conclusions: Our results demonstrate the utility of ASL in regions where susceptibility artifacts decrease the quality of DSC images.