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Arterial Spin Labeling Magnetic Resonance Imaging Can Identify Posterior Fossa Hemangioblastoma: Comparison with Dynamic Susceptibility Contrast
by
,
Takeshi Hiu
1,*
,
Ayano Ishiyama
2,
Minoru Morikawa
2,
Shimpei Morimoto
3,4,
Ayaka Matsuo
1,
Hikaru Nakamura
1,
Hirofumi Koike
2,
Yaojing Lin
1,
Shiro Baba
1,
Kenta Ujifuku
1,
Koichi Yoshida
1,
Ryo Toya
2 and
Takayuki Matsuo
1 1
Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan
2
Department of Radiology, Nagasaki University Hospital, Nagasaki 852-8501, Japan
3
Innovation Platform & Office for Precision Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8523, Japan
4
Clinical Research Center, Nagasaki University Hospital, Nagasaki 852-8501, Japan
*
Author to whom correspondence should be addressed.
Cancers 2026, 18(12), 1926; https://doi.org/10.3390/cancers18121926 (registering DOI)
Submission received: 18 April 2026
/
Revised: 27 May 2026
/
Accepted: 6 June 2026
/
Published: 12 June 2026
(This article belongs to the Special Issue Advances in Neuro-Oncological Imaging (2nd Edition))
Simple Summary
Hemangioblastomas are benign World Health Organization grade I vascular central nervous system tumors that arise sporadically or as manifestations of von Hippel–Lindau disease. This study investigated the utility of arterial spin labeling, a noninvasive magnetic resonance imaging technique, compared with dynamic susceptibility contrast imaging-derived metrics for differentiating hemangioblastomas from other types of posterior fossa brain tumors. Across two adult patient cohorts, hemangioblastomas consistently showed much higher blood flow than non-hemangioblastoma tumors. Among several imaging measures, including regional cerebral blood flow, regional and corrected cerebral blood volume, and permeability index values, arterial spin labeling-derived perfusion showed the strongest diagnostic performance, with very high sensitivity and specificity. Arterial spin labeling imaging may help identify highly vascular tumors, such as hemangioblastomas, without the need for contrast agents, making it a useful and noninvasive tool for improving diagnosis and supporting clinical decision-making in patients with posterior fossa brain tumors.
Abstract
Background/Objectives: Diagnosing hemangioblastomas using magnetic resonance imaging (MRI) is challenging, especially when the tumors appear as solid posterior fossa masses. This study aimed to evaluate the diagnostic performance of perfusion MRI and identify the most useful quantitative features for differentiating hemangioblastomas from other posterior fossa tumors. Methods: Forty-five posterior fossa tumors were analyzed, including 18 hemangioblastomas (HB group) and 27 non-hemangioblastoma tumors (NHB group; 8 metastatic brain tumors, 6 pilocytic astrocytomas, 5 malignant lymphomas, 4 glioblastomas, 2 medulloblastomas, and 2 other tumors). All patients underwent 3.0-T MRI. Arterial spin labeling (ASL) was used to calculate the relative tumor blood flow normalized to the contralateral gray matter. Dynamic susceptibility contrast (DSC) imaging was used to obtain regional cerebral blood flow, regional and corrected cerebral blood volume (CBV), and permeability index (K2) values. Regions of interest (ROIs) were placed within the contrast-enhancing areas. Results: The relative ASL values and corrected CBV were significantly higher in hemangioblastomas than in other tumors (p < 0.001). Relative ASL showed the highest diagnostic performance (sensitivity, 100%; specificity, 93.3%). Conclusions: Non-contrast ASL showed strong diagnostic performance for identifying posterior fossa hemangioblastomas and may serve as a practical alternative to contrast-enhanced DSC, although ROI placement can be challenging in very small mural nodules.
