Improved Visibility of Diffuse Gliomas using Multi-delay Pseudo-continuous ASL with a Variable-TR Scheme

Motivation: The multi-delay ASL-cerebral blood flow (CBF) offers superior diagnostic performance compared to single-delay ASL-CBF for glioma grading. Furthermore, arterial transit time (ATT) and dynamic signal intensity (SI) changes may also be key factors in differentiating diffuse gliomas. Goal(s): To determine if time-intensity profiles with multi-delay ASL could distinguish among diffuse gliomas. Approach: The SI peak time was obtained based on the time-intensity curve. The SI peak time and ATT were compared between diffuse gliomas with IDH-wildtype and IDH-mutant. Results: IDH-wildtype gliomas showed a shorter SI peak time than with IDH-mutant gliomas. IDH-mutant astrocytomas show longer ATT than IDH-wildtype gliomas. Impact: The multi-delay PCASL with a variable-TR technique facilitates the identification of increased blood flow regions in diffuse gliomas at the optimal timing. New insights related to dynamic parameters play a vital role in the diagnosis and treating adult-type diffuse gliomas.