ASL radiomics rivals DSC-enhanced MRI to differentiate radiation brain injury from glioma recurrence

ASL perfusion radiomics AUC 0.955 in validation for distinguishing radiation brain injury from glioma recurrence, comparable to combined conventional+DSC (0.960). Suggests non-contrast alternative. Single-center retrospective study needs validation.

• Retrospective single-center study with 131 patients for training and 37 for independent validation, all pathologically confirmed diffuse gliomas post-radiotherapy.
• In validation, ASL-CBF radiomics alone achieved AUC 0.955, outperforming DSC-rCBF alone (AUC 0.887) and conventional MRI (AUC 0.720), while combined conventional+DSC reached 0.960.
• Major limitations: small validation cohort (n=37), single-center design, retrospective nature; findings require prospective multi-center validation.

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