Non-contrast ASL perfusion rivals DSC-MRI for distinguishing recurrent high-grade glioma from treatment effects

Non-contrast arterial spin labeling (ASL) MRI showed diagnostic performance comparable to DSC perfusion for distinguishing recurrent high-grade glioma from treatment effects; mean AUCs were 0.946 for ASL-only, 0.997 for DSC-only, and 0.997 for combined machine-learning models.

• Retrospective cohort of 63 MRI examinations from 36 adults treated for high-grade glioma, with final diagnosis by histopathology or longitudinal follow-up.
• ASL- and DSC-derived perfusion parameters were significantly higher in recurrence than treatment-related changes (all p<0.001); DSC had the highest accuracy, while ASL provided high specificity.
• In grouped cross-validation, ASL-only, DSC-only, and combined models achieved mean AUCs of 0.946, 0.997, and 0.997; permutation testing gave empirical p=0.002 for the combined model versus chance.

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