Arterial spin labeling for diagnosis, presurgical planning, and postoperative management of meningiomas: A systematic review of the literature

Abstract Background Meningiomas account for approximately 20-30% of primary intracranial tumors. Their diversity of physical characteristics, location, blood supply, histopathology, and recurrence complicate management. Arterial spin labeling (ASL) is a novel MRI sequence to assess tissue perfusion. We performed a systemic review of ASL to evaluate its role in the management of meningiomas. Methods A PubMed database search was employed using the search string (“ASL” OR “arterial spin labeling” OR “arterial-spin labeling” OR “MR perfusion”) AND “meningioma”. Articles were included if they discussed ASL in relation to the diagnosis, treatment, and/or management of adult patients with meningiomas of any grade or subtype. Case reports, hypothetical/animal models, and review articles were excluded. Results Twenty-four texts were included. Meningiomas were found to have a higher normalized tumor blood flow (nTBF) when compared to most metastases. Parasellar and cerebellopontine angle (CPA) meningiomas demonstrate higher nTBF compared to pituitary adenomas and vestibular schwannomas. Current studies investigating ASL in relation to meningioma subtypes/grade are incongruent. ASL signal correlates to angiography and histological vascularity. ASL can predict and monitor radiation effects on meningiomas. Conclusions ASL offers valuable information for both physicians and patients. It can be easily integrated into current practice for evaluation and observation of meningiomas and other CNS pathologies.