{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T10:15:40Z","timestamp":1793182540803,"version":"4.5.0"},"reference-count":37,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["23K08503"],"award-info":[{"award-number":["23K08503"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]},{"award":["23K08503"],"award-info":[{"award-number":["23K08503"]}],"id":[{"id":"https:\/\/ror.org\/00hhkn466","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>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 &lt; 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.<\/jats:p>","DOI":"10.3390\/cancers18121926","type":"journal-article","created":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T03:01:27Z","timestamp":1781492487000},"page":"1926","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Arterial Spin Labeling Magnetic Resonance Imaging Can Identify Posterior Fossa Hemangioblastoma: Comparison with Dynamic Susceptibility Contrast"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7090-1662","authenticated-orcid":false,"given":"Takeshi","family":"Hiu","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayano","family":"Ishiyama","sequence":"additional","affiliation":[{"name":"Department of Radiology, Nagasaki University Hospital, Nagasaki 852-8501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minoru","family":"Morikawa","sequence":"additional","affiliation":[{"name":"Department of Radiology, Nagasaki University Hospital, Nagasaki 852-8501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shimpei","family":"Morimoto","sequence":"additional","affiliation":[{"name":"Innovation Platform & Office for Precision Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8523, Japan"},{"name":"Clinical Research Center, Nagasaki University Hospital, Nagasaki 852-8501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayaka","family":"Matsuo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hikaru","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirofumi","family":"Koike","sequence":"additional","affiliation":[{"name":"Department of Radiology, Nagasaki University Hospital, Nagasaki 852-8501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaojing","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiro","family":"Baba","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenta","family":"Ujifuku","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koichi","family":"Yoshida","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryo","family":"Toya","sequence":"additional","affiliation":[{"name":"Department of Radiology, Nagasaki University Hospital, Nagasaki 852-8501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takayuki","family":"Matsuo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Yin, X., Duan, H., Yi, Z., Li, C., Lu, R., and Li, L. (2020). Incidence, prognostic factors and survival for hemangioblastoma of the central nervous system: Analysis based on the surveillance, epidemiology, and end results database. Front. Oncol., 10.","DOI":"10.3389\/fonc.2020.570103"},{"key":"ref_2","first-page":"1","article-title":"Advanced magnetic resonance imaging findings of cerebellar hemangioblastomas: A report of three cases and a literature review","volume":"11","author":"Matsusue","year":"2022","journal-title":"Acta Radiol. Open"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2059","DOI":"10.1016\/S0140-6736(03)13643-4","article-title":"Von Hippel\u2013Lindau disease","volume":"361","author":"Lonser","year":"2003","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1007\/s00401-013-1091-z","article-title":"Nervous system involvement in von Hippel\u2013Lindau disease: Pathology and mechanisms","volume":"125","author":"Vortmeyer","year":"2013","journal-title":"Acta Neuropathol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1007\/s11060-019-03189-w","article-title":"Sporadic and Von-Hippel Lindau disease-associated spinal hemangioblastomas: Institutional experience on their similarities and differences","volume":"143","author":"Yousef","year":"2019","journal-title":"J. Neurooncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1111\/j.1365-2613.2007.00535.x","article-title":"Central nervous system capillary haemangioblastoma: The pathologist\u2019s viewpoint","volume":"88","author":"Hussein","year":"2007","journal-title":"Int. J. Exp. Pathol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1111\/j.1365-2990.2005.00669.x","article-title":"Cellular and reticular variants of haemangioblastoma revisited: A clinicopathologic study of 88 cases","volume":"31","author":"Hasselblatt","year":"2005","journal-title":"Neuropathol. Appl. Neurobiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"6267","DOI":"10.1038\/s41598-020-63207-0","article-title":"Diagnostic challenges of posterior fossa hemangioblastomas: Refining current radiological classification scheme","volume":"10","author":"Kim","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"4334","DOI":"10.1007\/s00330-018-5404-4","article-title":"Arterial spin-labeling is useful for the diagnosis of residual or recurrent meningiomas","volume":"28","author":"Kikuchi","year":"2018","journal-title":"Eur. Radiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1512","DOI":"10.1002\/jmri.29230","article-title":"A convolutional neural network model for distinguishing hemangioblastomas from other cerebellar-and-brainstem tumors using contrast-enhanced MRI","volume":"60","author":"Sheng","year":"2024","journal-title":"J. Magn. Reson. Imaging"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Nabavizadeh, S.A., and Wolf, R.L. (2023). Clinical applications of MR perfusion imaging. Functional Neuroradiology, Springer.","DOI":"10.1007\/978-3-031-10909-6_5"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1148\/radiol.2231010594","article-title":"Intracranial mass lesions: Dynamic contrast-enhanced susceptibility-weighted echo-planar perfusion MR imaging","volume":"223","author":"Cha","year":"2002","journal-title":"Radiology"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Shiroishi, M.S., Jones, J.G.A., Muradyan, N., Lacerda, S., Chen, B.T., Go, J.L., and Law, M. (2014). MR perfusion imaging: ASL, T2*-Weighted DSC, and T1-Weighted DCE Methods. Functional Brain Tumor Imaging, Springer.","DOI":"10.1007\/978-1-4419-5858-7_1"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"E41","DOI":"10.3174\/ajnr.A4341","article-title":"ASFNR recommendations for clinical performance of MR dynamic susceptibility contrast perfusion imaging of the brain","volume":"36","author":"Welker","year":"2015","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1148\/radiology.191.1.8134596","article-title":"Cerebral blood volume maps of gliomas: Comparison with tumor grade and histologic findings","volume":"191","author":"Aronen","year":"1994","journal-title":"Radiology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1148\/radiology.211.3.r99jn46791","article-title":"Glial neoplasms: Dynamic contrast-enhanced T2*-weighted MR Imaging","volume":"211","author":"Knopp","year":"1999","journal-title":"Radiology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1479","DOI":"10.2214\/ajr.171.6.9843274","article-title":"Correlation of MR imaging-determined cerebral blood volume maps with histologic and angiographic determination of vascularity of gliomas","volume":"171","author":"Sugahara","year":"1998","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1097\/00002142-199904000-00004","article-title":"Value of dynamic susceptibility contrast magnetic resonance imaging in the evaluation of intracranial tumors","volume":"10","author":"Sugahara","year":"1999","journal-title":"Top. Magn. Reson. Imaging"},{"key":"ref_19","first-page":"1220","article-title":"Dynamic susceptibility contrast and dynamic contrast-enhanced MRI characteristics to distinguish microcystic meningiomas from traditional Grade I meningiomas and high-grade gliomas","volume":"126","author":"Hussain","year":"2017","journal-title":"J. Neurol. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1844","DOI":"10.3174\/ajnr.A4809","article-title":"Differentiating hemangioblastomas from brain metastases using diffusion-weighted imaging and dynamic susceptibility contrast-enhanced perfusion-weighted MR imaging","volume":"37","author":"She","year":"2016","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"9120","DOI":"10.1007\/s00330-023-09892-7","article-title":"MR dynamic-susceptibility-contrast perfusion metrics in the presurgical discrimination of adult solitary intra-axial cerebellar tumors","volume":"33","year":"2023","journal-title":"Eur. Radiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1097\/RCT.0b013e3181ef77e2","article-title":"Magnetic resonance dynamic susceptibility-weighted contrast-enhanced perfusion imaging in the diagnosis of posterior fossa hemangioblastomas and pilocytic astrocytomas: Initial results","volume":"34","author":"Kumar","year":"2010","journal-title":"J. Comput. Assist. Tomogr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e31708","DOI":"10.1097\/MD.0000000000031708","article-title":"Differentiation of pilocytic astrocytoma, medulloblastoma, and hemangioblastoma on diffusion-weighted and dynamic susceptibility contrast perfusion MRI","volume":"101","author":"Kurokawa","year":"2022","journal-title":"Medicine"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"178","DOI":"10.3174\/ajnr.A8442","article-title":"Comparison of arterial spin-labeling and DSC perfusion MR imaging in pediatric brain tumors: A systematic review and meta-analysis","volume":"46","author":"Vella","year":"2025","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_25","first-page":"859","article-title":"Relative cerebral blood volume maps corrected for contrast agent extravasation significantly correlate with glioma tumor grade, whereas uncorrected maps do not","volume":"27","author":"Boxerman","year":"2006","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e078378","DOI":"10.1136\/bmj-2023-078378","article-title":"TRIPOD+AI statement: Updated guidance for reporting clinical prediction models that use regression or machine learning methods","volume":"385","author":"Collins","year":"2024","journal-title":"BMJ"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"688","DOI":"10.3174\/ajnr.A0903","article-title":"Perfusion imaging of brain tumors using arterial spin-labeling: Correlation with histopathologic vascular density","volume":"29","author":"Noguchi","year":"2008","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2052","DOI":"10.3174\/ajnr.A5363","article-title":"Added value of arterial spin-labeling MR imaging for the differentiation of cerebellar hemangioblastoma from metastasis","volume":"38","author":"Kang","year":"2017","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1007\/s00234-011-0977-5","article-title":"Arterial spin labeling of hemangioblastoma: Differentiation from metastatic brain tumors based on quantitative blood flow measurement","volume":"54","author":"Yamashita","year":"2012","journal-title":"Neuroradiology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1545","DOI":"10.1016\/j.ejrad.2016.05.015","article-title":"Comparison between dynamic susceptibility contrast magnetic resonance imaging and arterial spin labeling techniques in distinguishing malignant from benign brain tumors","volume":"85","author":"Ata","year":"2016","journal-title":"Eur. J. Radiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2432","DOI":"10.3892\/etm.2016.3225","article-title":"Differentiation between recurrent gliomas and radiation necrosis using arterial spin labeling perfusion imaging","volume":"11","author":"Ye","year":"2016","journal-title":"Exp. Ther. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"255","DOI":"10.3174\/ajnr.A6384","article-title":"Effects of Susceptibility Artifacts on Perfusion MRI in Patients with Primary Brain Tumor: A Comparison of arterial Spin-Labeling versus DSC","volume":"41","author":"Maral","year":"2020","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1784","DOI":"10.3174\/ajnr.A8391","article-title":"Arterial spin-labeling perfusion lightbulb sign: An imaging biomarker of pediatric posterior fossa hemangioblastoma","volume":"45","author":"Simsek","year":"2024","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_34","first-page":"155","article-title":"Three-Stage Transfer Learning with AlexNet50 for MRI Image Mul-ti-Class Classification with Optimal Learning Rate","volume":"142","author":"Athisayamani","year":"2025","journal-title":"Comput. Model. Eng. Sci."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1002\/(SICI)1097-0258(19960229)15:4<361::AID-SIM168>3.0.CO;2-4","article-title":"Multivariable prognostic models: Issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors","volume":"15","author":"Harrell","year":"1996","journal-title":"Stat. Med."},{"key":"ref_36","unstructured":"Morimoto, S. (2026, May 29). makedatar: Load and Prepare Clinical Trial Data from Column-Info Excel Workbooks (Version 0.1.0). GitHub Repository, 2026. Available online: https:\/\/github.com\/Shimpeim\/makedatar."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"837","DOI":"10.2307\/2531595","article-title":"Comparing the areas under two or more correlated receiver operating characteristic curves: A nonparametric approach","volume":"44","author":"DeLong","year":"1988","journal-title":"Biometrics"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/12\/1926\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T04:11:12Z","timestamp":1781842272000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/12\/1926"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,12]]},"references-count":37,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["cancers18121926"],"URL":"https:\/\/doi.org\/10.3390\/cancers18121926","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,12]]}}}