{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T12:29:37Z","timestamp":1787574577369,"version":"build-2736575974"},"reference-count":27,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T00:00:00Z","timestamp":1787356800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Differentiating high-grade glioma recurrence from treatment-related changes remains challenging on conventional MRI. This study evaluated non-contrast arterial spin labeling (ASL) perfusion MRI for this distinction and compared its performance with dynamic susceptibility contrast (DSC) perfusion MRI. Methods: Postoperative follow-up MRI examinations obtained between November 2019 and May 2021 were retrospectively reviewed. The cohort included 63 MRI examinations from 36 adults treated for high-grade glioma. ASL, routine MRI, and DSC images were independently assessed by two neuroradiologists. Final diagnosis was based on histopathology or longitudinal clinical and imaging follow-up. Reader agreement, diagnostic performance, and an exploratory patient-level grouped machine learning analysis using ASL-only, DSC-only, and combined ASL\u2013DSC features were evaluated. Results: ASL- and DSC-derived perfusion parameters were significantly higher in tumor recurrence than in treatment-related changes (all p &lt; 0.001). Both techniques showed high diagnostic performance; DSC achieved the highest accuracy, whereas ASL provided high specificity across readers. Inter-reader agreement ranged from substantial to almost perfect. In grouped cross-validation, ASL-only, DSC-only, and combined models achieved mean AUCs of 0.946, 0.997, and 0.997, respectively. Permutation testing confirmed that combined-model performance exceeded chance expectations (empirical p = 0.002). Conclusions: Non-contrast ASL perfusion showed diagnostic performance comparable to DSC for differentiating high-grade glioma recurrence from treatment effects. ASL may provide a reliable non-invasive alternative for longitudinal surveillance, particularly when gadolinium administration is undesirable or contraindicated.<\/jats:p>","DOI":"10.3390\/jcm15176505","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T11:47:19Z","timestamp":1787572039000},"page":"6505","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Machine Learning-Based Comparison of Non-Contrast ASL and DSC-MRI Perfusion for Differentiating Recurrent High-Grade Glioma from Treatment Effects"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0547-872X","authenticated-orcid":false,"given":"Seyit","family":"Erol","sequence":"first","affiliation":[{"name":"Department of Radiology, Faculty of Medicine, Selcuk University, Konya 42130, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1141-1094","authenticated-orcid":false,"given":"Halil","family":"\u00d6zer","sequence":"additional","affiliation":[{"name":"Department of Radiology, Faculty of Medicine, Selcuk University, Konya 42130, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2865-9379","authenticated-orcid":false,"given":"Abdussamet","family":"Batur","sequence":"additional","affiliation":[{"name":"Department of Radiology, Faculty of Medicine, Selcuk University, Konya 42130, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehmet Sedat","family":"Durmaz","sequence":"additional","affiliation":[{"name":"Department of Radiology, Faculty of Medicine, Selcuk University, Konya 42130, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6027-874X","authenticated-orcid":false,"given":"Abidin","family":"K\u0131l\u0131n\u00e7er","sequence":"additional","affiliation":[{"name":"Department of Radiology, Faculty of Medicine, Selcuk University, Konya 42130, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8533-4939","authenticated-orcid":false,"given":"Emine","family":"Uysal","sequence":"additional","affiliation":[{"name":"Department of Radiology, Faculty of Medicine, Selcuk University, Konya 42130, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2017-3166","authenticated-orcid":false,"given":"Hakan","family":"Cebeci","sequence":"additional","affiliation":[{"name":"Department of Radiology, Faculty of Medicine, Selcuk University, Konya 42130, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Martucci, M., Russo, R., Giordano, C., Schiarelli, C., D\u2019Apolito, G., Tuzza, L., Lisi, F., Ferrara, G., Schimperna, F., and Vassalli, S. 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