
Purpose The aim of this study was to clarify whether arterial spin labeling (ASL) perfusion imaging can assess biological effects from bevacizumab (BEV) therapy as reliably as PET with 11C-methyl-L-methionine (11C-met-PET). Materials and Methods Twenty-four patients with recurrent glioblastoma were examined using both ASL and 11C-met-PET before and 4 and 8 weeks after starting BEV treatment. Tumor-to-normal brain (T/N) ratios, fluctuations in T/N ratio, and tumor volumes were compared between ASL and 11C-met-PET. Accuracy of predicting patient with long progression-free survival (PFS) was assessed for T/N ratios and fluctuations for ASL and 11C-met-PET in each phase and in each period using receiver operating characteristic curves. Between 2 groups of patients assigned by cutoff values from receiver operating characteristic curves, PFS was compared in each phase or in each period. Results T/N ratios, fluctuations in ratio, and tumor volumes correlated significantly between ASL and 11C-met-PET at all time points and all periods. Arterial spin labeling was eligible as a predictor for long PFS only in assessment of fluctuations in T/N ratio. However, the most accurate predictors for long PFS were T/N ratio from 11C-met-PET at 8 weeks and the fluctuation from baseline to 4 weeks in T/N ratio from 11C-met-PET. Conclusions Blood flows on ASL correlated with accumulations of 11C-met on PET in recurrent glioblastoma under BEV treatment. Although 11C-met-PET offered superior accuracy for predicting patients with long PFS from time points, ASL offered reliable prediction of long PFS, provided that fluctuations in T/N ratio between consecutive scans are assessed.
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