• Hussam Metwali, Mathijs Raemaekers, Tamer Ibrahim, and Amir Samii.
• Kliniken Nordoberpfalz AG, Klinikum Weiden, Department of Neurosurgery, Weiden, Germany. Electronic address: drhussamm@yahoo.com.
• World Neurosurg. 2020 Oct 1; 142: e10-e17.

ObjectiveIn this study we present the nature and characteristic of the fluctuation of blood oxygen level-dependent (BOLD) signals measured from brain tumors.MethodsSupratentorial astrocytomas, which were neither operated nor previously managed with chemotherapy or radiotherapy, were segmented, and the time series of the BOLD signal fluctuations were extracted. The mean (across patients) power spectra were plotted for the different World Health Organization tumor grades. One-way analysis of variance (ANOVA) was performed to identify significant differences between the power spectra of different tumor grades. Results were considered significant at P < 0.05.ResultsA total of 58 patients were included in the study. This group of patients included 1 patient with grade I glioma; 15 with grade II; 12 with grade III; and 30 with grade IV. The power spectra of the tumor time series were individually inspected, and all tumors exhibited high peaks at the lower frequency signals, but these were more pronounced in high-grade tumors. ANOVA showed a significant difference in power spectra between groups (P = 0.000). Post hoc analysis with Bonferroni correction showed a significant difference between grade II and grade III (P = 0.012) and grade IV (P = 0.000). There was no significant power spectra difference between grade III and IV tumors (P = 1).ConclusionsThe power spectra of BOLD signals from tumor tissue showed fluctuations in the low-frequency signals and were significantly correlated with tumor grade. These signals could have a misleading effect when analyzing resting state functional magnetic resonance imaging and could be also viewed as a potential method of tumor characterization.Copyright © 2020 Elsevier Inc. All rights reserved.

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