Arterial Spin Labeling MRI in Carotid Stenosis: Arterial Transit Artifacts May Predict Symptoms

Napoli, A. Di; Cheng, Suk Fun; Gregson, John; Atkinson, David; Markus, Julia; Richards, Toby; Brown, Martin M.; Sokolska, Magdalena; Jäger, Hans Rolf

doi:10.1148/radiol.2020200225

Cited by 29 publications

(18 citation statements)

References 38 publications

(46 reference statements)

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“…Later study revealed that vessel‐encoded arterial spin labeling (VEPCASL) could achieve collateral perfusion and delayed blood arrival information noninvasively and serially in AIS patients, which information was proved to be related to tissue survival 26 . In previous studies, ATA in ASL images has been proved to be associated with recent ischemic symptoms in patients with carotid stenosis 8 . Notably, ATA can attenuate the association between ASL perfusion defects and ipsilateral early ischemic recurrence in patients with DWI‐negative transient ischemic attacks 6 .…”

Section: Discussionmentioning

confidence: 99%

“…26 In previous studies, ATA in ASL images has been proved to be associated with recent ischemic symptoms in patients with carotid stenosis. 8 Notably, ATA can attenuate the association between ASL perfusion defects and ipsilateral early ischemic recurrence in patients with DWI-negative transient ischemic attacks. 6 In recent study, the presence of collaterals blood vessels, defined as ATA in ASL images, was observed to be associated with admission NIHSS score and lower median mRS scores at discharge.…”

Section: Ta B L E 3 Performance Of Classifiersmentioning

confidence: 99%

“…One of the dominant applications is in cerebrovascular diseases like stroke and moyamoya disease. 8,9 ASL was used to quantify serial CBF, visualize distal cerebral arteries and collateral vessels, evaluate revascularization, and even predict symptoms or prognosis in these studies. 6,10,11 ASL can be employed to assess collaterals, via territorial spin labeling or arterial transit artifact (ATA).…”

Section: Introductionmentioning

confidence: 99%

“…As the techniques developed in the past several years, ASL has gained popularity in clinic and biomedical research. One of the dominant applications is in cerebrovascular diseases like stroke and moyamoya disease 8,9 . ASL was used to quantify serial CBF, visualize distal cerebral arteries and collateral vessels, evaluate revascularization, and even predict symptoms or prognosis in these studies 6,10,11 .…”

Section: Introductionmentioning

confidence: 99%

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Collateral circulation detected by arterial spin labeling predicts outcome in acute ischemic stroke

Liu

Fan

Zang

et al. 2022

Acta Neuro Scandinavica

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Background: Robust collateral circulation is strongly associated with good outcomes in acute ischemic stroke (AIS).Aims: To determine whether collateral circulation detected by arterial spin labeling (ASL) magnetic resonance imaging could predict good clinical outcome in AIS patients with 90 days follow-up. Materials and Methods:Total 58 AIS patients with anterior circulation stroke were recruited. Collateral circulation was defined as arterial transit artifact in ASL images.Modified Rankin Scale (mRS), the Barthel Index, and National Institutes of Health Stroke Scale (NIHSS) were employed to evaluate neurological function for the baseline and 90 days follow-up. The percent changes of these scores were also calculated, respectively. Finally, a support vector classifier model of machine learning and receiver operating characteristic curve were employed to estimate the power of ASL collaterals (ASLcs) predicting the clinical outcome.Results: Patients with ASLcs represented higher rate of good outcome (83.30% vs. 31.25%, p < .001) and lower follow-up mRS scores (p < .001), when compared to patients without ASLcs. There were significant differences for percent changes of mRS scores and NIHSS scores between these two groups. Further, the presence of ASLcs could predict good clinical outcome (OR, 1.54; 95% CI, 1.10-2.16), even after controlling for baseline NIHSS scores. The SVC model incorporating baseline NIHSS scores and ASLcs had significant predictive effect (accuracy, 79.3%; AUC, 0.806) on clinical prognosis for AIS patients.Discussion: We targeted on the non-invasive assessment of collateral circulation using ASL technique and found that patients with ASLcs were more likely to have a good clinical outcome after AIS. This finding is of guiding significance for treatment selection and prognostic prediction. Conclusions:Early ASLcs assessment provides a good powerful tool to predict clinical outcome for AIS patients with 90 days follow-up.

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Section: Discussionmentioning

confidence: 99%

Section: Ta B L E 3 Performance Of Classifiersmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Collateral circulation detected by arterial spin labeling predicts outcome in acute ischemic stroke

Liu

Fan

Zang

et al. 2022

Acta Neuro Scandinavica

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“…An incomplete circle of Willis was defined if any of the three arterial segments was absent or hypoplastic (<0.8 mm in diameter) ( 27 ). Since the presence of posterior communicating artery had little effect on cerebral hemodynamics and clinical symptoms ( 28 ), posterior circulation arterial segments were not included.…”

Section: Methodsmentioning

confidence: 99%

Cerebral Small Vessel Disease Burden Related to Carotid Intraplaque Hemorrhage Serves as an Imaging Marker for Clinical Symptoms in Carotid Stenosis

et al. 2021

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Objectives: In patients with carotid stenosis, to investigate the relationship between carotid intraplaque hemorrhage (IPH) and total burden of cerebral small vessel disease (CSVD) and preliminarily explore whether the total CSVD burden as an imaging marker can distinguish the severity of clinical symptoms.Methods: A total of 108 patients (the mean age was 66 ± 7 years, and 85.2% were male) with unilateral carotid stenosis ≥50% underwent brain MRI and high-resolution MRI for carotid plaque characterization. The total burden of CSVD was calculated by accumulating one point according to the presence or severity of each of the four MRI markers: white matter hyperintensities, lacunes, perivascular spaces, and cerebral microbleeds. Recent clinical symptoms including transient ischemic attack, amaurosis fugax, and ischemic stroke were recorded. The association between intraplaque hemorrhage (IPH) and total CSVD burden was examined adjusted for other risk factors. The symmetry of CSVD burdens between the ipsilateral and contralateral hemispheres of IPH was tested. Imaging features (CSVD score, IPH, degree of stenosis, and completeness of the circle of Willis) were correlated with clinical symptoms by Kruskal–Wallis H test, Chi-square test, and Fisher's exact test.Results: Multivariable logistic regression analysis showed that IPH (OR = 2.98, 95% CI [1.39, 6.40], p = 0.005) was independently associated with a higher CSVD score. The presence of unilateral IPH was associated with the inter-hemispheric CSVD score difference (p = 0.004). Patients with stroke had a higher ipsilateral CSVD score than asymptomatic patients (p = 0.004) and those with transient ischemic attack/amaurosis fugax (p = 0.008). The statistical difference was marginally significant between symptoms and IPH (p = 0.057). No statistical difference was found between the symptoms and degree of stenosis and the completeness of the circle of Willis (p > 0.05).Conclusions: Carotid IPH is associated with an elevated total burden of CSVD in patients with carotid stenosis. Compared with the degree of stenosis, primary collaterals, and IPH, the total CSVD score might be a more effective imaging marker linked with clinical symptoms.

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Current state and guidance on arterial spin labeling perfusion MRI in clinical neuroimaging

Lindner

Bolar

Achten

et al. 2023

Magnetic Resonance in Med

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This article focuses on clinical applications of arterial spin labeling (ASL) and is part of a wider effort from the International Society for Magnetic Resonance in Medicine (ISMRM) Perfusion Study Group to update and expand on the recommendations provided in the 2015 ASL consensus paper. Although the 2015 consensus paper provided general guidelines for clinical applications of ASL MRI, there was a lack of guidance on disease-specific parameters. Since that time, the clinical availability and clinical demand for ASL MRI has increased. This position paper provides guidance on using ASL in specific clinical scenarios, including acute ischemic stroke and steno-occlusive disease, arteriovenous malformations and fistulas, brain tumors, neurodegenerative disease, seizures/epilepsy, and pediatric neuroradiology applications, focusing on disease-specific considerations for sequence optimization and interpretation. We present several neuroradiological applications in which ASL provides unique information essential for making the diagnosis. This guidance is intended for anyone interested in using ASL in a routine clinical setting (i.e., on a single-subject basis rather than in cohort studies) building on the previous ASL consensus review.

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Arterial Spin Labeling MRI in Carotid Stenosis: Arterial Transit Artifacts May Predict Symptoms

Cited by 29 publications

References 38 publications

Collateral circulation detected by arterial spin labeling predicts outcome in acute ischemic stroke

Collateral circulation detected by arterial spin labeling predicts outcome in acute ischemic stroke

Cerebral Small Vessel Disease Burden Related to Carotid Intraplaque Hemorrhage Serves as an Imaging Marker for Clinical Symptoms in Carotid Stenosis

Current state and guidance on arterial spin labeling perfusion MRI in clinical neuroimaging

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