Cerebrovascular Occlusive Disease: Quantitative Cerebral Blood Flow Using Dynamic Susceptibility Contrast MR Imaging Correlates with Quantitative H₂[¹⁵O] PET

Abstract

Purpose:To compare quantitative values of cerebral blood flow (CBF) derived from dynamic susceptibility contrast (DSC) magnetic resonance (MR) imaging with reference standard positron emission tomography (PET) in patients with confirmed cerebrovascular occlusive disease. Materials and Methods:Local institutional review board approval and informed consent were obtained for a prospective study of 18 patients (six men, 12 women; age range, 28-71 years; mean age, 45 years 6 10.4 [standard deviation]) with angiographically confirmed Moyamoya (n = 8) or internal carotid artery occlusions (n = 10). DSC MR images and oxygen 15-labeled water (H 2 [15 O]) PET images were acquired on the same day. DSC images were postprocessed to yield parametric images of CBF (in mL/100 g/min), coregistered, and analyzed using grid-based regions of interest. Mean values of CBF in each region of interest from MR imaging and PET data sets were compared. Correlations for each patient were determined and overall agreement between pooled MR imaging and PET CBF was reported using linear regression analysis and Bland-Altman plots. Results:Strong correlations (r 2  0.55) were found between MR imaging and PET CBF values in all patients. Use of the bookend approach was found to underestimate CBF predictably across the patient cohort (mean slope, 0.82; standard deviation, 0.18; slope of aggregated data, 0.75). This allowed for a simple rescaling of MR imaging values producing strong agreement with PET values in the aggregated data (r 2 = 0.66; slope = 1.00; intercept = 0.00). Conclusion:The

Evaluation of 4D Vascular Flow and Tissue Perfusion in Cerebral Arteriovenous Malformations: Influence of Spetzler-Martin Grade, Clinical Presentation, and AVM Risk Factors

“…The perfusion method used in this study has been successfully applied in the evaluation of brain tumor, 10 but it was only validated against the reference standard (PET) for gradient-echo PWI. 28 In addition, a wide variability in contralateral white matter CBF values was reported in the presence of vascular pathology. 29 Thus, we were cautious to use the values in our study as quantitative perfusion measurement in cerebral AVMs without further validation.…”

Regional Frontal Perfusion Deficits in Relapsing-Remitting Multiple Sclerosis with Cognitive Decline

“…15 Briefly, these Look-Locker EPI scans allow for DSC calibration, independent of an arterial input function, by quantifying WM T1 signal changes relative to blood pool to calculate the steady state CBV in WM using a water-correction factor to correct for intra- to extravascular water exchange. Deconvolution of tissue concentration-time curves by the arterial input function using singular value decomposition yields the rCBF while rCBV is determined by calculating the ratio of the area under the tissue-concentration-time curve and the arterial input function.…”

“…By using pre- and post-gadolinium scans to calibrate DSC, the bookend technique offers accurate cerebral perfusion quantification with high PET correlation and inter-observer reliability. 14,15 …”

Spatial Correlation of Pathology and Perfusion Changes within the Cortex and White Matter in Multiple Sclerosis

“…Quantitative CBF (ml/100g/min), quantitative CBV (ml/100g), and MTT (seconds) were obtained using Bookend MRI perfusion as previously published 17 . The technique uses pre- and post-gadolinium ‘bookend’ scans to calculate WM quantitative CBV without need for an arterial input function while accounting for the effects of intravascular-to-extravascular water exchange.…”