MR Imaging of Individual Perfusion Reorganization Using Superselective Pseudocontinuous Arterial Spin-Labeling in Patients with Complex Extracranial Steno-Occlusive Disease

Richter, V.; Helle, Michael; Osch, Matthias J.P. van; Lindner, Thomas; Gersing, Alexandra S.; Tsantilas, Pavlos; Eckstein, H.‐H.; Preibisch, Christine; Zimmer, Claus

doi:10.3174/ajnr.a5090

Cited by 21 publications

(17 citation statements)

References 45 publications

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“…Second, configurations of the circle of Willis can vary a great deal among patients and can cause very different collateralization patterns. 15,63 An unilateral CPP decrease in ICAS together with high recruitment of collateral blood flow can cause strong shifts of perfusion territories in the entire brain. 14,63 Consequently, locations of hemodynamic impairments are highly subject specific.…”

Section: Discussionmentioning

confidence: 99%

“…15,63 An unilateral CPP decrease in ICAS together with high recruitment of collateral blood flow can cause strong shifts of perfusion territories in the entire brain. 14,63 Consequently, locations of hemodynamic impairments are highly subject specific. At the same time, different hemodynamic mechanisms are indicated to act at different locations, which complicated the interpretation of individual maps of hemodynamic biomarkers.…”

Section: Discussionmentioning

confidence: 99%

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Hemodynamic impairments within individual watershed areas in asymptomatic carotid artery stenosis by multimodal MRI

Kaczmarz

Göttler

Petr

et al. 2020

J Cereb Blood Flow Metab

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Improved understanding of complex hemodynamic impairments in asymptomatic internal carotid artery stenosis (ICAS) is crucial to better assess stroke risks. Multimodal MRI is ideal for measuring brain hemodynamics and has the potential to improve diagnostics and treatment selections. We applied MRI-based perfusion and oxygenation-sensitive imaging in ICAS with the hypothesis that the sensitivity to hemodynamic impairments will improve within individual watershed areas (iWSA). We studied cerebral blood flow (CBF), cerebrovascular reactivity (CVR), relative cerebral blood volume (rCBV), relative oxygen extraction fraction (rOEF), oxygen extraction capacity (OEC) and capillary transit-time heterogeneity (CTH) in 29 patients with asymptomatic, unilateral ICAS (age 70.3 ± 7.0 y) and 30 age-matched healthy controls. In ICAS, we found significant impairments of CBF, CVR, rCBV, OEC, and CTH (strongest lateralization ΔCVR = –24%), but not of rOEF. Although the spatial overlap of compromised hemodynamic parameters within each patient varied in a complex manner, most pronounced changes of CBF, CVR and rCBV were detected within iWSAs (strongest effect ΔCVR = +117%). At the same time, CTH impairments were iWSA independent, indicating widespread dysfunction of capillary-level oxygen diffusivity. In summary, complementary MRI-based perfusion and oxygenation parameters offer deeper perspectives on complex microvascular impairments in individual patients. Furthermore, knowledge about iWSAs improves the sensitivity to hemodynamic impairments.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Hemodynamic impairments within individual watershed areas in asymptomatic carotid artery stenosis by multimodal MRI

Kaczmarz

Göttler

Petr

et al. 2020

J Cereb Blood Flow Metab

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“…More recently, ASL has been extended to vessel-selective labeling to measure the perfusion territory of individual arteries [10] [11]. The diagnostic capabilities of vesselselective ASL (VS-ASL) have previously been demonstrated in patients with extracranial stenosis and arteriovenous malformation [12] [13]. Additionally, cerebral angiograms have been performed based on VS-ASL to visualize blood supply in the cerebral arteries [14], rendering similar qualitative information on cerebral flow patterns as DSA.…”

Section: Introductionmentioning

confidence: 99%

A combined computational fluid dynamics and MRI Arterial Spin Labeling modeling strategy to quantify patient-specific cerebral hemodynamics in cerebrovascular occlusive disease

Schollenberger

Osborne

Hernandez‐García

et al. 2021

Preprint

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Cerebral hemodynamics in the presence of cerebrovascular occlusive disease (CVOD) are influenced by the anatomy of the intracranial arteries, the degree of stenosis, the patency of collateral pathways, and the condition of the cerebral microvasculature. Accurate characterization of cerebral hemodynamics is a challenging problem. In this work, we present a strategy to quantify cerebral hemodynamics using computational fluid dynamics (CFD) in combination with arterial spin labeling MRI (ASL). First, we calibrated patient-specific CFD outflow boundary conditions using ASL-derived flow splits in the Circle of Willis. Following, we validated the calibrated CFD model by evaluating the fractional blood supply from the main neck arteries to the vascular territories using Lagrangian particle tracking and comparing the results against vessel-selective ASL (VS-ASL). Finally, cerebral hemodynamics were assessed in two patients with CVOD and a healthy control subject. We demonstrated that the calibrated CFD model accurately reproduced the fractional blood supply to the vascular territories, as obtained from VS-ASL. The two patients revealed significant differences in pressure drop over the stenosis, collateral flow, and resistance of the distal vasculature, despite similar degrees of clinical stenosis severity. Our results demonstrated the advantages of a patient-specific CFD analysis for assessing the hemodynamic impact of stenosis.

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“…In the presence of steno-occlusive cerebrovascular disease, vascular territory maps can be used to identify and evaluate collateral flow pathways. 1,2 In cryptogenic stroke, blood supply knowledge of individual arteries to different parts of the brain can help identify the origin of the stroke and guide treatment. 3 The current clinical gold standard for measuring brain vascular territories is digital subtraction angiography, an invasive, nonquantitative procedure that relies on the injection of a contrast agent, which increases the risk of neurologic complications.…”

Section: Introductionmentioning

confidence: 99%

“…Perfusion measurements of vascular territories in the brain offer critical clinical information on cerebrovascular function. In the presence of steno‐occlusive cerebrovascular disease, vascular territory maps can be used to identify and evaluate collateral flow pathways . In cryptogenic stroke, blood supply knowledge of individual arteries to different parts of the brain can help identify the origin of the stroke and guide treatment .…”

Section: Introductionmentioning

confidence: 99%

Practical considerations for territorial perfusion mapping in the cerebral circulation using super‐selective pseudo‐continuous arterial spin labeling

Schollenberger

Figueroa

Nielsen

et al. 2019

Magnetic Resonance in Med

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Purpose: This paper discusses several challenges faced by super-selective pseudo-continuous arterial spin labeling, which is used to quantify territorial perfusion in the cerebral circulation. The effects of off-resonance, pulsatility, vessel movement, and label rotation scheme are investigated, and methods to maximize labeling efficiency and overall image quality are evaluated. A strategy to calculate the territorial perfusion fractions of individual vessels is proposed. Methods: The effects of off-resonance, label rotation scheme, and vessel movement on labeling efficiency were simulated. Two off-resonance compensation strategies (multiphase prescan, field map), cardiac triggering, and vessel movement were studied in vivo in a group of 10 subjects. Subsequently, a territorial perfusion fraction map was acquired in 2 subjects based on the mean vessel labeling efficiency. Results: Multiphase calibration provided the highest labeling efficiency (P = .002) followed by the field map compensation (P = .037) compared with the uncompensated acquisition. Cardiac triggering resulted in a qualitative improvement of the image and an increase in signal contrast between the perfusion territory and the surrounding tissue (P = .010) but failed to show a significant change in temporal and spatial SNR. The constant clockwise label rotation scheme yielded the highest labeling efficiency. Significant vessel movement (>2 mm according to simulations) was observed in 50% of subjects. The measured territorial perfusion fractions showed good agreement with anatomical data. Conclusion: Optimized labeling efficiency resulted in increased image quality and accuracy of territorial perfusion fraction maps. Labeling efficiency depends critically on off-resonance calibration, cardiac triggering, optimal label rotation scheme, and vessel location tracking. K E Y W O R D Sarterial spin labeling, cardiac triggering, labeling efficiency, off-resonance, super-selective, territorial perfusion | 493 SCHOLLENBERGER Et aL.

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MR Imaging of Individual Perfusion Reorganization Using Superselective Pseudocontinuous Arterial Spin-Labeling in Patients with Complex Extracranial Steno-Occlusive Disease

Abstract: BACKGROUND AND PURPOSE:Patients with multiple stenoses or occlusions of the extracranial arteries require an individualized diagnostic approach. We evaluated the feasibility and clinical utility of a novel MR imaging technique for regional perfusion imaging in this patient group.

Cited by 21 publications

References 45 publications

Hemodynamic impairments within individual watershed areas in asymptomatic carotid artery stenosis by multimodal MRI

Hemodynamic impairments within individual watershed areas in asymptomatic carotid artery stenosis by multimodal MRI

A combined computational fluid dynamics and MRI Arterial Spin Labeling modeling strategy to quantify patient-specific cerebral hemodynamics in cerebrovascular occlusive disease

Practical considerations for territorial perfusion mapping in the cerebral circulation using super‐selective pseudo‐continuous arterial spin labeling

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