Subtraction of arterial spin-labeling magnetic resonance perfusion images acquired at dual post-labeling delay: Potential for evaluating cerebral hyperperfusion syndrome following carotid endarterectomy

Haga, Sei; Morioka, Takato; Kameda, Katsuharu; Takahara, Kenta; Amano, Toshiyuki; Tomohara, Saori; Takaki, Hayato; Tsurusaki, Yuichiro; Arihiro, Shoji

doi:10.1016/j.jocn.2019.01.044

Cited by 10 publications

(8 citation statements)

References 17 publications

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“…Second, since there is a difference in the velocity of CBF between (peri) ictal and interictal periods[ 22 ] it should always be borne in mind that it may not be possible to obtain a complete subtraction image of CBF on SIACOM, which is susceptible to ATT. [ 1 , 8 - 10 , 19 , 22 , 23 ] However, this possibility was not clearly seen in our four patients. Third, it is practically difficult to obtain interictal ASL data and subsequent SIACOM during and immediately after the initial treatment.…”

Section: Discussionmentioning

confidence: 57%

“…Conversely, in Patient 2, SIACOM clearly revealed that the slight increase in CBF at a PLD of 1.5 s, which was visualized posterior to the lesion, gradually increased in intensity and extent at a PLD of 1.8 s and 2.0 s. ese hemodynamic changes, which could be visualized by taking advantage of the characteristic that ASL is susceptible to arterial transit time (ATT), [1,[8][9][10]19,22,23] indicate a slower blood flow velocity, despite being with structural focal epilepsy. In this case, it is possible that the NCSE was already in the improvement process, since ictal ASL was obtained 1 day after intensive treatment for the epileptic ictus.…”

Section: Discussionmentioning

confidence: 98%

“…To obtain SIACOM, the data from each voxel of the ictal ASL were automatically subtracted from the data from the corresponding voxel of the interictal ASL using a clinically used volume analyzer SYNAPSE VINCENT (Fujifilm, Tokyo, Japan) as previously described. [ 10 , 22 ] In addition, the subtracted ASL images were automatically superimposed on the conventional anatomical MR images, including T1-weighted images (T1WI), T2-weighted images (T2WI), and images with fluid-attenuated inversion recovery sequence (FLAIR). The evaluation of ASL findings was based on visual inspection by a board-certified radiologist (A.T.) and a neurosurgeon (T.S.)…”

Section: Methodsmentioning

confidence: 99%

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Detection of ictal and periictal hyperperfusion with subtraction of ictal-interictal 1.5-Tesla pulsed arterial spin labeling images co-registered to conventional magnetic resonance images (SIACOM)

Abé

Shimogawa

Mukae

et al. 2023

Surgical Neurology International

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Background: Our recent report showed that 1.5-T pulsed arterial spin labeling (ASL) magnetic resonance (MR) perfusion imaging (1.5-T Pulsed ASL [PASL]), which is widely available in the field of neuroemergency, is useful for detecting ictal hyperperfusion. However, the visualization of intravascular ASL signals, namely, arterial transit artifact (ATA), is more remarkable than that of 3-T pseudocontinuous ASL and is easily confused with focal hyperperfusion. To eliminate ATA and enhance the detectability of (peri) ictal hyperperfusion, we developed the subtraction of ictal-interictal 1.5-T PASL images co-registered to conventional MR images (SIACOM). Methods: We retrospectively analyzed the SIACOM findings in four patients who underwent ASL during both (peri) ictal and interictal states and examined the detectability for (peri) ictal hyperperfusion. Results: In all patients, the ATA of the major arteries was almost eliminated from the subtraction image of the ictal-interictal ASL. In patients 1 and 2 with focal epilepsy, SIACOM revealed a tight anatomical relationship between the epileptogenic lesion and the hyperperfusion area compared with the original ASL image. In patient 3 with situation-related seizures, SIACOM detected minute hyperperfusion at the site coinciding with the abnormal electroencephalogram area. SIACOM of patient 4 with generalized epilepsy diagnosed ATA of the right middle cerebral artery, which was initially thought to be focal hyperperfusion on the original ASL image. Conclusion: Although it is necessary to examine several patients, SIACOM can eliminate most of the depiction of ATA and clearly demonstrate the pathophysiology of each epileptic seizure.

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Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 98%

Section: Methodsmentioning

confidence: 99%

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Detection of ictal and periictal hyperperfusion with subtraction of ictal-interictal 1.5-Tesla pulsed arterial spin labeling images co-registered to conventional magnetic resonance images (SIACOM)

Abé

Shimogawa

Mukae

et al. 2023

Surgical Neurology International

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“…We selected another PLD of 2.5 s, in addition to the routinely used PLD of 1.5 sec. [1,8,15,19,20] We reported that 3-T pCASL with dual PLDs of 1.5 s and 2.5 s could demonstrate the hemodynamics of various pathological conditions associated with epilepsy [19] as well as steno-occlusive cerebrovascular disease, [1,7,8] dural arterio-venous fistula, [20] and giant cerebral aneurysm. [15] Herein, we selected a longer PLD of 2.0 s instead of 2.5 s to reduce the T1 shortening effect on 1.5-T PASL.…”

Section: Introductionmentioning

confidence: 97%

Implications and limitations of magnetic resonance perfusion imaging with 1.5-Tesla pulsed arterial spin labeling in detecting ictal hyperperfusion during non-convulsive status epileptics

Goto

Shimogawa

Mukae

et al. 2022

Surgical Neurology International

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Background: Recent our reports showed that 3-T pseudocontinuous arterial spin labeling (3-T pCASL) magnetic resonance perfusion imaging with dual post labeling delay (PLD) of 1.5 and 2.5 s clearly demonstrated the hemodynamics of ictal hyperperfusion associated with non-convulsive status epilepticus (NCSE). We aimed to examine the utility of 1.5-T pulsed arterial spin labeling (1.5-T PASL), which is more widely available for daily clinical use, for detecting ictal hyperperfusion. Methods: We retrospectively analyzed the findings of 1.5-T PASL with dual PLD of 1.5 s and 2.0 s in six patients and compared the findings with ictal electroencephalographic (EEG) findings. Results: In patients 1 and 2, we observed the repeated occurrence of ictal discharges (RID) on EEG. In patient 1, with PLDs of 1.5 s and 2.0 s, ictal ASL hyperperfusion was observed at the site that matched the RID localization. In patient 2, the RID amplitude was extremely low, with no ictal ASL hyperperfusion. In patient 3 with lateralized periodic discharges (LPD), we observed ictal ASL hyperperfusion at the site of maximal LPD amplitude, which was apparent at a PLD of 2.0 s but not 1.5 sec. Among three patients with rhythmic delta activity (RDA) of frequencies <2.5 Hz (Patients 4–6), we observed obvious and slight increases in ASL signals in patients 4 and 5 with NCSE, respectively. However, there was no apparent change in ASL signals in patient 6 with possible NCSE. Conclusion: The detection of ictal hyperperfusion on 1.5-T PASL might depend on the electrophysiological intensity of the epileptic ictus, which seemed to be more prominent on 1.5-T PASL than on 3-T pCASL. The 1.5-T PASL with dual PLDs showed the hemodynamics of ictal hyperperfusion in patients with RID and LPD. However, it may not be visualized in patients with extremely low amplitude RID or RDA (frequencies <2.5 Hz).

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“…Furthermore, Koziak et al found that shorter PLD time (1.2 s) might lead to the overestimation of CBF due to substantial intravascular signal ( Koziak et al, 2008 ). Moreover, Haga et al found that PLD with 1.5 s would lead to an overestimation of the CBF due to the improvement in anterograde ICA perfusion after CEA ( Haga et al, 2019 ). Several hypotheses have been proposed to explain these phenomena: (1) preoperatively, ATT might be prolonged due to the severe stenosis of the feeding arteries and the formation of collateral blood flow, leading to a loss of perfusion signal in which the labeled blood does not arrive between the time of labeling and image acquisition, and finally results in artificially low CBF values ( Calamante et al, 1999 ).…”

Section: Discussionmentioning

confidence: 99%

Perioperative cerebral blood flow measured by arterial spin labeling with different postlabeling delay in patients undergoing carotid endarterectomy: a comparison study with CT perfusion

Xu,

Han,

Liu

et al. 2023

Front. Neurosci.

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BackgroundArterial spin labeling (ASL) is a non-invasive technique for measuring cerebral perfusion. Its accuracy is affected by the arterial transit time. This study aimed to (1) evaluate the accuracy of ASL in measuring the cerebral perfusion of patients who underwent carotid endarterectomy (CEA) and (2) determine a better postlabeling delay (PLD) for pre- and postoperative perfusion imaging between 1.5 and 2.0 s.MethodsA total of 24 patients scheduled for CEA due to severe carotid stenosis were included in this study. All patients underwent ASL with two PLDs (1.5 and 2.0 s) and computed tomography perfusion (CTP) before and after surgery. Cerebral blood flow (CBF) values were measured on the registered CBF images of ASL and CTP. The correlation in measuring perioperative relative CBF (rCBF) and difference ratio of CBF (DRCBF) between ASL with PLD of 1.5 s (ASL1.5) or 2.0 s (ASL2.0) and CTP were also determined.ResultsThere were no significant statistical differences in preoperative rCBF measurements between ASL1.5 and CTP (p = 0.17) and between ASL2.0 and CTP (p = 0.42). Similarly, no significant differences were found in rCBF between ASL1.5 and CTP (p = 0.59) and between ASL2.0 and CTP (p = 0.93) after CEA. The DRCBF measured by CTP was found to be marginally lower than that measured by ASL2.0_1.5 (p = 0.06) and significantly lower than that measured by ASL1.5_1.5 (p = 0.01), ASL2.0_2.0 (p = 0.03), and ASL1.5_2.0 (p = 0.007). There was a strong correlation in measuring perioperative rCBF and DRCBF between ASL and CTP (r = 0.67–0.85, p < 0.001). Using CTP as the reference standard, smaller bias can be achieved in measuring rCBF by ASL2.0 (−0.02) than ASL1.5 (−0.07) before CEA. In addition, the same bias (0.03) was obtained by ASL2.0 and ASL1.5 after CEA. The bias of ASL2.0_2.0 (0.31) and ASL2.0_1.5 (0.32) on DRCBF measurement was similar, and both were smaller than that of ASL1.5_1.5 (0.60) and ASL1.5_2.0 (0.60).ConclusionStrong correlation can be found in assessing perioperative cerebral perfusion between ASL and CTP. During perioperative ASL imaging, the PLD of 2.0 s is better than 1.5 s for preoperative scan, and both 1.5 and 2.0 s are suitable for postoperative scan.

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Subtraction of arterial spin-labeling magnetic resonance perfusion images acquired at dual post-labeling delay: Potential for evaluating cerebral hyperperfusion syndrome following carotid endarterectomy

Cited by 10 publications

References 17 publications

Detection of ictal and periictal hyperperfusion with subtraction of ictal-interictal 1.5-Tesla pulsed arterial spin labeling images co-registered to conventional magnetic resonance images (SIACOM)

Detection of ictal and periictal hyperperfusion with subtraction of ictal-interictal 1.5-Tesla pulsed arterial spin labeling images co-registered to conventional magnetic resonance images (SIACOM)

Implications and limitations of magnetic resonance perfusion imaging with 1.5-Tesla pulsed arterial spin labeling in detecting ictal hyperperfusion during non-convulsive status epileptics

Perioperative cerebral blood flow measured by arterial spin labeling with different postlabeling delay in patients undergoing carotid endarterectomy: a comparison study with CT perfusion

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