The Value of Arterial Spin-Labeled Perfusion Imaging in Acute Ischemic Stroke

Wang, Danny J.J.; Alger, Jeffry R.; Qiao, Jian-Hua; Hao, Qing; Hou, Samuel Y; Fiaz, Rana; Günther, Matthias; Pope, Whitney B.; Saver, Jeffrey L.; Salamon, Noriko; Liebeskind, David S

doi:10.1161/strokeaha.111.631929

Cited by 150 publications

(79 citation statements)

References 23 publications

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“…if the use of contrast agent needs to be avoided. The high correlation between ASL and DSC we found is in concordance with a report in the literature showing correlation coefficients between ASL and DSC of 0.62-0.79 in patients with acute ischemic stroke [28]. The values of quantitative CBF we found were significantly higher in territories with qualitatively normal perfusion, compared to those with reduced perfusion (49.6 ± 8.0 ml x 100g -1 x min -1 vs. 37.1 ± 18.8 ml x 100g -1 x min -1 ; p < 0.001).…”

Section: Discussionsupporting

confidence: 93%

Arterial spin labelling MRI for assessment of cerebral perfusion in children with moyamoya disease: comparison with dynamic susceptibility contrast MRI

et al. 2013

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INTRODUCTION:This study seeks to evaluate the diagnostic accuracy of cerebral perfusion imaging with arterial spin labelling (ASL) MR imaging in children with moyamoya disease compared to dynamic susceptibility contrast (DSC) imaging. METHODS: Ten children (7 females; age, 9.2 ± 5.4 years) with moyamoya disease underwent cerebral perfusion imaging with ASL and DSC on a 3-T MRI scanner in the same session. Cerebral perfusion images were acquired with ASL (pulsed continuous 3D ASL sequence, 32 axial slices, TR = 5.5 s, TE = 25 ms, FOV = 24 cm, matrix = 128 × 128) and DSC (gradient echo EPI sequence, 35 volumes of 28 axial slices, TR = 2,000 ms, TE = 36 ms, FOV = 24 cm, matrix = 96 × 96, 0.2 ml/kg Gd-DOTA). Cerebral blood flow maps were generated. ASL and DSC images were qualitatively assessed regarding perfusion of left and right ACA, MCA, and PCA territories by two independent readers using a 3-point-Likert scale and quantitative relative cerebral blood flow (rCBF) was calculated. Correlation between ASL and DSC for qualitative and quantitative assessment and the accuracy of ASL for the detection of reduced perfusion per territory with DSC serving as the standard of reference were calculated. RESULTS: With a good interreader agreement ( = 0.62) qualitative perfusion assessment with ASL and DSC showed a strong and significant correlation ( = 0.77; p < 0.001), as did quantitative rCBF (r = 0.79; p < 0.001). ASL showed a sensitivity, specificity and accuracy of 94 %, 93 %, and 93 % for the detection of reduced perfusion per territory. CONCLUSION: In children with moyamoya disease, unenhanced ASL enables the detection of reduced perfusion per vascular territory with a good accuracy compared to contrast-enhanced DSC. Methods: 10 children (7 females, age: 9.2±5.4years) with moyamoya disease underwent cerebral perfusion imaging with ASL and DSC on a 3T MRI scanner in the same session.Cerebral perfusion images were acquired with ASL (pulsed continuous 3D ASL sequence, 32 axial slices, TR=5.5s, TE=25ms, FOV=24cm, matrix=128x128) and DSC (gradient echo EPI sequence, 35 volumes of 28 axial slices, TR=2000ms, TE=36ms, FOV=24cm, matrix=96x96, 0.2ml/kg Gd-DOTA). Cerebral blood flow maps were generated. ASL and DSC images were qualitatively assessed regarding perfusion of left and right ACA, MCA and PCA territories by two independent readers using a 3-point-Likert scale and quantitative relative cerebral blood flow (rCBF) was calculated. Correlation between ASL and DSC for qualitative and quantitative assessment and the accuracy of ASL for the detection of reduced perfusion per territory with DSC serving as the standard of reference were calculated.Results: With a good interreader agreement (k=0.62) qualitative perfusion assessment with ASL and DSC showed a strong and significant correlation (ρ = 0.77; p<0.001), as did quantitative rCBF (r=0.79; p<0.001). ASL showed a sensitivity, specificity and accuracy of 94%, 93% and 93% for the detection of reduced perfusion per territory. Conclusion:In children with moyamoya dis...

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Section: Discussionsupporting

confidence: 93%

Arterial spin labelling MRI for assessment of cerebral perfusion in children with moyamoya disease: comparison with dynamic susceptibility contrast MRI

et al. 2013

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“…In a direct quantitative comparison to DSC-MRI in 24 acute stroke patients, arterial transit time on multidelay arterial spin labeling maps was moderately correlated with Tmax (r=0.66) and MTT (r=0.59). 23 BOLD delay showed comparable correlations with DSC-MRI in our study (with Tmax, r=0.60; and MTT, r=0.50). Directly comparing the diagnostic performances of BOLD delay and arterial spin labeling for detecting hypoperfusion in acute stroke could provide useful information about their relative merits.…”

Section: Discussionsupporting

confidence: 82%

Relationship Between Changes in the Temporal Dynamics of the Blood-Oxygen-Level-Dependent Signal and Hypoperfusion in Acute Ischemic Stroke

Khalil

Ostwaldt

Nierhaus

et al. 2017

Stroke

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Background and Purpose-Changes in the blood-oxygen-level-dependent (BOLD) signal provide a noninvasive measure of blood flow, but a detailed comparison with established perfusion parameters in acute stroke is lacking. We investigated the relationship between BOLD signal temporal delay and dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) in stroke patients. Methods-In 30 patients with acute (<24 hours) ischemic stroke, we performed Pearson correlation and multiple linear regression between DSC-MRI parameters (time to maximum [Tmax], mean transit time, cerebral blood flow, and cerebral blood volume) and BOLD-based parameters (BOLD delay and coefficient of BOLD variation). Prediction of severe hypoperfusion (Tmax >6 seconds) was assessed using receiver-operator characteristic (ROC) analysis. Results-Correlation was highest between Tmax and BOLD delay (venous sinus reference; time shift range 7; median r=0.60; interquartile range=0.49-0.71). Coefficient of BOLD variation correlated with cerebral blood volume (median r= 0.37; interquartile range=0.24-0.51). Mean R 2 for predicting BOLD delay by DSC-MRI was 0.54 (SD=0.2) and for predicting coefficient of BOLD variation was 0.37 (SD=0.17). BOLD delay (whole-brain reference, time shift range 3) had an area under the curve of 0.76 for predicting severe hypoperfusion (sensitivity=69.2%; specificity=80%), whereas BOLD delay (venous sinus reference, time shift range 3) had an area under the curve of 0.76 (sensitivity=67.3%; specificity=83.5%). Conclusions-BOLD delay is related to macrovascular delay and microvascular hypoperfusion, can identify severely hypoperfused tissue in acute stroke, and is a promising alternative to gadolinium contrast agent-based perfusion assessment in acute stroke. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00715533 and NCT02077582.

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“…Dynamic susceptibility contrast-enhanced MRI techniques have been the main MR perfusion imaging method used in AIS [16]. Previous studies have suggested that ASL perfusion MRI can be an alternative method for invasive CBF assessments in patients with stroke [8,9,10,11].…”

Section: Discussionmentioning

confidence: 99%

Arterial Spin Labeling Perfusion MRI in Children and Young Adults with Previous Ischemic Stroke and Unilateral Intracranial Arteriopathy

Bulder

Bokkers

Hendrikse³

et al. 2013

Cerebrovasc Dis

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Background: Little is known about cerebral blood flow (CBF) in young patients with ischemic stroke caused by an intracranial arteriopathy. Arterial spin labeling (ASL) perfusion is a noninvasive technique for measuring CBF. We aimed to investigate whether, in young patients with unilateral intracranial arteriopathy and previous ischemic stroke, CBF is compromised in noninfarcted brain areas of the symptomatic hemisphere and whether this is related to the severity of the arteriopathy. Methods: Patients aged 5-50 years, with previous middle cerebral artery (MCA) territory infarction and a unilateral intracranial arteriopathy, underwent magnetic resonance imaging (MRI), MR angiography and pseudocontinuous ASL perfusion MRI. We assessed the severity of stenosis of arteries that fed the symptomatic MCA territory, quantified CBF in the noninfarcted cortex of both MCA territories and generated CBF maps for visual CBF interpretation. Results: A total of 17 patients were included (median age 29 years, range 5-49, 29% male). We found a similar median quantified CBF in the symptomatic and asymptomatic MCA territories (86 ml·100 g^-1·min^-1). CBF maps showed hypoperfusion in the symptomatic MCA territory in 59% of patients compared to 18% based on quantified CBF. Patients with a severe arteriopathy more often showed hypoperfusion on CBF maps than patients with a mild arteriopathy. In 53% of patients, small foci of increased signal intensity were visible on CBF maps around an area of hypoperfusion, indicating vascular artifacts. In these patients, we found large intraindividual variation in the quantified CBF in the symptomatic hemisphere. In 47% of patients, the visual interpretation of perfusion did not correspond with the quantified CBF. Conclusions: This study shows that more than half of young patients with previous ischemic stroke in the MCA territory and a unilateral intracranial arteriopathy have hypoperfusion in the noninfarcted cortex of the symptomatic hemisphere when CBF is visually assessed using a CBF map, in particular in patients with a severe arteriopathy. In the same patients, quantification of CBF shows hypoperfusion in the symptomatic hemisphere in only 18%. This discrepancy is caused by labeled blood within the arteries that has not yet reached the tissue at the time of imaging. Visual assessment can show hypoperfusion, while the quantified CBF in a similar region appears higher when the intravascular labeled blood is included in the region of interest. Further research should focus on elucidating whether cerebral perfusion deficits in young stroke patients with intracranial arteriopathy might help to identify patients who are at risk of poor outcome or stroke recurrence.

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The Value of Arterial Spin-Labeled Perfusion Imaging in Acute Ischemic Stroke

Cited by 150 publications

References 23 publications

Arterial spin labelling MRI for assessment of cerebral perfusion in children with moyamoya disease: comparison with dynamic susceptibility contrast MRI

Arterial spin labelling MRI for assessment of cerebral perfusion in children with moyamoya disease: comparison with dynamic susceptibility contrast MRI

Relationship Between Changes in the Temporal Dynamics of the Blood-Oxygen-Level-Dependent Signal and Hypoperfusion in Acute Ischemic Stroke

Arterial Spin Labeling Perfusion MRI in Children and Young Adults with Previous Ischemic Stroke and Unilateral Intracranial Arteriopathy

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