Perfusion imaging using arterial spin labeling

Partial volume correction of multiple inversion time arterial spin labeling MRI data

The accuracy of cerebral blood flow (CBF) estimates from arterial spin labeling (ASL) is affected by the presence of both gray matter (GM) and white matter within any voxel. Recently a partial volume (PV) correction method for ASL has been demonstrated (Asllani et al. Magn Reson Med 2008; 60:1362-1371), where PV estimates were used with a local linear regression to separate the GM and white matter ASL signal. Here a new PV correction method for multi-inversion time ASL is proposed that exploits PV estimates within a spatially regularized kinetic curve model analysis. The proposed method exploits both PV estimates and the different kinetics of the ASL signal arising from GM and white matter. The new correction method is shown, on both simulated and real data, to provide correction of GM CBF comparable to a linear regression approach, whilst preserving greater spatial detail in the CBF image. On real data corrected GM CBF values were found to be largely independent of GM PV, implying that the correction had been successful. Increases of mean GM CBF after correction of 69-80% were observed.

Arterial spin labeling MRI for assessment of perfusion in native and transplanted kidneys

PURPOSE

To apply a magnetic resonance arterial spin labeling (ASL) technique to evaluate kidney perfusion in native and transplanted kidneys.

MATERIALS AND METHODS

This study was compliant with the Health Insurance Portability and Accountability Act and approved by the institutional review board. Informed consent was obtained from all subjects. Renal perfusion exams were performed at 1.5 T in a total of 25 subjects: 10 with native and 15 with transplanted kidneys. A flow-sensitive alternating inversion recovery (FAIR) ASL sequence was performed with respiratory triggering in all subjects and under free-breathing conditions in five transplant subjects. Thirty-two control/tag pairs were acquired and processed using a single-compartment model. Perfusion in native and transplanted kidneys was compared above and below an estimated glomerular filtration rate (eGFR) threshold of 60 ml/min per 1.73 m² and correlations with eGFR were determined.

RESULTS

In many of the transplanted kidneys, major feeding vessels in the coronal plane required a slice orientation sagittal to the kidney. Renal motion during the examination was observed in native and transplant subjects and was corrected with registration. Cortical perfusion correlated with eGFR in native (r=0.85, P=.002) and transplant subjects (r=0.61, P=.02). For subjects with eGFR >60 ml/min per 1.73 m², native kidneys demonstrated greater cortical (P=.01) and medullary (P=.04) perfusion than transplanted kidneys. For subjects with eGFR <60 ml/min per 1.73 m², native kidneys demonstrated greater medullary perfusion (P=.04) compared to transplanted kidneys. Free-breathing acquisitions provided renal perfusion measurements that were slightly lower compared to the coached/triggered technique, although no statistical differences were observed.

CONCLUSION

In conclusion, FAIR-ASL was able to measure renal perfusion in subjects with native and transplanted kidneys, potentially providing a clinically viable technique for monitoring kidney function.

Magnetic resonance perfusion imaging without contrast media

PURPOSE

Principles of magnetic resonance imaging techniques providing perfusion-related contrast weighting without administration of contrast media are reported and analysed systematically. Especially common approaches to arterial spin labelling (ASL) perfusion imaging allowing quantitative assessment of specific perfusion rates are described in detail. The potential of ASL for perfusion imaging was tested in several types of tissue.

METHODS

After a systematic comparison of technical aspects of continuous and pulsed ASL techniques the standard kinetic model and tissue properties of influence to quantitative measurements of perfusion are reported. For the applications demonstrated in this paper a flow-sensitive alternating inversion recovery (FAIR) ASL perfusion preparation approach followed by true fast imaging with steady precession (true FISP) data recording was developed and implemented on whole-body scanners operating at 0.2, 1.5 and 3 T for quantitative perfusion measurement in various types of tissue.

RESULTS

ASL imaging provides a non-invasive tool for assessment of tissue perfusion rates in vivo. Images recorded from kidney, lung, brain, salivary gland and thyroid gland provide a spatial resolution of a few millimetres and sufficient signal to noise ratio in perfusion maps after 2-5 min of examination time.

CONCLUSIONS

Newly developed ASL techniques provide especially high image quality and quantitative perfusion maps in tissues with relatively high perfusion rates (as also present in many tumours). Averaging of acquisitions and image subtraction procedures are mandatory, leading to the necessity of synchronization of data recording to breathing in abdominal and thoracic organs.

Time-resolved vessel-selective digital subtraction MR angiography of the cerebral vasculature with arterial spin labeling

PURPOSE

To demonstrate an arterial spin-labeling (ASL) magnetic resonance (MR) angiographic technique that covers the entire cerebral vasculature and yields transparent-background, time-resolved hemodynamic, and vessel-specific information similar to that obtained with x-ray digital subtraction angiography (DSA) without the use of exogenous contrast agents.

MATERIALS AND METHODS

Prior institutional review board approval and written informed consent were obtained for this HIPAA-compliant study in which 12 healthy volunteers (five women, seven men; age range, 21-62 years; average age, 28 years) underwent imaging. An ASL technique in which variable labeling durations are used to acquire hemodynamic inflow information and a vessel-selective pulsed-continuous ASL technique were tested. Region-of-interest signal intensities in various vessel segments were averaged across subjects and used to quantitatively compare images. For comparison, a standard time of flight (TOF) acquisition was performed in the circle of Willis.

RESULTS

Inflow temporal resolution of 200 msec was demonstrated, revealing arterial transit times of 750, 950, and 1100 msec to consecutive segments of the middle cerebral artery from distal to the circle of Willis to deep regions of the midbrain. Selective labeling resulted in an average of eightfold suppression of contralateral vessels relative to the labeled vessel. Signal-to-noise ratios and contrast-to-noise ratios on maximum intensity projection images obtained with 88-second volumetric acquisitions (60 ± 15 [standard deviation] and 57 ± 15, respectively) and 11-second single-projection acquisitions (19 ± 5 and 17 ± 5, respectively) were comparable with standard TOF acquisitions, in which a 2.7-fold longer imaging duration for a 2.6-fold lower pixel area was used. Normal variations of the vasculature were identified with ASL angiography.

CONCLUSION

ASL angiography can be used to acquire hemodynamic vessel-specific information similar to that obtained with x-ray DSA.

Time-resolved vessel-selective digital subtraction MR angiography of the cerebral vasculature with arterial spin labeling

PURPOSE

To demonstrate an arterial spin-labeling (ASL) magnetic resonance (MR) angiographic technique that covers the entire cerebral vasculature and yields transparent-background, time-resolved hemodynamic, and vessel-specific information similar to that obtained with x-ray digital subtraction angiography (DSA) without the use of exogenous contrast agents.

MATERIALS AND METHODS

Prior institutional review board approval and written informed consent were obtained for this HIPAA-compliant study in which 12 healthy volunteers (five women, seven men; age range, 21-62 years; average age, 28 years) underwent imaging. An ASL technique in which variable labeling durations are used to acquire hemodynamic inflow information and a vessel-selective pulsed-continuous ASL technique were tested. Region-of-interest signal intensities in various vessel segments were averaged across subjects and used to quantitatively compare images. For comparison, a standard time of flight (TOF) acquisition was performed in the circle of Willis.

RESULTS

Inflow temporal resolution of 200 msec was demonstrated, revealing arterial transit times of 750, 950, and 1100 msec to consecutive segments of the middle cerebral artery from distal to the circle of Willis to deep regions of the midbrain. Selective labeling resulted in an average of eightfold suppression of contralateral vessels relative to the labeled vessel. Signal-to-noise ratios and contrast-to-noise ratios on maximum intensity projection images obtained with 88-second volumetric acquisitions (60 ± 15 [standard deviation] and 57 ± 15, respectively) and 11-second single-projection acquisitions (19 ± 5 and 17 ± 5, respectively) were comparable with standard TOF acquisitions, in which a 2.7-fold longer imaging duration for a 2.6-fold lower pixel area was used. Normal variations of the vasculature were identified with ASL angiography.

CONCLUSION

ASL angiography can be used to acquire hemodynamic vessel-specific information similar to that obtained with x-ray DSA.

Arterial spin labeling in neuroimaging

Arterial spin labeling (ASL) is a magnetic resonance imaging technique for measuring tissue perfusion using a freely diffusible intrinsic tracer. As compared with other perfusion techniques, ASL offers several advantages and is now available for routine clinical practice in many institutions. Its noninvasive nature and ability to quantitatively measure tissue perfusion make ASL ideal for research and clinical studies. Recent technical advances have increased its sensitivity and also extended its potential applications. This review focuses on some basic knowledge of ASL perfusion, emerging techniques and clinical applications in neuroimaging.

Mapping brain function using a 30-day interval between baseline and activation: a novel arterial spin labeling fMRI approach

By comparing hemodynamic signals acquired immediately before and during activation, functional magnetic resonance imaging (fMRI) is well suited for mapping acute changes in brain function. However, it remains unclear whether fMRI can map functional changes over longer periods. Here, we address this issue by empirically testing the feasibility of arterial spin labeling (ASL) fMRI to detect changes in cerebral blood flow (CBF) with baseline and task separated by 1 month. To increase the sensitivity of the method, we applied an algorithm that yielded flow density (CBFd) images that were independent of tissue content. To increase the accuracy, we developed a technique that generated arterial transit time at each voxel, independently. Results showed that activation changes in CBFd during the same session were statistically the same as across 30 days. The activation CBFd on day-30 was 34% (motor) and 25% (visual) higher than the respective baselines of 83 and 107 mL/100 g/min obtained on day-1. Furthermore, the signal-to-noise ratio of the CBFd measurement was 2.1 and 2.9 times higher than that of the conventional CBF for within-subject and across-subjects comparisons, respectively (n=9 healthy young subjects). Taken together, these results indicate that CBFd measure could be better suited than net CBF to map long-term changes in brain function.

On the sensitivity of ASL MRI in detecting regional differences in cerebral blood flow

Arterial-spin-labeling (ASL) magnetic resonance imaging (MRI) provides a noninvasive tool to measure cerebral blood flow (CBF) and is increasingly used as a surrogate for baseline neural activity. However, the power of ASL MRI in detecting CBF differences between patient and control subjects is hampered by inter-subject variations in global CBF, which are associated with non-neural factors and may contribute to the noise in the across-group comparison. Here, we investigated the sensitivity of this technique and proposed a normalization strategy to better detect such a difference. A "model" situation was employed in which two visual stimuli (i.e. cross fixation and flashing checkerboard) were presented to two groups of subjects to mimic "control" and "patient" groups (N=7 for each group), respectively. It was found that absolute CBF (aCBF) in the occipital lobe in the checkerboard group was 26.0% greater compared to the fixation group, but the level of significance was modest (P=.03). In contrast, when normalizing the CBF with whole-brain CBF or CBF in a reference region [termed relative CBF (rCBF)], the statistical significance was improved considerably (P<.003). For voxel-based analysis, the rCBF indices correctly detected CBF differences in the occipital lobe in the across-group comparison, while aCBF failed to detect any significant cluster using the same statistical threshold. We also performed Monte Carlo simulation to confirm the experimental findings and found that the power improvement was most pronounced when signal-to-noise-ratio is moderate and the underlying CBF difference was small. The simulation also showed that, with the proposed normalization, a detection power of 80% can be achieved using a sample size of about 20. In summary, rCBF is a more sensitive index to detect small differences in CBF, rather than the much-sought-after aCBF, since it reduces data noise caused by inter-subject variations in global CBF.

Imaging of brain tumors: perfusion/permeability

The use of biomarkers of microvascular structure and function from perfusion and permeability imaging is now well established in neuro-oncological research. There remain significant challenges to be overcome before these techniques and related biomarkers can find general clinical acceptance. Core to this is the standardization of acquisition and processing protocols for robust use across multiple clinical sites. The potential clinical benefits of these approaches are already becoming clear, particularly in the setting of novel antiangiogenic therapies. With an increasing body of evidence in the scientific literature, and with a steadily falling barrier to entry, the coming decade should see rapid developments in imaging biomarkers, and facilitate their transition into routine clinical practice.

Detecting changes in human cerebral blood flow after acute exercise using arterial spin labeling: implications for fMRI

The use of arterial spin labeling to measure cerebral blood flow (CBF) after acute exercise has not been reported. The aims of this study were to examine: (1) the optimal inversion time to detect changes in CBF after acute exercise and (2) if acute exercise alters CBF in the motor cortex at rest or during finger-tapping. Subjects (n=5) performed 30 min of moderate intensity exercise on an electronically braked cycle ergometer (perceived exertion 'somewhat hard'). Before and after exercise, relative CBF was measured using multiple inversion time (TI) pulsed arterial spin labeling (PASL). Two multiple TI runs were obtained at rest and during 4 Hz finger-tapping. Four inversion times (675, 975, 1275, and 1,575 ms) were acquired per run, with 20 interleaved pairs of tag and control images per inversion time (320 s run). The results indicated that global CBF increased approximately 20% following exercise, with significant differences observed at an inversion time of 1,575 ms (p<.05). Finger-tapping induced CBF in the motor cortex significantly increased from before to after exercise at TI=1,575 ms (p<.01). These findings suggest changes in human cerebral blood flow that result from acute moderate intensity exercise can be detected afterwards using PASL at 3T with an inversion time of 1,575 ms. The effect of prior acute exercise to increase motor cortex CBF during the performance of a motor task suggests future use of indices of functional activation should account for exercise-induced changes in cardio-pulmonary physiology and CBF.

Reliability and reproducibility of perfusion MRI in cognitively normal subjects

Arterial spin labeling (ASL) magnetic resonance imaging (MRI) is becoming a popular method for measuring perfusion due to its ability of generating perfusion maps noninvasively. This allows for frequent repeat scanning, which is especially useful for follow-up studies. However, limited information is available regarding the reliability and reproducibility of ASL perfusion measurements. Here, the reliability and reproducibility of pulsed ASL was investigated in an elderly population to determine the variation in perfusion among cognitively normal individuals in different brain structures. Intraclass correlation coefficients (ICC) and within-subject variation coefficients (wsCV) were used to estimate reliability and reproducibility over a period of 1 year. Twelve cognitively normal subjects (75.5 ± 5.3 years old, six male and six female) were scanned four times (at 0, 3, 6 and 12 months). No significant difference in cerebral blood flow (CBF) was found over this period. CBF values ranged from 46 to 53 ml/100 g per minute in the medial frontal gyrus (MFG) and from 40 to 44 ml/100 g per minute over all gray matter regions in the superior part of the brain. Data obtained from the first two scans were processed by two readers and showed high reliability (ICC >0.97) and reproducibility (wsCV <6%). However, over the total period of 1 year, reliability reduced to a moderate level (ICC=0.63-0.74) with wsCVs of gray matter, left MFG, right MFG of 13.5%, 12.3%, and 15.4%, respectively. In conclusion, measurement of CBF with pulsed ASL provided good agreement between inter-raters. A moderate level of reliability was obtained over a 1-year period, which was attributed to variance in slice positioning and coregistration. As such pulsed ASL has the potential to be used for CBF comparison in longitudinal studies.

Arterial spin labeling perfusion MRI at multiple delay times: a correlative study with H(2)(15)O positron emission tomography in patients with symptomatic carotid artery occlusion

Arterial spin labeling (ASL) perfusion magnetic resonance imaging (MRI) with image acquisition at multiple inversion times is a noninvasive ASL technique able to compensate for spatial heterogeneities in transit times caused by collateral blood flow in patients with severe stenosis of the cerebropetal blood vessels. Our aim was to compare ASL-MRI and H(2)(15)O positron emission tomography (PET), the gold standard for cerebral blood flow (CBF) assessment, in patients with a symptomatic internal carotid artery (ICA) occlusion. Fourteen patients (63+/-14 years) with a symptomatic ICA occlusion underwent both ASL-MRI and H(2)(15)O PET. The ASL-MRI was performed using a pulsed STAR labeling technique at multiple inversion times within 7 days of the PET. The CBF was measured in the gray-matter of the anterior, middle and posterior cerebral artery, and white-matter. Both PET and ASL-MRI showed a significantly decreased CBF in the gray-matter of the middle cerebral artery in the hemisphere ipsilateral to the ICA occlusion. The average gray-matter CBF measured with ASL-MRI (71.8+/-4.3 mL/min/100 g) was higher (P<0.01) than measured with H(2)(15)O PET (43.1+/-1.0 mL/min/100 g). In conclusion, ASL-MRI at multiple TIs is capable of depicting areas of regions with low CBF in patients with an occlusion of the ICA, although a systematic overestimation of CBF relative to H(2)(15)O PET was noted.

Functional imaging and related techniques: an introduction for rehabilitation researchers

Functional neuroimaging and related neuroimaging techniques are becoming important tools for rehabilitation research. Functional neuroimaging techniques can be used to determine the effects of brain injury or disease on brain systems related to cognition and behavior and to determine how rehabilitation changes brain systems. These techniques include: functional magnetic resonance imaging (fMRI), positron emission tomography (PET), electroencephalography (EEG), magnetoencephalography (MEG), near infrared spectroscopy (NIRS), and transcranial magnetic stimulation (TMS). Related diffusion weighted magnetic resonance imaging techniques (DWI), including diffusion tensor imaging (DTI) and high angular resolution diffusion imaging (HARDI), can quantify white matter integrity. With the proliferation of these imaging techniques in rehabilitation research, it is critical that rehabilitation researchers, as well as consumers of rehabilitation research, become familiar with neuroimaging techniques, what they can offer, and their strengths and weaknesses The purpose to this review is to provide such an introduction to these neuroimaging techniques.

Quantification of renal allograft perfusion using arterial spin labeling MRI: initial results

OBJECTIVE

To quantify renal allograft perfusion in recipients with stable allograft function and acute decrease in allograft function using nonenhanced flow-sensitive alternating inversion recovery (FAIR)-TrueFISP arterial spin labeling (ASL) MR imaging.

METHODS

Following approval of the local ethics committee, 20 renal allograft recipients were included in this study. ASL perfusion measurement and an anatomical T2-weighted single-shot fast spin-echo (HASTE) sequence were performed on a 1.5-T scanner (Magnetom Avanto, Siemens, Erlangen, Germany). T2-weighted MR urography was performed in patients with suspected ureteral obstruction. Patients were assigned to three groups: group a, 6 patients with stable allograft function over the previous 4 months; group b, 7 patients with good allograft function who underwent transplantation during the previous 3 weeks; group c, 7 allograft recipients with an acute deterioration of renal function.

RESULTS

Mean cortical perfusion values were 304.8 +/- 34.4, 296.5 +/- 44.1, and 181.9 +/- 53.4 mg/100 ml/min for groups a, b and c, respectively. Reduction in cortical perfusion in group c was statistically significant.

CONCLUSION

Our results indicate that ASL is a promising technique for nonenhanced quantification of cortical perfusion of renal allografts. Further studies are required to determine the clinical value of ASL for monitoring renal allograft recipients.

Cerebral collateral circulation in carotid artery disease

Carotid artery disease is common and increases the risk of stroke. However, there is wide variability on the severity of clinical manifestations of carotid disease, ranging from asymptomatic to fatal stroke. The collateral circulation has been recognized as an important aspect of cerebral circulation affecting the risk of stroke as well as other features of stroke presentation, such as stroke patterns in patients with carotid artery disease. The cerebral circulation attempts to maintain constant cerebral perfusion despite changes in systemic conditions, due to its ability to autoregulate blood flow. In case that one of the major cerebral arteries is compromised by occlusive disease, the cerebral collateral circulation plays an important role in preserving cerebral perfusion through enhanced recruitment of blood flow. With the advent of techniques that allow rapid evaluation of cerebral perfusion, the collateral circulation of the brain and its effectiveness may also be evaluated, allowing for prompt assessment of patients with acute stroke due to involvement of the carotid artery, and risk stratification of patients with carotid stenosis in chronic stages. Understanding the cerebral collateral circulation provides a basis for the future development of new diagnostic tools, risk stratification, predictive models and new therapeutic modalities. In the present review we discuss basic aspects of the cerebral collateral circulation, diagnostic methods to assess collateral circulation, and implications in occlusive carotid artery disease.

Perfusion magnetic resonance imaging in psychiatry

INTRODUCTION

Cerebral perfusion imaging using magnetic resonance imaging (MRI) is widely used in the research and clinical fields to assess the profound changes in blood flow related to ischemic events such as acute stroke, chronic steno-occlusive disease, vasospasm, and abnormal vessel formations from congenital conditions or tumoral neovascularity. With continuing improvements in the precision of MRI-based perfusion techniques, it is increasingly feasible to use this tool in the study of the subtle brain perfusion changes occurring in psychiatric illnesses. This article aims to review the existing literature on applications of perfusion MRI in psychiatric disorder and substance abuse research. The article also provides a brief introductory overview of dynamic susceptibility contrast MRI and arterial spin labeling techniques. An outlook of necessary steps to bring perfusion MRI into the realm of clinical psychiatry as a diagnostic tool is brought forth. Opportunities for research in unexplored disorders and with higher field strengths are briefly examined.

METHODS

PubMed, ISI Web of Knowledge & Scopus were used to search the literature and cross reference several neuropsychiatric disorders with a search term construct, including "magnetic resonance imaging," "dynamic susceptibility contrast," "arterial spin labeling," perfusion or "cerebral blood flow" or "cerebral blood volume" or "mean transit time." The list of disorders used in the search included schizophrenia, depression and bipolar disorder, dementia and Alzheimer's disease, Parkinson's disease, posttraumatic stress disorder, autism, Asperger disease, attention deficit, Tourette syndrome, obsessive-compulsive disorder, Huntington's disease, bulimia nervosa, anorexia nervosa, and substance abuse. For each disorder for which perfusion MRI studies were found, a brief overview of the disorder symptoms, treatment, prevalence, and existing models is provided, and previous findings from nuclear medicine-based perfusion imaging are overviewed. Findings of perfusion MRI studies are then summarized, and overlap of findings are discussed. Overarching conclusions are made, or an outlook for future work in the area is offered, where appropriate.

RESULTS

Despite the now fairly broad availability of perfusion MRI, only a limited number of studies were found using this technology. The search produced 13 studies of schizophrenia, 7 studies in major depression, 12 studies in Alzheimer's disease, and 2 studies in Parkinson's disease. Drug abuse and other disorders have mainly been studied with nuclear medicine-based perfusion imaging. The literature concerning the use of perfusion imaging in psychiatry has not been reviewed in the last 5 years or more. The use of MRI for perfusion measurements in psychiatry has not been reviewed in 10 years.

CONCLUSIONS

Although MRI-based perfusion imaging in psychiatry has mainly been used as a research tool, a path is progressively being cleared for its application in clinical diagnostic and treatment monitoring. The precision of perfusion MRI methods now rivals that of nuclear medicine-based perfusion imaging techniques. Because of their noninvasive nature, arterial spin labeling methods have gained popularity in studies of neuropsychiatric disorders such as schizophrenia, depression, Alzheimer's, and Parkinson's diseases. Perfusion imaging measurements have yet to be included within the diagnostic criteria of neuropsychiatric disorders despite having shown to have great discriminant power in specific disorders. As this young methodology continues to improve and research studies demonstrate the correlation of measured perfusion abnormalities to microcirculatory abnormalities and neuropsychiatric symptomatology, the idea of including such a test within diagnostic criteria for certain mental illnesses becomes increasingly plausible.

Acquisition time and reproducibility of continuous arterial spin-labeling perfusion imaging at 3T

Arterial spin-labeling (ASL) is a relatively new and noninvasive MR imaging technique, used to measure cerebral blood flow (CBF). Scanning time and reproducibility remain important issues in the clinical applicability of ASL. We expected both to benefit from higher field strengths. We describe that when performing ASL at 3T, 20 averages suffice to obtain steady and reproducible CBF values. Scanning time can be as short as 3 minutes.

Understanding anesthesia through functional imaging

PURPOSE OF REVIEW

This review will highlight the recent functional magnetic resonance imaging, positron emission tomogram scan and connectivity studies in anesthesia and analgesia.

RECENT FINDINGS

In regional cerebral blood flow (rCBF) studies with isoflurane and sevoflurane, there is a consistent pattern of rise in rCBF in the anterior cingulate cortex and insula while the thalamus, lingual cortex and cerebellum show a decrease in rCBF, in a dose range of 0.2-1 minimum alveolar concentration. Even 0.25 minimum alveolar concentration causes a predominant decrease of rCBF in the cortical regions and increase of rCBF in the subcortical regions. This minimum alveolar concentration level primarily affects the association cortices. Thalamus and thalamo-cortical pathways seem to be linked to the hypnotic effects of anesthesia and deep sedation. Connectivity studies also confirm this. The electroencephalogram equivalent of this appears to be a transition from 'alpha' wave activity to 'delta' wave activity. Anterior cingulate cortex, S1 and S2 are the regions consistently activated in acute pain. Remifentanil infusion in acute pain decreases the activation in pain perception regions while activating the pain modulation regions. In chronic pain states, prefrontal cortex and insula are activated whereas there is a decrease in activity in the thalamus.

SUMMARY

Slowly, a pattern of neuronal activity reflecting hypnosis, analgesia, amnesia and reflex suppression seems to be emerging giving us a better insight into the central nervous system effects of anesthesia.

Dynamic magnetic resonance imaging of cerebral blood flow using arterial spin labeling

Modern functional neuroimaging techniques, including positron emission tomography, optical imaging of intrinsic signals, and magnetic resonance imaging (MRI) rely on a tight coupling between neural activity and cerebral blood flow (CBF) to visualize brain activity using CBF as a surrogate marker. Because the spatial and temporal resolution of neuroimaging modalities is ultimately determined by the spatial and temporal specificity of the underlying hemodynamic signals, characterization of the spatial and temporal profiles of the hemodynamic response to focal brain stimulation is of paramount importance for the correct interpretation and quantification of functional data. The ability to properly measure and quantify CBF with MRI is a major determinant of progress in our understanding of brain function. We review the dynamic arterial spin labeling (DASL) method to measure CBF and the CBF functional response with high temporal resolution.

Usefulness of pulsed arterial spin labeling MR imaging in mesial temporal lobe epilepsy

PURPOSE

Arterial spin labeling (ASL) is a developing magnetic resonance imaging (MRI) method for noninvasive measurement of cerebral blood flow (CBF). The purpose of this study was to evaluate the usefulness of ASL for detecting interictal temporal hypoperfusion in temporal lobe epilepsy (TLE). ASL-derived CBF measurements were compared with those derived from H(2)(15)O positron emission tomography (PET).

METHODS

11 normal controls and 10 patients with medically intractable TLE were studied. Pulsed ASL (PASL) with quantitative imaging of perfusion using a single subtraction, second version (QUIPSS II) was performed in all subjects and H(2)(15)O PET was performed in patients. Regional CBF values in the mesial and lateral temporal lobes were measured utilizing quantitative analysis of perfusion images. A perfusion asymmetry index (AI) was calculated for each region.

RESULTS

In patients, mean CBF in the mesial temporal lobe was not significantly different between PASL and H(2)(15)O PET, and ipsilateral mesial temporal CBF was lower than contralateral CBF with both techniques. PASL detected significant mesial temporal perfusion asymmetry agreeing with EEG laterality in four patients. H(2)(15)O PET found ipsilateral interictal hypoperfusion in three. Both scans found unilateral hypoperfusion in one patient with bilateral EEG discharges.

CONCLUSIONS

Pulsed ASL may be a promising approach to detecting interictal hypoperfusion in TLE. This method has potential as a clinical alternative to H(2)(15)O PET due to noninvasiveness and easy accessibility.

Territorial Arterial Spin Labeling in the Assessment of Collateral Circulation

Background and Purpose— Collateral circulation plays a vital role in patients with steno-occlusive disease, in particular for predicting stroke outcome. Digital subtraction angiography (DSA) is the gold standard for the assessment of collateral circulation, despite its invasive nature. Recently, the development of a new class of arterial spin labeling (ASL) methods allowed independent measurement of territorial flow information without the need for contrast media injection. Here, we compared combined territorial ASL (TASL) and MR angiography (MRA) against DSA in the assessment of collateral circulation.

Methods— Eighteen patients presenting with extra- or intracranial arterial steno-occlusive disease were recruited. All DSA studies were performed using a biplane angiography unit. MR imaging consisted of time-of-flight MRA and TASL, performed at 3T. Collateral circulation on both modalities was evaluated in consensus in a double-blinded manner by 3 neuroradiologists.

Results— Good agreement was found between DSA and TASL in the assessment of collateral flow: Cramer coefficient, V=0.53 ( P <0.0001) and Contingency coefficient, C=0.67, with kappa=0.70 and kappa=0.72 in the assessment of flow and collaterals, respectively. TASL and DSA successfully evaluated 89% and 98% of the vessels, respectfully. Failure was linked to motion-related artifacts in TASL, and highly tortuous vessels in DSA. Generally, combined MRA-TASL was comparable to DSA in diagnostic quality.

Conclusions— TASL provided radiological information comparable to DSA on collateral flow, with the advantage that it could be performed during routine MRI studies. TASL may provide insight on collateral perfusion in patients who may not otherwise be candidates for DSA, and may potentially replace it.

Magnetic resonance perfusion imaging in neuro-oncology

Recent advances in magnetic resonance imaging (MRI) have seen the development of techniques that allow quantitative imaging of a number of anatomical and physiological descriptors. These techniques have been increasingly applied to cancer imaging where they can provide some insight into tumour microvascular structure and physiology. This review details technical approaches and application of quantitative MRI, focusing particularly on perfusion imaging and its role in neuro-oncology.

Arterial spin-labeling MR imaging measurements of timing parameters in patients with a carotid artery occlusion

BACKGROUND AND PURPOSE

Arterial spin-labeling (ASL) with image acquisition at multiple delay times can be exploited in perfusion MR imaging to visualize and quantify the temporal dynamics of arterial blood inflow. In this study, we investigated the consequences of an internal carotid artery (ICA) occlusion and collateral blood flow on regional timing parameters.

MATERIALS AND METHODS

Seventeen functionally independent patients with a symptomatic ICA occlusion (15 men, 2 women; mean age, 57 years) and 29 sex- and age-matched control subjects were investigated. ASL at multiple delay times was used to quantify regional cerebral blood flow (CBF) and the transit and trailing edge times (arterial timing parameters) reflecting, respectively, the beginning and end of the labeled bolus. Intra-arterial digital subtraction angiography and MR angiography were used to grade collaterals.

RESULTS

In the hemisphere ipsilateral to the ICA occlusion, the CBF was lower in the anterior frontal (31 +/- 4 versus 47 +/- 3 mL/min/100 g, P < .01), posterior frontal (39 +/- 4 versus 55 +/- 2 mL/min/100 g, P < .01), and frontal parietal region (49 +/- 3 versus 61 +/- 3 mL/min/100 g, P = .04) than that in control subjects. The trailing edge of the frontal-parietal region was longer in the hemisphere ipsilateral to the ICA occlusion compared with that in control subjects (2225 +/- 167 versus 1593 +/- 35 ms, P < .01). In patients with leptomeningeal collateral flow, the trailing edge was longer in the anterior frontal region (2436 +/- 275 versus 1648 +/- 201 ms, P = .03) and shorter in the occipital region (1815 +/- 128 versus 2388 +/- 203 ms, P = .04), compared with patients without leptomeningeal collaterals.

CONCLUSION

Regional assessment of timing parameters with ASL may provide valuable information on the cerebral hemodynamic status. In patients with leptomeningeal collaterals, the most impaired territory was found in the frontal lobe.

Nonenhanced MR angiography

While nonenhanced magnetic resonance (MR) angiographic methods have been available since the earliest days of MR imaging, prolonged acquisition times and image artifacts have generally limited their use in favor of gadolinium-enhanced MR angiographic techniques. However, the combination of recent technical advances and new concerns about the safety of gadolinium-based contrast agents has spurred a resurgence of interest in methods that do not require exogenous contrast material. After a review of basic considerations in vascular imaging, the established methods for nonenhanced MR angiographic techniques, such as time of flight and phase contrast, are considered and their advantages and disadvantages are discussed. This article then focuses on new techniques that are becoming commercially available, such as electrocardiographically gated partial-Fourier fast spin-echo methods and balanced steady-state free precession imaging both with and without arterial spin labeling. Challenges facing these methods and possible solutions are considered. Since different imaging techniques rely on different mechanisms of image contrast, recommendations are offered for which strategies may work best for specific angiographic applications. Developments on the horizon include techniques that provide time-resolved imaging for assessment of flow dynamics by using nonenhanced approaches.

3T MRI: advances in brain imaging

Since its approval by the FDA in 2000, brain MR imaging at 3.0 T has been increasingly used in clinical practice. Theoretically, the signal-to-noise ratio (SNR) of a 3T MR scanner will be double that of a 1.5 T scanner. However, the relationship between the magnetic field used and the image obtained is very complex. Today, using a 3T magnet in Neuroradiology has far more advantages than disadvantages, and the diagnostic potential of higher strength magnets for structural and vascular scans, diffusion and perfusion imaging, spectroscopy and cortical activation studies is improving. However, it is useful to have an awareness of how increasing field strength affects each of these techniques so that full advantage may be taken of them.

Mapping resting-state functional connectivity using perfusion MRI

Resting-state, low-frequency (<0.08 Hz) fluctuations of blood oxygenation level-dependent (BOLD) magnetic resonance signal have been shown to exhibit high correlation among functionally connected regions. However, correlations of cerebral blood flow (CBF) fluctuations during the resting state have not been extensively studied. The main challenges of using arterial spin labeling perfusion magnetic resonance imaging to detect CBF fluctuations are low sensitivity, low temporal resolution, and contamination from BOLD. This work demonstrates CBF-based quantitative functional connectivity mapping by combining continuous arterial spin labeling (CASL) with a neck labeling coil and a multi-channel receiver coil to achieve high perfusion sensitivity. In order to reduce BOLD contamination, the CBF signal was extracted from the CASL signal time course by high frequency filtering. This processing strategy is compatible with sinc interpolation for reducing the timing mismatch between control and label images and has the flexibility of choosing an optimal filter cutoff frequency to minimize BOLD fluctuations. Most subjects studied showed high CBF correlation in bilateral sensorimotor areas with good suppression of BOLD contamination. Root-mean-square CBF fluctuation contributing to bilateral correlation was estimated to be 29+/-19% (N=13) of the baseline perfusion, while BOLD fluctuation was 0.26+/-0.14% of the mean intensity (at 3 T and 12.5 ms echo time).

Arterial spin labeling of cerebral perfusion territories using a separate labeling coil

PURPOSE

To obtain cerebral perfusion territories of the left, the right, and the posterior circulation in humans with high signal-to-noise ratio (SNR) and robust delineation.

MATERIALS AND METHODS

Continuous arterial spin labeling (CASL) was implemented using a dedicated radio frequency (RF) coil, positioned over the neck, to label the major cerebral feeding arteries in humans. Selective labeling was achieved by flow-driven adiabatic fast passage and by tilting the longitudinal labeling gradient about the Y-axis by theta = +/- 60 degrees .

RESULTS

Mean cerebral blood flow (CBF) values in gray matter (GM) and white matter (WM) were 74 +/- 13 mL . 100 g(-1) . minute(-1) and 14 +/- 13 mL . 100 g(-1) . minute(-1), respectively (N = 14). There were no signal differences between left and right hemispheres when theta = 0 degrees (P > 0.19), indicating efficient labeling of both hemispheres. When theta = +60 degrees , the signal in GM on the left hemisphere, 0.07 +/- 0.06%, was 92% lower than on the right hemisphere, 0.85 +/- 0.30% (P < 1 x 10(-9)), while for theta = -60 degrees , the signal in the right hemisphere, 0.16 +/- 0.13%, was 82% lower than on the contralateral side, 0.89 +/- 0.22% (P < 1 x 10(-10)). Similar attenuations were obtained in WM.

CONCLUSION

Clear delineation of the left and right cerebral perfusion territories was obtained, allowing discrimination of the anterior and posterior circulation in each hemisphere.

Arterial Spin Labeling: a one-stop-shop for measurement of brain perfusion in the clinical settings

Arterial Spin Labeling (ASL) has opened a unique window into the human brain function and perfusion physiology. Altogether fast and of intrinsic high spatial resolution, ASL is a technique very appealing not only for the diagnosis of vascular diseases, but also in basic neuroscience for the follow-up of small perfusion changes occurring during brain activation. However, due to limited signal-to-noise ratio and complex flow kinetics, ASL is one of the more challenging disciplines within magnetic resonance imaging. In this paper, the theoretical background and main implementations of ASL are revisited. In particular, the different uses of ASL, the pitfalls and possibilities are described and illustrated using clinical cases.

Multivariate and univariate analysis of continuous arterial spin labeling perfusion MRI in Alzheimer's disease

Continuous arterial spin labeling (CASL) magnetic resonance imaging (MRI) was combined with multivariate analysis for detection of an Alzheimer's disease (AD)-related cerebral blood flow (CBF) covariance pattern. Whole-brain resting CBF maps were obtained using spin echo, echo planar imaging (SE-EPI) CASL in patients with mild AD (n=12, age=70.7+/-8.7 years, 7 males, modified Mini-Mental State Examination (mMMS)=38.7/57+/-11.1) and age-matched healthy controls (HC) (n=20; age=72.1+/-6.5 years, 8 males). A covariance pattern for which the mean expression was significantly higher (P<0.0005) in AD than in HC was identified containing posterior cingulate, superior temporal, parahippocampal, and fusiform gyri, as well as thalamus, insula, and hippocampus. The results from this analysis were supplemented with those from the more standard, region of interest (ROI) and voxelwise, univariate techniques. All ROIs (17/hemisphere) showed significant decrease in CBF in AD (P<0.001 for all ROIs, alphacorrected=0.05). The area under the ROC curve for discriminating AD versus HC was 0.97 and 0.94 for covariance pattern and gray matter ROI, respectively. Fewer areas of depressed CBF in AD were detected using voxelwise analysis (corrected, P<0.05). These areas were superior temporal, cingulate, middle temporal, fusiform gyri, as well as inferior parietal lobule and precuneus. When tested on extensive split-half analysis to map out the replicability of both multivariate and univariate approaches, the expression of the pattern from multivariate analysis was superior to that of the univariate.

Perfusion imaging of brain tumors using arterial spin-labeling: correlation with histopathologic vascular density

BACKGROUND AND PURPOSE

We investigated the relationship between tumor blood-flow measurement based on perfusion imaging by arterial spin-labeling (ASL-PI) and histopathologic findings in brain tumors.

MATERIALS AND METHODS

We used ASL-PI to examine 35 patients with brain tumors, including 11 gliomas, 9 meningiomas, 9 schwannomas, 1 diffuse large B-cell lymphoma, 4 hemangioblastomas, and 1 metastatic brain tumor. As an index of tumor perfusion, the relative signal intensity (SI) of each tumor (%Signal intensity) was determined as a percentage of the maximal SI within the tumor per averaged SI within normal cerebral gray matter on ASL-PI. Relative vascular attenuation (%Vessel) was determined as the total microvessel area per the entire tissue area on CD-34-immunostained histopathologic specimens. MIB1 indices of gliomas were also calculated. The differences in %Signal intensity among different histopathologic types and between high- and low-grade gliomas were compared. In addition, the correlations between %Signal intensity and %Vessel or MIB1 index were evaluated in gliomas.

RESULTS

Statistically significant differences in %Signal intensity were observed between hemangioblastomas versus gliomas (P < .005), meningiomas (P < .05), and schwannomas (P < .005). Among gliomas, %Signal intensity was significantly higher for high-grade than for low-grade tumors (P < .05). Correlation analyses revealed significant positive correlations between %Signal intensity and %Vessel in 35 patients, including all 6 histopathologic types (rs = 0.782, P < .00005) and in gliomas (rs = 0.773, P < .05). In addition, in gliomas, %Signal intensity and MIB1 index were significantly positively correlated (rs = 0.700, P < .05).

CONCLUSION

ASL-PI may predict histopathologic vascular densities of brain tumors and may be useful in distinguishing between high- and low-grade gliomas and in differentiating hemangioblastomas from other brain tumors.

An investigation of statistical power for continuous arterial spin labeling imaging at 1.5 T

Variance estimates can be used in conjunction with scientifically meaningful effect sizes to design experiments with type II error control. Here we present estimates of intra- and inter-subject variances for region of interest (ROI) from resting cerebral blood flow (CBF) maps obtained using whole brain, spin echo echoplanar (SE-EPI) continuous arterial spin labeling (CASL) imaging on 52 elderly subjects (age=70.5+/-7.9 years, 29 males). There was substantial intrasubject systematic variability in CBF of gray matter ROIs corresponding to a range of standard deviations=[39-168] (ml/(100 g min)). This variability was mainly due to two factors: (1) an expected inverse relationship between ROI volume and intrasubject variance and (2) an increased effective post-labeling delay for more superior slices acquired later in the sequence. For example, intrasubject variance in Brodmann area 4 (BA 4) was approximately 8 times larger than in hippocampus, despite their similar gray matter volumes. Estimated ROI-wise power was computed for various numbers of acquired CBF images, numbers of subjects, and CBF effect sizes for two experimental designs: independent sample t-test and paired t-test. The theoretical effects of pulse sequence and field strength on general applicability of these results are discussed.

Basics of Magnetic Resonance Imaging and Magnetic Resonance Spectroscopy

In this chapter, the basic principles of magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) (Sects. 2.2, 2.3, and 2.4), the technical components of the MRI scanner (Sect. 2.5), and the basics of contrast agents and the application thereof (Sect. 2.6) are described. Furthermore, flow phenomena and MR angiography (Sect. 2.7) as well as diffusion and tensor imaging (Sect. 2.7) are elucidated.

Measurement of cerebral perfusion territories using arterial spin labelling

The ability to assess the perfusion territories of major cerebral arteries can be a valuable asset to the diagnosis of a number of cerebrovascular diseases. Recently, several arterial spin labeling (ASL) techniques have been proposed for determining the cerebral perfusion territories of individual arteries by three different approaches: (1) using a dedicated labeling radio frequency (RF) coil; (2) applying selective inversion of spatially confined areas; (3) employing multidimensional RF pulses. Methods that use a separate labeling RF coil have high signal-to-noise ratio (SNR), low RF power deposition, and unrestricted three-dimensional coverage, but are mostly limited to separation of the left and right circulation, and do require extra hardware, which may limit their implementation in clinical systems. Alternatively, methods that utilize selective inversion have higher flexibility of implementation and higher arterial selectivity, but suffer from imaging artifacts resulting from interference between the labeling slab and the volume of interest. The goal of this review is to provide the reader with a critical survey of the different ASL approaches proposed to date for determining cerebral perfusion territories, by discussing the relative advantages and disadvantages of each technique, so as to serve as a guide for future refinement of this promising methodology.

Functional imaging with FENSI: flow-enhanced signal intensity

Flow measurement methods for functional MRI (fMRI) are desirable as they are more closely tied to neuronal activity than the commonly used blood oxygenation techniques. In this work we introduce a flow-based functional imaging method. The method, called flow enhancement of signal intensity (FENSI), is an extension of the diffusion enhancement of signal and resolution (DESIRE) method from MR microscopy. The FENSI method offers a localized flow-weighted signal across a very thin slice (0.4 mm in this study) that provides a signal enhancement that is dependent on the velocity and direction of the flow. The FENSI method was implemented on a human 3 T system and applied to a blocked visual cognitive task. Activation maps showed good localization and the measured signal changes of around 10% were in good agreement with the predicted enhancements.

MRI of tumor angiogenesis

Angiogenesis has long been established as a key element in the pathophysiology of tumor growth and metastasis. Increasingly, new molecularly targeted antiangiogenic drugs are being developed in the fight against cancer. These drugs bring with them a need for an accurate means of diagnosing tumor angiogenesis and monitoring response to treatment. Imaging techniques can offer this in a noninvasive way, while also providing functional information about the tumor. Among the many clinical imaging techniques available, MRI alone can provide relatively good spatial resolution and specificity, without ionizing radiation and with limited side effects. Arterial spin labeling (ASL) and blood oxygenation level-dependent (BOLD) imaging techniques can be employed to confer indirect measures of angiogenesis, such as blood flow and blood volume, without the need for external contrast agents. Dynamic contrast-enhanced (DCE)-MRI is rapidly emerging as a standard method for directly measuring angiogenesis during angiogenesis-inhibitor drug trials. As macromolecular MR contrast agents become available, they will inevitably be utilized in the assessment of tumor perfusion and vessel permeability. Meanwhile, technological advances have made imaging at a molecular level a possibility. They have brought the potential to directly target MR contrast agents to markers of angiogenesis, such as the alpha(v)beta(3) integrin. Before this is used clinically, however, substantial gains in sensitivity brought about by improved coils, pulse sequences, and contrast agents will be needed. Herein we discuss the techniques currently available for MRI of angiogenesis, along with their respective advantages and disadvantages, and what the future holds for this evolving field of imaging.

Sevoflurane 0.25 MAC preferentially affects higher order association areas: a functional magnetic resonance imaging study in volunteers

BACKGROUND

Functional magnetic resonance imaging (fMRI) can objectively measure the subjective effects of anesthesia. Memory-related regions (association areas) are affected by subanesthetic doses of volatile anesthetics. In this study we measured the regional neuronal effects of 0.25 MAC sevoflurane in healthy volunteers and differentiated the effect between primary cortical regions and association areas.

METHODS

The effect of 0.25 MAC sevoflurane on visual, auditory, and motor activation was studied in 16 ASA I volunteers. With fMRI (3 Tesla Siemens magnetom), regional cerebral blood flow (rCBF) was measured by the pulsed arterial spin labeling technique. Subjects inhaled a mixture of O2 and 0.25 MAC sevoflurane and standard ASA monitoring was performed. Visual, auditory, and motor activation tasks were used. rCBF was measured in the awake state and during inhalation of 0.25 MAC sevoflurane, without and with activation. The change in rCBF (deltaCBF) with 0.25 MAC Sevoflurane during baseline state and with activation was calculated in 11 regions of interest related to visual, auditory, and motor activation tasks.

RESULTS

The change from baseline rCBF with 0.25 MAC sevoflurane was not statistically significant in the 11 regions of interest. With activation there was a significant increase in CBF in several regions. However, only in the primary and secondary visual cortices (V1, V2), thalamus, hippocampus, and supplementary motor area was the decrease in activation with 0.25 MAC sevoflurane statistically significant (P < 0.05).

CONCLUSION

Memory-related regions (association areas) are affected by subanesthetic concentrations of volatile anesthetics. Using fMRI, this study showed that 0.25 MAC sevoflurane predominantly affects the primary visual cortex, the related association cortex, and certain other higher order association cortices.

A single 20 mg dose of the full D1 dopamine agonist dihydrexidine (DAR-0100) increases prefrontal perfusion in schizophrenia

Dopamine D1 receptors play an important role in memory and cognition in non-human primates. Dopamine D1 agonists have been shown to reverse performance deficits in both aged non-human primates and in primates with lesions to dopamine systems. This study explored whether a single dose of the first full D1 agonist dihydrexidine (DAR-0100) would cause changes in brain activity (perfusion) in dopamine-rich brain regions. We used a new gadolinium-contrast magnetic resonance perfusion scanning technique to measure brain activity. A within-subject cross-over double-blind randomized design was used in 20 adults with SCID-diagnosed schizophrenia. Each morning at 0800 h, they were scanned on a 3.0 T MRI scanner for perfusion. They then received either 20 mg of dihydrexidine, or placebo, subcutaneously over 15 min. Over the next 45 min, they had intermittent MRI scans. Two days later, they had a repeat of the Day 1 schedule, but received the opposite treatment from that given on the first day. Within-day, as well as between-day, comparisons were made to test for perfusion effects of dihydrexidine. Analysis revealed that dihydrexidine induced a significant increase in both prefrontal and non-prefrontal perfusion compared to placebo. The greatest increases occurred approximately 20 min after dihydrexidine infusion, consistent with the short pharmacokinetic half-life of dihydrexidine. These data are consistent with the hypothesis formulated from studies of non-human primates that dihydrexidine and other D1 agonists may be able to modulate prefrontal dopaminergic function.

Use of functional magnetic resonance imaging in the early identification of Alzheimer's disease

A growing body of evidence suggests that a preclinical phase of Alzheimer's disease (AD) exists several years or more prior to the overt manifestation of clinical symptoms and is characterized by subtle neuropsychological and brain changes. Identification of individuals prior to the development of significant clinical symptoms is imperative in order to have the greatest treatment impact by maintaining cognitive abilities and preserving quality of life. Functional magnetic resonance imaging (fMRI) offers considerable promise as a non-invasive tool for detecting early functional brain changes in asymptomatic adults. In fact, evidence to date indicates that functional brain decline precedes structural decline in preclinical samples. Therefore, fMRI may offer the unique ability to capture the dynamic state of change in the degenerating brain. This review examines the clinical utility of blood oxygen level dependent (BOLD) fMRI in those at risk for AD as well as in early AD. We provide an overview of fMRI findings in at-risk groups by virtue of genetic susceptibility or mild cognitive decline followed by an appraisal of the methodological issues concerning the diagnostic usefulness of fMRI in early AD. We conclude with a discussion of future directions and propose that BOLD-fMRI in combination with cerebral blood flow or diffusion techniques will provide a more complete accounting of the neurovascular changes that occur in preclinical AD and thus improve our ability to reliably detect early brain changes prior to disease onset.

Quantification of cerebral blood flow in nonhuman primates using arterial spin labeling and a two-compartment model

Noninvasive absolute quantification of cerebral blood flow (CBF) with high spatial resolution is still a challenging task. Arterial spin labeling (ASL) is a promising magnetic resonance imaging (MRI) method for accurate perfusion quantification. However, modeling of ASL data is far from being standardized and has not been investigated in great detail. In this study, two-compartment modeling of monkey ASL data in three physiological conditions (baseline, sensory activated and globally elevated CBF) is reported. Absolute perfusion and arterial transit times were derived for gray matter (GM) and white matter (WM) separately. The uncertainties of the model's result were determined by Monte Carlo simulations. The fitted CBF values for GM were 133 ml/min/100 ml at baseline condition, 165 ml/min/100 ml during visual stimulation and 234 ml/min/100 ml for globally elevated CBF after intravenous injection of acetazolamide. The ratio of GM to WM CBF was 2.5 at baseline and was found to decrease to 1.6 after application of acetazolamide. The corresponding arterial transit times decreased from 742 to 607 ms in GM and from 985 to 875 ms in WM. Monte Carlo simulations showed that absolute CBF values can be determined with an error of 11-15%, while the arterial transit time values have a coefficient of variation of 25-31%. With an alternative acquisition scheme, the precision of the arterial transit times can be improved significantly. The CBF values in the occipital lobe of the monkey brain quantified with ASL are higher than previously reported in positron emission tomography studies.

Reproducibility of continuous arterial spin labeling perfusion MRI after 7 weeks

BACKGROUND

Continuous arterial spin labeling (CASL) is a non-invasive technique for the measurement of cerebral blood flow (CBF). The aim of the present study was to examine the reproducibility of CASL measurements and its suitability to consistently detect differences between groups, regions, and resting states.

MATERIALS AND METHODS

Thirty-eight healthy subjects (19 female) were examined at 1.5 T on two measurement occasions that were seven weeks apart. Resting CBF was measured with eyes open and eyes closed.

RESULTS

In different regions of interest (ROIs) the repeatability estimates varied between 9 and 19 ml/100 g/min. There were no significant mean differences between occasions in all ROIs (P > 0.05). Greater CBF in the eyes-open than in the eyes-closed state was consistently present in the primary and secondary visual areas. Furthermore, CBF was consistently greater in the right than in the left hemisphere (P < 0.05) and differed between lobes and between arterial territories (P < 0.001). Finally, we consistently observed greater CBF in women than in men (P < 0.001).

CONCLUSION

This study demonstrates the suitability of CASL to consistently detect differences between groups, regions, and resting states even after seven weeks. This emphasizes its usefulness for longitudinal designs.

Imagerie de perfusion : principes et applications cliniques

MR and CT imaging techniques provide both morphological data and functional data. MR and recently CT perfusion have substantially modified the treatment of acute stroke. CT perfusion offers new opportunities to improve the management strategy in vasospasm after subarachnoid hemorrhage. Both are also helpful for the diagnosis of brain tumors and the assessment of treatment effects.

Magnetic resonance approaches to brain aging and Alzheimer disease-associated neuropathology

The noninvasive, nonradioactive, quantitative nature of magnetic resonance techniques has propelled them to the forefront of neuroscience and neuropsychiatric research. In particular, recent advances have confirmed their enormous potential in patients with Alzheimer disease (AD). Structural and functional magnetic resonance (MR) imaging have demonstrated significant correlation with clinical outcomes and underlying pathology and are used increasingly in the AD clinic. This review will highlight the role of high-resolution structural MR imaging and functional magnetic resonance imaging in the identification of atrophic and hemodynamic changes in AD and their potential as diagnostic biomarkers and surrogates of therapeutic response. Advanced MR techniques based on diffusion, perfusion, and neurochemical abnormalities in the aging brain will be presented briefly. These newer techniques continue to expand our understanding of neuropathology in the aging brain and are likely to play an important clinical role in the future.

Dual vessel arterial spin labeling scheme for regional perfusion imaging

Regional perfusion imaging (RPI) based on pulsed arterial spin labeling and angulated inversion slabs has been recently proposed. The technique allows mapping of individual brain perfusion territories of the major feeding arteries and could become a valuable clinical tool for evaluation of patients with cerebrovascular diseases. Here we propose a new labeling scheme for RPI where lateral and posterior circulations are labeled simultaneously. Two scans instead of three are sufficient to obtain the same perfusion territories as in the original approach, allowing for a 33% reduction in the total RPI protocol time. Moreover, the position of the inversion slabs with respect to vascular anatomy facilitates the planning and allows potentially better labeling efficiency. The new approach was tested on seven healthy volunteers and compared to the original labeling scheme. The results showed that the same perfusion territories and regional CBF values can be obtained.