Perfusion imaging using arterial spin labeling

(Paediatric) magnetic resonance urography: just fancy images or a new important diagnostic tool?

PURPOSE OF REVIEW

Magnetic resonance urography has become an established imaging tool in uroradiology. Its potential to assess anatomy and function makes it an ideal tool for evaluation of urinary tract malformations, renal cysts, genito-urinary tract tumours, infections and renal transplants. This review tries to highlight the potential of magnetic resonance urography in the light of new advances, particularly focusing on paediatric applications.

RECENT FINDINGS

Technical innovations such as diaphragmatic tracking, parallel or propeller imaging, faster gradients and higher field strength improve applicability in infants and children. Dynamic studies enable assessment of renal functional parameters such as split renal function, glomerular filtration rate or urinary drainage. Recent advances in magnetic resonance spectroscopy, diffusion imaging and perfusion imaging and new contrast agents promise to widen the potential of magnetic resonance urography as a functional imaging tool, not only in paediatrics but also for other magnetic resonance applications in the genito-urinary tract, such as prostate imaging or in the staging of ovarian and endometrial cancer.

SUMMARY

Besides ultrasound being used as the initial imaging method, particularly in children (and as computed tomography in adults), magnetic resonance urography can be envisioned as the major imaging modality for almost all (paediatric) uroradiological queries, consequently creating a growing demand for available equipment and procedural expertise.

Accuracy of blood flow values determined by arterial spin labeling: A validation study in isolated porcine kidneys

PURPOSE

To validate the accuracy of quantitative blood flow values determined using pulsed arterial spin labeling (ASL) in the preserved and reperfused porcine kidney.

MATERIALS AND METHODS

Ex vivo porcine kidneys were perfused with whole blood under physiological conditions, in particular including pulsatile flow. Total flow through the kidney was determined using an ultrasound flowmeter. ASL measurements at two different inversion times and four different flow rates in the range of 70-210 mL/100 mL*minute were performed. Absolute values of blood flow and arterial transit times were determined in the kidney cortex.

RESULTS

The quantitative values were in good agreement with the reference values obtained after calibration of the total flow. The greatest difference observed was 13%.

CONCLUSION

Isolated organ hemoperfusion allows validating perfusion imaging techniques. The experimental setup enables long-term radiotherapeutic or toxicological studies using noninvasive ASL to monitor blood flow quantitatively.

An account of the discrepancy between MRI and PET cerebral blood flow measures. A high-field MRI investigation

There is controversy concerning the discrepancy between absolute cerebral blood flow (CBF) values measured using positron emission tomography (PET) and magnetic resonance imaging (MRI). To gain insight into this problem, the increased signal-to-noise ratio (SNR) and extended T(1) relaxation times of blood and tissue at 3.0 T were exploited to perform pulsed arterial spin labeling (PASL) MRI measurements as a function of spatial resolution and post-labeling delay. The results indicate that, when using post-labeling delays shorter than 1500 ms, MRI gray matter flow values may become as high as several times the correct CBF values owing to tissue signal contamination by remaining arterial blood water label. For delays above 1500 ms, regional PASL-based CBF values (n = 5; frontal gray matter: 48.8 +/- 3.3(SD) ml/100 g/min; occipital gray matter: 49.3 +/- 4.5 ml/100 g/min) comparable with PET-based measurements can be obtained by using spatial resolutions comparable with PET (5-7.5 mm in-plane). At very high resolution (2.5 x 2.5 x 3 mm(3)), gray matter CBF values were found to increase by 10-20%, a consequence attributed to reduction in partial volume effects with cerebrospinal fluid and white matter. The recent availability of MRI field strengths of 3.0 T and higher will facilitate the use of MRI-based CBF measurements in the clinic.

Muscle blood flow and oxygenation measured by NMR imaging and spectroscopy

Tissue perfusion and oxygenation in many organs can be evaluated by various NMR techniques. This review focuses on the specificities, limitations and adaptations of the NMR tools available to investigate perfusion and oxygenation in the skeletal muscle of humans and animal models. A description of how they may be used simultaneously is provided as well. 1H NMR spectroscopy of myoglobin (Mb) monitors intramyocytic oxygenation. It measures the level of deoxy-Mb, from which Mb concentration, Mb desaturation/resaturation rates, muscle oxygenation changes and intracellular partial oxygen pressure (pO2) can be calculated. Positive and negative blood oxygen level-dependent (BOLD) contrasts exist in skeletal muscle. BOLD contrasts primarily reflect changes in capillary-venous oxygenation, but are also directly or indirectly dependent on muscle blood volume, perfusion, vascular network architecture and angulation, relative to the main magnetic field. Arterial spin labelling (ASL) techniques, having high spatial and temporal resolution, are the methods of choice to quantify and map skeletal muscle perfusion non-invasively. Limitations of ASL are poor contrast-to-noise ratio and sensitivity to movement; however, with the introduction of specific adaptations, it has been proven possible to measure skeletal muscle perfusion at both rest and during exercise. The possibility of combining these NMR measurements with others into a single dynamic protocol is most interesting. The 'multiparametric functional (mpf) NMR' concept can be extended to include the evaluation of muscle energy metabolism simultaneously with 31P NMR or with lactate double quantum filtered 1H NMR spectroscopy, an approach which would make NMR an exceptional tool for non-invasive investigations of integrative physiology and biochemistry in skeletal muscle in vivo.

Non-invasive measurement of perfusion: a critical review of arterial spin labelling techniques

The non-invasive nature of arterial spin labelling (ASL) has opened a unique window into human brain function and perfusion physiology. High spatial and temporal resolution makes the technique very appealing not only for the diagnosis of vascular diseases, but also in basic neuroscience where the aim is to develop a more comprehensive picture of the physiological events accompanying neuronal activation. However, low signal-to-noise ratio and the complexity of flow quantification make ASL one of the more demanding disciplines within MRI. In this review, the theoretical background and main implementations of ASL are revisited. In particular, the perfusion quantification methods, including the problems and pitfalls involved, are thoroughly discussed in this article. Finally, a brief summary of applications is provided.

In vivo measurement of the longitudinal relaxation time of arterial blood (T1a) in the mouse using a pulsed arterial spin labeling approach

A novel method for measuring the longitudinal relaxation time of arterial blood (T1a) is presented. Knowledge of T1a is essential for accurately quantifying cerebral perfusion using arterial spin labeling (ASL) techniques. The method is based on the flow-sensitive alternating inversion recovery (FAIR) pulsed ASL (PASL) approach. We modified the standard FAIR acquisition scheme by incorporating a global saturation pulse at the beginning of the recovery period. With this approach the FAIR tissue signal difference has a simple monoexponential dependence on the recovery time, with T1a as the time constant. Therefore, FAIR measurements performed over a range of recovery times can be fitted to a monoexponential recovery curve and T1a can be calculated directly. This eliminates many of the difficulties associated with the measurement of T1a. Experiments performed in vivo in the mouse at 2.35T produced a mean value of 1.51 s for T1a, consistent with previously published values.

Current and future applications of magnetic resonance imaging and spectroscopy of the brain in hepatic encephalopathy

Hepatic encephalopathy (HE) is a common neuro-psychiatric abnormality, which complicates the course of patients with liver disease and results from hepatocellular failure and/or portosystemic shunting. The manifestations of HE are widely variable and involve a spectrum from mild subclinical disturbance to deep coma. Research interest has focused on the role of circulating gut-derived toxins, particularly ammonia, the development of brain swelling and changes in cerebral neurotransmitter systems that lead to global CNS depression and disordered function. Until recently the direct investigation of cerebral function has been difficult in man. However, new magnetic resonance imaging (MRI) techniques provide a non-invasive means of assessment of changes in brain volume (coregistered MRI) and impaired brain function (fMRI), while proton magnetic resonance spectroscopy (¹H MRS) detects changes in brain biochemistry, including direct measurement of cerebral osmolytes, such as myoinositol, glutamate and glutamine which govern processes intrinsic to cellular homeostasis, including the accumulation of intracellular water. The concentrations of these intracellular osmolytes alter with hyperammonaemia. MRS-detected metabolite abnormalities correlate with the severity of neuropsychiatric impairment and since MR spectra return towards normal after treatment, the technique may be of use in objective patient monitoring and in assessing the effectiveness of various treatment regimens.

Advanced neuroimaging of pediatric brain tumors: MR diffusion, MR perfusion, and MR spectroscopy

This article highlights the MR imaging techniques of MR perfusion, MR diffusion, and MR spectroscopy in the evaluation of the child with a pediatric brain tumor. These techniques are complementary to conventional MR imaging in providing tumor physiologic information useful for diagnosis and therapy.

Arterial Spin Labeling: Benefits and Pitfalls of High Magnetic Field

Arterial spin labeling (ASL) techniques are MR imaging methods designed to measure the endogenous perfusion signal coming from arterial blood by manipulation of its magnetization. These methods are based on the subtraction of two consecutively acquired images: one acquired after preparation of the arterial blood magnetization upstream to the area of interest, and the second without any manipulation of its arterial magnetization. The subtraction of both images provides information on the perfusion of the tissue present in the slice of interest. Because ASL is a very low SNR technique, the shift from 1.5 T to 3.0 T should be regarded as a great way to increase signal-to-noise ratio (SNR). Furthermore, the concomitant increase in blood T(1) should improve the SNR of ASL further. Other effects related to poorer magnetic filed homogeneities and reduced T(2) relaxation times, however, will counterbalance both effects partially. In this article, the pros and cons of the use of ASL at high field are summarized, after a brief description of the major techniques used and their theoretical limitations. Finally, a summary of the few existing dedicated ASL perfusion techniques available are presented.

Physiological noise reduction for arterial spin labeling functional MRI

Three methods for the reduction of physiological noise in arterial spin labeling (ASL) functional magnetic resonance imaging (fMRI) are presented and compared. The methods are based upon a general linear model of the ASL measurement process and on a previously described retrospective image-based method (RETROICOR) for physiological noise reduction in blood oxygenation level dependent fMRI. In the first method, the contribution of physiological noise to the interleaved control and tag images that comprise the ASL time series are assumed to be equal, while in the second method this assumption is not made. For the third method, it is assumed that physiological noise primarily impacts the perfusion time series obtained from the filtered subtraction of the control and tag images. The methods were evaluated using studies of functional activity in the visual cortex and the hippocampal region. The first and second methods significantly improved statistical performance in both brain regions, whereas the third method did not provide a significant gain. The second method provided significantly better performance than the first method in the hippocampal region, whereas the differences between methods were less pronounced in visual cortex. The improved performance of the second method in the hippocampal region appears to reflect the relatively greater effect of cardiac fluctuations in this brain region. The proposed methods should be particularly useful for ASL studies of cognitive processes where the intrinsic signal to noise ratio is typically lower than for studies of primary sensory regions.

Comparative overview of brain perfusion imaging techniques

Numerous imaging techniques have been developed and applied to evaluate brain hemodynamics. Among these are: Positron Emission Tomography (PET), Single Photon Emission Computed Tomography (SPECT), Xenon-enhanced Computed Tomography (XeCT), Dynamic Perfusion-computed Tomography (PCT), Magnetic Resonance Imaging Dynamic Susceptibility Contrast (DSC), Arterial Spin-Labeling (ASL), and Doppler Ultrasound. These techniques give similar information about brain hemodynamics in the form of parameters such as cerebral blood flow (CBF) or volume (CBV). All of them are used to characterize the same types of pathological conditions. However, each technique has its own advantages and drawbacks. This article addresses the main imaging techniques dedicated to brain hemodynamics. It represents a comparative overview, established by consensus among specialists of the various techniques. For clinicians, this paper should offers a clearer picture of the pros and cons of currently available brain perfusion imaging techniques, and assist them in choosing the proper method in every specific clinical setting.

Model-free arterial spin labeling quantification approach for perfusion MRI

In this work a model-free arterial spin labeling (ASL) quantification approach for measuring cerebral blood flow (CBF) and arterial blood volume (aBV) is proposed. The method is based on the acquisition of a train of multiple images following the labeling scheme. Perfusion is obtained using deconvolution in a manner similar to that of dynamic susceptibility contrast (DSC) MRI. Local arterial input functions (AIFs) can be estimated by subtracting two perfusion-weighted images acquired with and without crusher gradients, respectively. Furthermore, by knowing the duration of the bolus of tagged arterial blood, one can estimate the aBV on a voxel-by-voxel basis. The maximum of the residue function obtained from the deconvolution of the tissue curve by the AIF is a measure of CBF after scaling by the locally estimated aBV. This method provides averaged gray matter (GM) perfusion values of 38 +/- 2 ml/min/100 g and aBV of 0.93% +/- 0.06%. The average CBF value is 10% smaller than that obtained on the same data set using the standard general kinetic model (42 +/- 2 ml/min/100 g). Monte Carlo simulations were performed to compare this new methodology with parametric fitting by the conventional model.

Reducing contamination while closing the gap: BASSI RF pulses in PASL

Bandwidth-modulated selective saturation and inversion (BASSI) pulses are a class of frequency- and gradient-modulated radiofrequency (RF) pulses, derived from the hyperbolic secant pulse by temporal variation of the bandwidth parameter. These pulses afford optimal amplitude modulation, achieving uniform and highly selective profiles at any effective flip angle. In this paper, BASSI pulses are parameterized to obtain low RF energy pulsed arterial spin labeling (PASL) label pulses with minimal contamination of static spins outside the label region and highly selective PICORE/QUIPSS II saturation pulses allowing for small label gaps. They are compared to frequency offset corrected inversion (FOCI) label pulses and sinc saturation pulses in simulations and a phantom experiment. Drawing on the outstanding selectivity of bandwidth-modulated saturation pulses, a new noninvasive method to measure in vivo the contamination effects due to direct and indirect saturation of static spins by the label pulse is presented. In an in vivo study on four subjects, contamination effects in a QUIPSS II PASL implementation based on BASSI pulses are compared to those present in a state-of-the-art Q2TIPS sequence employing a FOCI label pulse. Residual contamination in the QUIPSS II/BASSI sequence is shown to be reduced by a factor of 3, compared to the Q2TIPS/FOCI sequence. In vivo human perfusion images obtained with a label gap of only 2 mm are presented.

Comparative overview of brain perfusion imaging techniques

BACKGROUND AND PURPOSE

Numerous imaging techniques have been developed and applied to evaluate brain hemodynamics. Among these are positron emission tomography, single photon emission computed tomography, Xenon-enhanced computed tomography, dynamic perfusion computed tomography, MRI dynamic susceptibility contrast, arterial spin labeling, and Doppler ultrasound. These techniques give similar information about brain hemodynamics in the form of parameters such as cerebral blood flow or cerebral blood volume. All of them are used to characterize the same types of pathological conditions. However, each technique has its own advantages and drawbacks.

SUMMARY OF REVIEW

This article addresses the main imaging techniques dedicated to brain hemodynamics. It represents a comparative overview established by consensus among specialists of the various techniques.

CONCLUSIONS

For clinicians, this article should offer a clearer picture of the pros and cons of currently available brain perfusion imaging techniques and assist them in choosing the proper method for every specific clinical setting.

Gradient-enhanced FAWSETS perfusion measurements

This work describes the use of custom-built gradients to enhance skeletal muscle perfusion measurements acquired with a previously described arterial spin labeling technique known as FAWSETS (flow-driven arterial water stimulation with elimination of tissue signal). Custom-built gradients provide active control of the static magnetic field gradient on which FAWSETS relies for labeling. This allows selective, 180 degrees modulations of the phase of the perfusion component of the signal. Phase cycling can then be implemented to eliminate all extraneous components leaving a signal that exclusively reflects capillary-level perfusion. Gradient-enhancement substantially reduces acquisition time and eliminates the need to acquire an ischemic signal to quantify perfusion. This removes critical obstacles to application of FAWSETS in organs other than skeletal muscle and makes the measurements more desirable for clinical environments. The basic physical principles of gradient-enhancement are demonstrated in flow phantom experiments and in vivo utility is demonstrated in rat hind limb during stimulated exercise.

In vivo functional NMR imaging of resistance artery control

Arterial spin labeling (ASL) in combination with NMR imaging is an in vivo technique that quantifies tissue perfusion in absolute values (ml blood x min(-1) x g tissue(-1)) with high temporal (1-10 s) and spatial (0.1-3 mm) resolution. It uses the arterial water spins as endogenous freely diffusible markers of perfusion and, hence, is a totally noninvasive method. The technique has been successfully applied to quantify baseline perfusion in many organs, including the heart, in humans and animals, and results were validated by comparison with gold standards, PET and microspheres, respectively. Because of the high sampling rate of perfusion with ASL and the possibility that measurements could be obtained without harm over indefinite periods of time, the technique has the potential for use in functional investigations of microcirculation regulation and resistance artery control in vivo. We describe examples of the use of ASL to this end. With use of specific technological developments, ASL determination of perfusion can be coupled with simultaneous acquisitions of (1)H and (31)P NMR spectroscopy data. These protocols offer new possibilities whereby the microcirculatory control of cell oxygenation and high-energy phosphate metabolism can be explored.

A signal processing model for arterial spin labeling functional MRI

A model of the signal path in arterial spin labeling (ASL)-based functional magnetic resonance imaging (fMRI) is presented. Three subtraction-based methods for forming a perfusion estimate are considered and shown to be specific cases of a generalized estimate consisting of a modulator followed by a low pass filter. The performance of the methods is evaluated using the signal model. Contamination of the perfusion estimate by blood oxygenation level dependent contrast (BOLD) is minimized by using either sinc subtraction or surround subtraction for block design experiments and by using pair-wise subtraction for randomized event-related experiments. The subtraction methods all tend to decorrelate the 1/f type low frequency noise often observed in fMRI experiments. Sinc subtraction provides the flattest noise power spectrum at low frequencies, while pair-wise subtraction yields the narrowest autocorrelation function. The formation of BOLD estimates from the ASL data is also considered and perfusion weighting of the estimates is examined using the signal model.

Hyperacute imaging of ischemic stroke: Role in therapeutic management

Ischemic stroke remains a significant cause of morbidity and mortality. Current therapeutic options for acute ischemic stroke include intravenous thrombolysis and endovascular approaches for recanalization of proximal arterial occlusion. The rapid identification of underlying stroke etiology or mechanism may facilitate selection criteria for emergent therapy. Hyperacute imaging plays an integral role in the delineation of stroke pathophysiology and the formulation of rational stroke therapy. Hyperacute imaging of ischemic stroke may demonstrate proximal vascular occlusion, compensatory collateral circulation, residual or collateral tissue perfusion, and the differentiation of ischemic core from penumbral regions. Characterization of the ischemic field, including core and penumbra, with various mismatch models on multimodal computed tomography or MRI may refine current therapeutic strategies for cerebral ischemia. The diagnostic and therapeutic role of hyperacute imaging has emerged as a pivotal component in the evaluation and management of ischemic stroke.

Susac syndrome: serial diffusion-weighted MR imaging

Susac syndrome (SS) is a clinical triad of hearing loss, retinal artery occlusion and encephalopathy. The typical MR imaging findings of multiple focal lesions in the corpus callosum and subcortical white matter can be easily misdiagnosed as multiple sclerosis. On diffusion-weighted (DW) MR imaging, new lesions were hyperintense, with reduced apparent diffusion coefficient (ADC). These lesions later became less prominent or hypointense on subsequent DW MR imaging. Serial DW imaging and ADC maps may be useful in differentiating SS from demyelinating diseases.

Parallel imaging techniques in functional MRI

Originally developed for increased scanning velocity in cardiac imaging, parallel imaging (PI) techniques have recently also been applied for the reduction of artifacts in single-shot techniques. In functional brain imaging (fMRI) techniques, PI has been used for several purposes. It has been applied to reduce the distortions caused by the length of the echo-planar imaging readout, diminution of the gradient-related acoustic noise, as a means to increase acquisition speed or to increase the achievable brain coverage per unit time. In this article, the different applications of PI techniques in fMRI are reviewed, together with the basic theoretical background and the recently developed hardware necessary to achieve rapid, high signal-to-noise ratio PI-fMRI.