Measurements of cerebral perfusion and arterial hemodynamics during visual stimulation using TURBO-TILT

Multidelay ASL of the pediatric brain

Arterial spin labeling (ASL) is a powerful noncontrast MRI technique for evaluation of cerebral blood flow (CBF). A key parameter in single-delay ASL is the choice of postlabel delay (PLD), which refers to the timing between the labeling of arterial free water and measurement of flow into the brain. Multidelay ASL (MDASL) utilizes several PLDs to improve the accuracy of CBF calculations using arterial transit time (ATT) correction. This approach is particularly helpful in situations where ATT is unknown, including young subjects and slow-flow conditions. In this article, we discuss the technical considerations for MDASL, including labeling techniques, quantitative metrics, and technical artefacts. We then provide a practical summary of key clinical applications with real-life imaging examples in the pediatric brain, including stroke, vasculopathy, hypoxic-ischemic injury, epilepsy, migraine, tumor, infection, and metabolic disease.

Consensus statement on current and emerging methods for the diagnosis and evaluation of cerebrovascular disease

Cerebrovascular disease (CVD) remains a leading cause of death and the leading cause of adult disability in most developed countries. This work summarizes state-of-the-art, and possible future, diagnostic and evaluation approaches in multiple stages of CVD, including (i) visualization of sub-clinical disease processes, (ii) acute stroke theranostics, and (iii) characterization of post-stroke recovery mechanisms. Underlying pathophysiology as it relates to large vessel steno-occlusive disease and the impact of this macrovascular disease on tissue-level viability, hemodynamics (cerebral blood flow, cerebral blood volume, and mean transit time), and metabolism (cerebral metabolic rate of oxygen consumption and pH) are also discussed in the context of emerging neuroimaging protocols with sensitivity to these factors. The overall purpose is to highlight advancements in stroke care and diagnostics and to provide a general overview of emerging research topics that have potential for reducing morbidity in multiple areas of CVD.

Non-contrast MR imaging of blood-brain barrier permeability to water

PURPOSE

Many brain diseases are associated with an alteration in blood-brain barrier (BBB) and its permeability. Current methods using contrast agent are primarily sensitive to major leakage of BBB to macromolecules, but may not detect subtle changes in BBB permeability. The present study aims to develop a novel non-contrast MRI technique for the assessment of BBB permeability to water.

METHODS

The central principle is that by measuring arterially labeled blood spins that are drained into cerebral veins, water extraction fraction (E) and permeability-surface-area product (PS) of BBB can be determined. Four studies were performed. We first demonstrated the proof-of-principle using conventional ASL with very long post-labeling delays (PLD). Next, a new sequence, dubbed water-extraction-with-phase-contrast-arterial-spin-tagging (WEPCAST), and its Look-Locker (LL) version were developed. Finally, we demonstrated that the sensitivity of the technique can be significantly enhanced by acquiring the data under mild hypercapnia.

RESULTS

By combining a strong background suppression with long PLDs (2500-4500 ms), ASL spins were reliably detected in the superior sagittal sinus (SSS), demonstrating the feasibility of measuring this signal. The WEPCAST sequence eliminated partial voluming effects of tissue perfusion and allowed quantitative estimation of E = 95.5 ± 1.1% and PS = 188.9 ± 13.4 mL/100 g/min, which were in good agreement with literature reports. LL-WEPCAST sequence shortened the scan time from 19 min to 5 min while providing results consistent with multiple single-PLD acquisitions. Mild hypercapnia increased SNR by 78 ± 25% without causing a discomfort in participants.

CONCLUSION

A new non-contrast technique for the assessment of global BBB permeability was developed, which may have important clinical applications.

Tripled Readout Slices in Multi Time-Point pCASL Using Multiband Look-Locker EPI

Multi time-point pseudo-continuous arterial spin labelling (pCASL) with a Look-Locker EPI readout can sample the signal curve of blood kinetics at multiple time points after the labelling pulse. However, due to signal relaxation of labelled blood, the number of readout slices is limited. The aim of this study is to employ a multiband excitation technique to triple the number of readout slices in multi time-point pCASL. The multiband technique, along with 2-fold in-plane parallel imaging, was incorporated into the Look-Locker EPI for the multi time-point sampling of blood kinetic behaviour following the pCASL labelling scheme. The performance evaluation of the multiband and the single-band techniques were performed on four healthy subjects using a 32-channel head RF coil at 3T. Quantitative perfusion maps were analysed using a combination of labelling with and without flow suppression gradients. The perfusion maps provided by the multiband accelerated multi time-point pCASL were in good agreement with the conventional single-band technique. Multiband acceleration caused SNR loss but offered quantitative perfusion maps in 6.23 min with 18 slices compared with 6 slices within the same time period for the single-band method. As conclusion, the multiband technique can successfully triple the number of readout slices while achieving comparable perfusion data in the same measurement time as the conventional single-band readout.

Time-efficient determination of spin compartments by time-encoded pCASL T2-relaxation-under-spin-tagging and its application in hemodynamic characterization of the cerebral border zones

Information on water-transport across the blood-brain barrier can be determined from the T2 of the arterial spin labeling (ASL) signal. However, the current approach of using separate acquisitions of multiple inversion times is too time-consuming for clinical (research) applications. The aim of this study was to improve the time-efficiency of this method by combining it with time-encoded pseudo-continuous ASL (te-pCASL). Furthermore, the hemodynamic properties of the border zone regions in the brains of healthy, young volunteers were characterized as an example application. The use of te-pCASL instead of multi-TI pCASL significantly reduced the total scan duration, while providing a higher temporal resolution. A significantly lower cerebral blood flow (CBF) was found in the border zone regions compared with the central regions in both the posterior and the middle cerebral artery (MCA) flow territory. The arterial transit time (ATT) was almost two times longer in the border zone regions than in the central regions (p<0.05), with an average delay in ATT of 382ms in the posterior and 539ms in the MCA flow territory. When corrected for the ATT, the change in T2 over time was not significantly different for the border zones as compared to the central regions. In conclusion, te-pCASL-TRUST provided a time-efficient method to distinguish spin compartments based on their T2. The ATT in the border zone is significantly longer than in the central region. However, the exchange of the label from the arterial to the tissue compartment appears to be at a similar rate.

Three-dimensional whole-brain perfusion quantification using pseudo-continuous arterial spin labeling MRI at multiple post-labeling delays: accounting for both arterial transit time and impulse response function

Measurement of the cerebral blood flow (CBF) with whole-brain coverage is challenging in terms of both acquisition and quantitative analysis. In order to fit arterial spin labeling-based perfusion kinetic curves, an empirical three-parameter model which characterizes the effective impulse response function (IRF) is introduced, which allows the determination of CBF, the arterial transit time (ATT) and T(1,eff). The accuracy and precision of the proposed model were compared with those of more complicated models with four or five parameters through Monte Carlo simulations. Pseudo-continuous arterial spin labeling images were acquired on a clinical 3-T scanner in 10 normal volunteers using a three-dimensional multi-shot gradient and spin echo scheme at multiple post-labeling delays to sample the kinetic curves. Voxel-wise fitting was performed using the three-parameter model and other models that contain two, four or five unknown parameters. For the two-parameter model, T(1,eff) values close to tissue and blood were assumed separately. Standard statistical analysis was conducted to compare these fitting models in various brain regions. The fitted results indicated that: (i) the estimated CBF values using the two-parameter model show appreciable dependence on the assumed T(1,eff) values; (ii) the proposed three-parameter model achieves the optimal balance between the goodness of fit and model complexity when compared among the models with explicit IRF fitting; (iii) both the two-parameter model using fixed blood T1 values for T(1,eff) and the three-parameter model provide reasonable fitting results. Using the proposed three-parameter model, the estimated CBF (46 ± 14 mL/100 g/min) and ATT (1.4 ± 0.3 s) values averaged from different brain regions are close to the literature reports; the estimated T(1,eff) values (1.9 ± 0.4 s) are higher than the tissue T1 values, possibly reflecting a contribution from the microvascular arterial blood compartment.

Noninvasive functional imaging of cerebral blood volume with vascular-space-occupancy (VASO) MRI

Functional MRI (fMRI) based on changes in cerebral blood volume (CBV) can probe directly vasodilatation and vasoconstriction during brain activation or physiologic challenges, and can provide important insights into the mechanism of blood oxygenation level-dependent (BOLD) signal changes. At present, the most widely used CBV fMRI technique in humans is called vascular-space-occupancy (VASO) MRI, and this article provides a technical review of this method. VASO MRI utilizes T1 differences between blood and tissue to distinguish between these two compartments within a voxel, and employs a blood-nulling inversion recovery sequence to yield an MR signal proportional to 1 - CBV. As such, vasodilatation will result in a VASO signal decrease and vasoconstriction will have the reverse effect. The VASO technique can be performed dynamically with a temporal resolution comparable with several other fMRI methods, such as BOLD or arterial spin labeling (ASL), and is particularly powerful when conducted in conjunction with these complementary techniques. The pulse sequence and imaging parameters of VASO can be optimized such that the signal change is predominantly of CBV origin, but careful considerations should be taken to minimize other contributions, such as those from the BOLD effect, cerebral blood flow (CBF) and cerebrospinal fluid (CSF). The sensitivity of the VASO technique is the primary disadvantage when compared with BOLD, but this technique is increasingly demonstrating its utility in neuroscientific and clinical applications.

Comparison of relative cerebral blood flow maps using pseudo-continuous arterial spin labeling and single photon emission computed tomography

Pseudo-continuous arterial spin labeling (PCASL) MRI is a relatively new arterial spin labeling technique and has the potential to extend the cerebral blood flow (CBF) measurement to all tissue types, including white matter. However, the arterial transit time (δ(a)) for white matter is not well established and a limited number of reports using multi-delay methods have yielded inconsistent findings. In this study, we used a different approach and measured white matter δ(a) (mean ± standard deviation, 1541 ± 173  ms) by determining the arrival times of exogenous contrast agent in a bolus tracking experiment. The data also confirmed δ(a) of gray matter to be 912 ± 209  ms. In the second part of this study, we used these parameters in PCASL kinetic models and compared relative CBF (rCBF, with respect to the whole brain) maps with those measured using a single photon emission computed tomography (SPECT) technique. It was found that the use of tissue-specific δ(a) in the PCASL model was helpful in improving the correspondence between the two modalities. On a regional level, the gray/white matter CBF ratios were 2.47 ± 0.39 and 2.44 ± 0.18 for PCASL and SPECT, respectively. On a single-voxel level, the variance between the modalities was still considerable, with an average rCBF difference of 0.27.

A comparison of physiologic modulators of fMRI signals

One of the main obstacles in quantitative interpretation of functional magnetic resonance imaging (fMRI) signal is that this signal is influenced by non-neural factors such as vascular properties of the brain, which effectively increases signal variability. One approach to account for non-neural components is to identify and measure these confounding factors and to include them as covariates in data analysis or interpretation. Previously, several research groups have independently identified four potential physiologic modulators of fMRI signals, including baseline venous oxygenation (Yv ), cerebrovascular reactivity (CVR), resting state BOLD fluctuation amplitude (RSFA), and baseline cerebral blood flow (CBF). This study sought to directly compare the modulation effects of these indices in the same fMRI session. The physiologic parameters were measured with techniques comparable with those used in the previous studies except for CBF, which was determined globally with a velocity-based phase-contrast MRI (instead of arterial-spin-labeling MRI). Using an event-related, scene-categorization fMRI task, we showed that the fMRI signal amplitude was positively correlated with CVR (P < 0.0001) and RSFA (P = 0.002), while negatively correlated with baseline Yv (P < 0.0001). The fMRI-CBF correlation did not reach significance, although the (negative) sign of the correlation was consistent with the earlier study. Furthermore, among the physiologic modulators themselves, significant correlations were observed between baseline Yv and baseline CBF (P = 0.01), and between CVR and RSFA (P = 0.05), suggesting that some of the modulators may partly be of similar physiologic origins. These observations as well as findings in recent literature suggest that additional measurement of physiologic modulator(s) in an fMRI session may provide a practical approach to control for inter-subject variations and to improve the ability of fMRI in detecting disease or medication related differences. Hum Brain Mapp 34:2078-2088, 2013. © 2011 Wiley Periodicals, Inc.

Simultaneous measurement of cerebral blood flow and transit time with turbo dynamic arterial spin labeling (Turbo-DASL): application to functional studies

A turbo dynamic arterial spin labeling method (Turbo-DASL) was developed to simultaneously measure cerebral blood flow (CBF) and blood transit time with high temporal resolution. With Turbo-DASL, images were repeatedly acquired with a spiral readout after small-angle excitations during pseudocontinuous arterial spin labeling and control periods. Turbo-DASL experiments at 9.4 T without and with diffusion gradients were performed on rats anesthetized with isoflurane or α-chloralose. We determined blood transit times from carotid arteries to cortical arterial vessels (TT(a) ) from data obtained without diffusion gradients and to capillaries (TT(c) ) from data obtained with diffusion gradients. Cerebral arterial blood volume (CBV(a) ) was also calculated. At the baseline condition, both CBF and CBV(a) in the somatosensory cortical area were 40-50% less in rats with α-chloralose than in rats with isoflurane, while TT(a) and TT(c) were similar for both anesthetics. Absolute CBF and CBV(a) were positively correlated, while CBF and TT(c) were slightly negatively correlated. During forepaw stimulation, CBF increase was 15 ± 3% (n = 7) vs. 60 ± 7% (n = 5), and CBV(a) increase was 19 ± 9% vs. 46 ± 17% under isoflurane vs. α-chloralose anesthesia, respectively; CBF vs. CBV(a) changes were highly correlated. However, TT(a) and TT(c) were not significantly changed during stimulation. Our results support that arterial CBV increase plays a major role in functional CBF changes.

Measurement of absolute arterial cerebral blood volume in human brain without using a contrast agent

Arterial cerebral blood volume (CBV(a) ) is a vital indicator of tissue perfusion and vascular reactivity. We extended the recently developed inflow vascular-space-occupancy (iVASO) MRI technique, which uses spatially selective inversion to suppress the signal from blood flowing into a slice, with a control scan to measure absolute CBV(a) using cerebrospinal fluid (CSF) for signal normalization. Images were acquired at multiple blood nulling times to account for the heterogeneity of arterial transit times across the brain, from which both CBV(a) and arterial transit times were quantified. Arteriolar CBV(a) was determined separately by incorporating velocity-dependent bipolar crusher gradients. Gray matter (GM) CBV(a) values (n=11) were 2.04 ± 0.27 and 0.76 ± 0.17 ml blood/100 ml tissue without and with crusher gradients (b=1.8 s/mm(2) ), respectively. Arterial transit times were 671 ± 43 and 785 ± 69 ms, respectively. The arterial origin of the signal was validated by measuring its T(2) , which was within the arterial range. The proposed approach does not require exogenous contrast agent administration, and provides a non-invasive alternative to existing blood volume techniques for mapping absolute CBV(a) in studies of brain physiology and neurovascular diseases.

On improving the speed and reliability of T2-relaxation-under-spin-tagging (TRUST) MRI

A T(2) -relaxation-under-spin-tagging technique was recently developed to estimate cerebral blood oxygenation, providing potentials for noninvasive assessment of the brain's oxygen consumption. A limitation of the current sequence is the need for long repetition time, as shorter repetition time causes an over-estimation in blood R(2). This study proposes a postsaturation T(2)-relaxation-under-spin-tagging by placing a nonselective 90° pulse after the signal acquisition to reset magnetization in the whole brain. This scheme was found to eliminate estimation bias at a slight cost of precision. To improve the precision, echo time of the sequence was optimized and it was found that a modest echo time shortening of 3.4 ms can reduce the estimation error by 49%. We recommend the use of postsaturation T(2)-relaxation-under-spin-tagging sequence with a repetition time of 3000 ms and a echo time of 3.6 ms, which allows the determination of global venous oxygenation with scan duration of 1 min 12 s and an estimation precision of ± 1% (in units of oxygen saturation percentage).

The relationship of resting cerebral blood flow and brain activation during a social cognition task in adolescents with chronic moderate to severe traumatic brain injury: a preliminary investigation

Alterations in cerebrovascular function are evident acutely in moderate to severe traumatic brain injury (TBI), although less is known about their chronic effects. Adolescent and adult patients with moderate to severe TBI have been reported to demonstrate diffuse activation throughout the brain during functional magnetic resonance imaging (fMRI). Because fMRI is a measure related to blood flow, it is possible that any deficits in blood flow may alter activation. An arterial spin labeling (ASL) perfusion sequence was performed on seven adolescents with chronic moderate to severe TBI and seven typically developing (TD) adolescents during the same session in which they had performed a social cognition task during fMRI. In the TD group, prefrontal CBF was positively related to prefrontal activation and negatively related to non-prefrontal, posterior, brain activation. This relationship was not seen in the TBI group, who demonstrated a greater positive relationship between prefrontal CBF and non-prefrontal activation than the TD group. An analysis of CBF data independent of fMRI showed reduced CBF in the right non-prefrontal region (p<.055) in the TBI group. To understand any role reduced CBF may play in diffuse extra-activation, we then related the right non-prefrontal CBF to activation. CBF in the right non-prefrontal region in the TD group was positively associated with prefrontal activation, suggesting an interactive role of non-prefrontal and prefrontal blood flow throughout the right hemisphere in healthy brains. However, the TBI group demonstrated a positive association with activation constrained to the right non-prefrontal region. These data suggest a relationship between impaired non-prefrontal CBF and the presence of non-prefrontal extra-activation, where the region with more limited blood flow is associated with activation limited to that region. In a secondary analysis, pathology associated with hyperintensities on T2-weighted FLAIR imaging over the whole brain was related to whole brain activation, revealing a negative relationship between lesion volume and frontal activation, and a positive relationship between lesion volume and posterior activation. These preliminary data, albeit collected with small sample sizes, suggest that reduced non-prefrontal CBF, and possibly pathological tissue associated with T2-hyperintensities, may provide contributions to the diffuse, primarily posterior extra-activation observed in adolescents following moderate to severe TBI.

Localized blood flow imaging using quantitative flow-enhanced signal intensity

Flow-enhanced signal intensity (FENSI) was previously introduced as a novel functional imaging method for measuring changes in localized blood flow in response to a stimulus. However, FENSI was limited to a qualitative functional MRI tool, due to magnetization transfer effects and different tagging plane profiles between tag and control images. In this work, a revised FENSI acquisition is proposed to enable quantitative imaging, which is capable of providing absolute localized blood flow maps free from magnetization transfer and slice profile errors. The feasibility and accuracy of measuring microvascular (arteriole, capillary, and venule) blood flow by using quantitative FENSI was validated by our phantom studies. Additionally, localized cerebral blood flow, 366 ± 45 μL/min/cm(2) in gray matter and 153 ± 23 μL/min/cm(2) in white matter, was measured in healthy subjects during resting state, whereas a flow change of 73 ± 13% was detected during a visual task.

Determination of spin compartment in arterial spin labeling MRI

A major difference between arterial-spin-labeling MRI and gold-standard radiotracer blood flow methods is that the compartment localization of the labeled spins in the arterial-spin-labeling image is often ambiguous, which may affect the quantification of cerebral blood flow. In this study, we aim to probe whether the spins are located in the vascular system or tissue by using T2 of the arterial-spin-labeling signal as a marker. We combined two recently developed techniques, pseudo-continuous arterial spin labeling and T2-Relaxation-Under-Spin-Tagging, to determine the T2 of the labeled spins at multiple postlabeling delay times. Our data suggest that the labeled spins first showed the T2 of arterial blood followed by gradually approaching and stabilizing at the tissue T2. The T2 values did not decrease further toward the venous T2. By fitting the experimental data to a two-compartment model, we estimated gray matter cerebral blood flow, arterial transit time, and tissue transit time to be 74.0 ± 10.7 mL/100g/min (mean ± SD, N = 10), 938 ± 156 msec, and 1901 ± 181 msec, respectively. The arterial blood volume was calculated to be 1.18 ± 0.21 mL/100 g. A postlabeling delay time of 2 s is sufficient to allow the spins to completely enter the tissue space for gray matter but not for white matter.

Pseudo-continuous transfer insensitive labeling technique

Transfer insensitive labeling technique (TILT) was previously applied to acquire multislice cerebral blood flow maps as a pulsed arterial spin labeling (PASL) method. The magnetization transfer effect with TILT is well controlled by using concatenated radiofrequency pulses. However, use of TILT has been limited by several challenges, including slice profile errors, sensitivity to arterial transit time and intrinsic low signal-to-noise ratio (SNR). In this work, we propose to address these challenges by making the original TILT method into a novel pseudo-continuous arterial spin labeling approach, named pseudo-continuous transfer insensitive labeling technique (pTILT). pTILT improves perfusion acquisitions by (i) realizing pseudo-continuous tagging with nonadiabatic pulses, (ii) being sensitive to slow flows in addition to fast flows, and (iii) providing flexible labeling geometries. Perfusion maps during both resting state and functional tasks are successfully demonstrated in healthy volunteers with pTILT. A comparison with typical SNR values from other perfusion techniques shows that although pTILT provides less SNR than inversion-based pseudo-continuous ASL techniques, the modified sequence provides similar SNR to inversion-based PASL techniques.

Inflow-based vascular-space-occupancy (iVASO) MRI

Vascular-space-occupancy (VASO) MRI, a blood nulling approach for assessing changes in cerebral blood volume (CBV), is hampered by low signal-to-noise ratio (SNR) because only 10-20% of tissue signal is recovered when using nonselective inversion for blood nulling. A new approach, called inflow-VASO (iVASO), is introduced in which only blood flowing into the slice has experienced inversion, thereby keeping tissue and cerebrospinal fluid (CSF) signal in the slice maximal and reducing CSF partial volume effects. SNR increases of 198% ± 12% and 334% ± 9% (mean ± SD, n = 7) with respect to VASO were found at TR values of 5 s and 2 s, respectively. When using inflow approaches, data interpretation is complicated by the fact that signal changes are affected by vascular transit times. An optimal TR-range (1.5-2.5 s) was derived in which the iVASO response during activation predominantly reflects arterial/arteriolar CBV (CBV(a)) changes. In this TR-range, perfusion contributions to the signal change are negligible because arterial label has not yet undergone capillary exchange, and arterial and precapillary blood signals are nulled. For TR = 2 s, the iVASO signal change upon visual stimulation corresponded to a CBV(a) increase of 58% ± 7%, in agreement with arteriolar CBV changes previously reported. The onset of the hemodynamic response for iVASO occurred 1.2 ± 0.5 s (n = 7) faster than for conventional VASO.

Separation of macrovascular signal in multi-inversion time arterial spin labelling MRI

Arterial spin labeling (ASL) provides a noninvasive method to measure brain perfusion and is becoming an increasingly viable alternative to more invasive MR methods due to improvements in acquisition, such as the use of a three-dimensional GRASE readout. A potential source of error in ASL measurements is signal arising from intravascular blood that is destined for more distal tissue. This is typically suppressed using diffusion gradients in many ASL sequences. However, several problems exist with this approach, such as the choice of cutoff velocity and gradient direction and incompatibility with certain readout modules. An alternative approach is to explicitly model the intravascular signal. This study exploits this approach by using multi-inversion time ASL data with a recently developed model-fitting method. The method employed permits the intravascular contribution to be discarded in voxels where there is no support in the data for its inclusion, thereby addressing the issue of overfitting. It is shown by comparing data with and without flow suppression, and by comparing the intravascular contribution in GRASE ASL data to MR angiographic images, that the model-fitting approach can provide a viable alternative to flow suppression in ASL where suppression is either not feasible or not desirable.

Estimation of labeling efficiency in pseudocontinuous arterial spin labeling

Pseudocontinuous arterial spin labeling MRI is a new arterial spin labeling technique that has the potential of combining advantages of continuous arterial spin labeling and pulsed arterial spin labeling. However, unlike continuous arterial spin labeling, the labeling process of pseudocontinuous arterial spin labeling is not strictly an adiabatic inversion and the efficiency of labeling may be subject specific. Here, three experiments were performed to study the labeling efficiency in pseudocontinuous arterial spin labeling MRI. First, the optimal labeling position was determined empirically to be approximately 84 mm below the anterior commissure-posterior commissure line in order to achieve the highest sensitivity. Second, an experimental method was developed to utilize phase-contrast velocity MRI as a normalization factor and to estimate the labeling efficiency in vivo, which was founded to be 0.86 +/- 0.06 (n = 10, mean +/- standard deviation). Third, we compared the labeling efficiency of pseudocontinuous arterial spin labeling MRI under normocapnic and hypercapnic (inhalation of 5% CO(2)) conditions and showed that a higher flow velocity in the feeding arteries resulted in a reduction in the labeling efficiency. In summary, our results suggest that labeling efficiency is a critical parameter in pseudocontinuous arterial spin labeling MRI not only in terms of achieving highest sensitivity but also in quantification of absolute cerebral blood flow in milliliters per minute per 100 g. We propose that the labeling efficiency should be estimated using phase-contrast velocity MRI on a subject-specific basis.

Assessment of arterial arrival times derived from multiple inversion time pulsed arterial spin labeling MRI

The purpose of this study was to establish a normal range for the arterial arrival time (AAT) in whole-brain pulsed arterial spin labeling (PASL) cerebral perfusion MRI. Healthy volunteers (N = 36, range: 20 to 35 years) provided informed consent to participate in this study. AAT was assessed in multiple brain regions, using three-dimensional gradient and spin echo (GRASE) pulsed arterial spin labeling at 3.0 T, and found to be 641 +/- 95, 804 +/- 91, 802 +/- 126, and 935 +/- 108 ms in the temporal, parietal, frontal, and occipital lobes, respectively. Mean gray matter AAT was found to be 694 +/- 89 ms for females (N = 15), which was significantly shorter than for men, 814 +/- 192 ms (N = 21; P < 0.0003), and significant after correcting for brain volume (P < 0.001). Significant AAT sex differences were also found using voxelwise permutation testing. An atlas of AAT values across the healthy brain is presented here and may be useful for future experiments that aim to quantify cerebral blood flow from ASL data, as well as for clinical comparisons where disease pathology may lead to altered AAT. Pulsed arterial spin labeling signals were simulated using an identical sampling scheme as the empiric study and revealed AAT can be estimated robustly when simulated arrival times are well beyond the normal range.

Arterial transit time effects in pulsed arterial spin labeling CBF mapping: insight from a PET and MR study in normal human subjects

Arterial transit time (ATT), a key parameter required to calculate absolute cerebral blood flow in arterial spin labeling (ASL), is subject to much uncertainty. In this study, ASL ATTs were estimated on a per-voxel basis using data measured by both ASL and positron emission tomography in the same subjects. The mean ATT increased by 260 +/- 20 (standard error of the mean) ms when the imaging slab shifted downwards by 54 mm, and increased from 630 +/- 30 to 1220 +/- 30 ms for the first slice, with an increase of 610 +/- 20 ms over a four-slice slab when the gap between the imaging and labeling slab increased from 20 to 74 mm. When the per-slice ATTs were employed in ASL cerebral blood flow quantification and the in-slice ATT variations ignored, regional cerebral blood flow could be significantly different from the positron emission tomography measures. ATT also decreased with focal activation by the same amount for both visual and motor tasks (approximately 80 ms). These results provide a quantitative relationship between ATT and the ASL imaging geometry and yield an assessment of the assumptions commonly used in ASL imaging. These findings should be considered in the interpretation of, and comparisons between, different ASL-based cerebral blood flow studies. The results also provide spatially specific ATT data that may aid in optimizing the ASL imaging parameters.

Noninvasive quantification of whole-brain cerebral metabolic rate of oxygen (CMRO2) by MRI

Cerebral metabolic rate of oxygen (CMRO(2)) is an important marker for brain function and brain health. Existing techniques for quantification of CMRO(2) with positron emission tomography (PET) or MRI involve special equipment and/or exogenous agents, and may not be suitable for routine clinical studies. In the present study, a noninvasive method is developed to estimate whole-brain CMRO(2) in humans. This method applies phase-contrast MRI for quantitative blood flow measurement and T(2)-relaxation-under-spin-tagging (TRUST) MRI for venous oxygenation estimation, and uses the Fick principle of arteriovenous difference for the calculation of CMRO(2). Whole-brain averaged CMRO(2) values in young, healthy subjects were 132.1 +/- 20.0 micromol/100 g/min, in good agreement with literature reports using PET. Various acquisition strategies for phase-contrast and TRUST MRI were compared, and it was found that nongated phase-contrast and sagittal sinus (SS) TRUST MRI were able to provide the most efficient and accurate estimation of CMRO(2). In addition, blood flow and venous oxygenation were found to be positively correlated across subjects. Owing to the noninvasive nature of this method, it may be a convenient and useful approach for assessment of brain metabolism in brain disorders as well as under various physiologic conditions.

On the assessment of cerebrovascular reactivity using hypercapnia BOLD MRI

Cerebrovascular reactivity (CVR) reflects the capacity of blood vessels to dilate and is an important marker for brain vascular reserve. It may provide a useful addition to the traditional baseline blood flow measurement when assessing vascular factors in brain disorders. Blood-oxygenation-level-dependent MRI under CO(2) inhalation offers a non-invasive and quantitative means to estimate CVR in humans. In this study, we investigated several important methodological aspects of this technique with the goal of optimizing the experimental and data processing strategies for clinical use. Comparing 4 min of 5% CO(2) inhalation (less comfortable) to a 1 min inhalation (more comfortable) duration, it was found that the CVR values were 0.31 +/- 0.05%/mmHg (N = 11) and 0.31 +/- 0.08%/mmHg (N = 9), respectively, showing no significant differences between the two breathing paradigms. Therefore, the 1 min paradigm is recommended for future application studies for patient comfort and tolerability. Furthermore, we have found that end-tidal CO(2) recording was useful for accurate quantification of CVR because it provided both timing and amplitude information regarding the input function to the brain vascular system, which can be subject-dependent. Finally, we show that inter-subject variations in CVR are of physiologic origin and affect the whole brain in a similar fashion. Based on this, it is proposed that relative CVR (normalized against the CVR of the whole brain or a reference tissue) may be a more sensitive biomarker than absolute CVR in clinical applications as it minimizes inter-subject variations. With these technological optimizations, CVR mapping may become a useful method for studies of neurological and psychiatric diseases.

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.

Baseline blood oxygenation modulates response amplitude: Physiologic basis for intersubject variations in functional MRI signals

Although BOLD functional MRI (fMRI) provides a useful tool for probing neuronal activities, large intersubject variations in signal amplitude are commonly observed. Understanding the physiologic basis for these variations will have a significant impact on many fMRI studies. First, the physiologic modulator can be used as a regressor to reduce variations across subjects, thereby improving statistical power for detecting group differences. Second, if a pathologic condition or a drug treatment is shown to change fMRI responses, monitoring this modulatory parameter is useful in correctly interpreting the fMRI changes to neuronal deficits/recruitments. Here we present evidence that the task-evoked fMRI signals are modulated by baseline blood oxygenation. To measure global blood oxygenation, we used a recently developed technique, T(2) relaxation under spin-tagging (TRUST) MRI, which yielded baseline oxygenation of 63.7% +/- 7.2% in the sagittal sinus with an estimation error of 1.3%. It was found that individuals with higher baseline oxygenation tend to have a smaller fMRI signal, and vice versa. For every 10% difference in baseline oxygenation across subjects, BOLD and cerebral blood flow (CBF) signals differ by -0.4% and -30.0%, respectively, when using visual stimulation. TRUST MRI is a useful measurement for fMRI studies to control for the modulatory effects of baseline oxygenation that are unique to each subject.

Assessment of the Contribution of the External Carotid Artery to Brain Perfusion in Patients With Internal Carotid Artery Occlusion

Background and Purpose— The purpose of this study was to prospectively investigate the contribution of the ipsilateral external carotid artery (ECA) to cerebral perfusion in patients with internal carotid artery occlusion.

Methods— Institutional Review Board approval and informed consent were obtained. Thirty functionally independent patients (24 men, 6 women; mean age, 63 years) with an angiographically proven unilateral internal carotid artery occlusion and transient or minor disabling ischemic attacks ipsilateral to the side of the internal carotid artery occlusion were included. Grading of ECA collateral flow was performed with intraarterial digital subtraction angiography. The contribution of the ECA to regional cerebral blood flow was assessed with selective arterial spin labeling MRI. Differences in regional cerebral blood flow were analyzed with Student t test.

Results— Twenty percent of the patients had ECA Grade 0 collateral flow (no filling of ophthalmic artery), 20% Grade 1 (filling of carotid siphon), and 60% Grade 2 (filling of anterior and/or middle cerebral artery) as demonstrated on digital subtraction angiography. Although in the Grade 1 group, the ECA supplied a smaller region of the brain compared with the Grade 2 group, the mean regional cerebral blood flow of the perfusion territory supplied by the ECA is similar ( P =0.70) in the Grade 1 group (mean±SD 57±16 mL/min/100 g) and the Grade 2 group (60±12 mL/min/100g).

Conclusion— In patients with symptomatic internal carotid artery occlusion, focal brain regions may strongly depend on the contribution to cerebral perfusion of the ECA ipsilateral to the side of the internal carotid artery occlusion, even in patients with limited ECA collateral supply as demonstrated on digital subtraction angiography.

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.

Modeling and optimization of Look-Locker spin labeling for measuring perfusion and transit time changes in activation studies taking into account arterial blood volume

This work describes a new compartmental model with step-wise temporal analysis for a Look-Locker (LL)-flow-sensitive alternating inversion-recovery (FAIR) sequence, which combines the FAIR arterial spin labeling (ASL) scheme with a LL echo planar imaging (EPI) measurement, using a multireadout EPI sequence for simultaneous perfusion and T*(2) measurements. The new model highlights the importance of accounting for the transit time of blood through the arteriolar compartment, delta, in the quantification of perfusion. The signal expected is calculated in a step-wise manner to avoid discontinuities between different compartments. The optimal LL-FAIR pulse sequence timings for the measurement of perfusion with high signal-to-noise ratio (SNR), and high temporal resolution at 1.5, 3, and 7T are presented. LL-FAIR is shown to provide better SNR per unit time compared to standard FAIR. The sequence has been used experimentally for simultaneous monitoring of perfusion, transit time, and T*(2) changes in response to a visual stimulus in four subjects. It was found that perfusion increased by 83 +/- 4% on brain activation from a resting state value of 94 +/- 13 ml/100 g/min, while T*(2) increased by 3.5 +/- 0.5%.

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.

Effect of cerebrovascular risk factors on regional cerebral blood flow

PURPOSE

To prospectively investigate which cerebrovascular risk factors are related to regional cerebral blood flow (rCBF), as measured noninvasively with arterial spin-labeling (ASL) magnetic resonance (MR) imaging, in a large group of patients with symptomatic atherosclerotic disease.

MATERIALS AND METHODS

Ethics committee approval and informed consent were obtained. One hundred thirty consecutive patients (107 men, 23 women; mean age, 58 years +/- 10 [standard deviation]) with symptomatic atherosclerotic disease were included in the study. Cerebrovascular risk factors (body mass index, carotid artery stenosis, diabetes mellitus, hyperhomocysteinemia, hyperlipidemia, hypertension, and smoking) were assessed by means of a questionnaire and physical, ultrasonographic, and laboratory examinations. The control group consisted of 10 subjects (eight men, two women; mean age, 58 years +/- 15) without symptomatic atherosclerotic disease. rCBF measurements were performed with ASL MR imaging. The effects of the individual cerebrovascular risk factors on the rCBF were assessed by using linear regression analysis.

RESULTS

Hypertension was significantly associated with higher rCBF (adjusted beta = 6.5 mL/min/100 g; 95% confidence interval: 1.4 mL/min/100 g, 11.7 mL/min/100 g). Hyperhomocysteinemia was significantly related to lower rCBF (adjusted beta = -7.4 mL/min/100 g; 95% confidence interval: -12.7 mL/min/100 g, -2.1 mL/min/100 g). No significant associations between rCBF and the other cerebrovascular risk factors were found.

CONCLUSION

In patients with symptomatic atherosclerotic disease, hypertension is related to higher rCBF and hyperhomocysteinemia is related to lower rCBF.

Noninvasive measurement of arterial cerebral blood volume using Look-Locker EPI and arterial spin labeling

This paper describes a method of noninvasively measuring regional arterial cerebral blood volume fractions (CBV(a)) in vivo using the combination of Look-Locker echo-planar imaging (LL-EPI) with arterial spin labeling (ASL). Using this technique the arterial inflow curve is rapidly sampled and the regional CBV(a) is measured, while tissue perfusion signals are suppressed. Two methods of spin labeling (LL-EPI flow-sensitive alternating inversion recovery (LL-EPI-FAIR) and LL-EPI signal targeting using alternating radiofrequency (LL-EPI-STAR)) are assessed and their advantages discussed. The application of vascular crushing to LL-EPI-FAIR is described and used to validate the insensitivity of the sequence to the perfusion difference signal. LL-EPI-STAR is used to assess changes in CBV(a) in response to a finger-tapping task. LL-EPI-STAR signal difference curves are shown to have a shortened vascular transit delay and increased peak signal change on activation. A 33 +/- 14% increase in CBV(a) on activation is found. CBV(a) is measured with a 6-s temporal resolution and the temporal response is compared with the BOLD signal change. CBV(a) is shown to increase more rapidly and return to baseline significantly faster than the BOLD signal change, which supports the suggestion that a change in CBV(a) is an input to the BOLD response.

Altered flow territories after carotid stenting and carotid endarterectomy

BACKGROUND

The hemodynamic effects of carotid angioplasty with stent placement (CAS) on the collateral blood supply and on the regional cerebral blood flow (rCBF) have not been established. Recently, arterial spin-labeling (ASL) magnetic resonance imaging (MRI) has been introduced as the first method to quantify the actual territorial contribution of individual collateral arteries as well as to noninvasively measure rCBF. This study investigated alterations in flow territories and rCBF in patients with symptomatic internal carotid artery (ICA) stenosis and compared them with healthy control subjects. In addition, we investigated whether possible differences in flow territories and rCBF were present between patients undergoing CAS and patients undergoing carotid endarterectomy (CEA).

METHODS

The study included 24 consecutive patients (15 men and 9 women; age 67+/-9 years) with symptomatic ICA stenosis. CAS was performed in 12 patients, and 12 patients underwent CEA. Flow territory mapping and rCBF measurements were performed with ASL MRI before intervention and 1 month after. The control group consisted of 40 subjects (25 men and 15 women; age 67+/-8 years).

RESULTS

The flow territory of the ipsilateral ICA in patients with ICA stenosis was smaller, and the territories of the contralateral ICA and vertebrobasilar arteries were larger compared with control subjects (P<.05). After CAS, rCBF in the ipsilateral hemisphere increased from 60.2+/-16.9 mL/(min.100 g) to 68.9+/-9.2 mL/(min.100 g) (P<.05). Differences in flow territories and rCBF between patients and control subjects disappeared after CAS. Changes in flow territories and rCBF were similar in patients who underwent CAS or CEA.

CONCLUSIONS

CAS results in a normalization of the territorial distribution and rCBF, as assessed by ASL MRI. The degree of improvement is similar to that seen after CEA.

Sensitivity comparison of multiple vs. single inversion time pulsed arterial spin labeling fMRI

PURPOSE

To study the sensitivity for detection of activation for multiple vs. single inversion time (TI) pulsed arterial spin labeling (PASL).

MATERIALS AND METHODS

The number of activated voxels and the mean t-statistic over activated voxels was measured by means of multiple and single TI PASL sequences in five volunteers during visual stimulation by means of an alternating checkerboard. Acquisition was performed by means of the transfer insensitive labeling technique (TILT) and TURBO-TILT.

RESULTS

It was found that the sensitivity for the detection of activation was lower for an individual TI out of a multiple TI sequence than for the corresponding single TI acquisition of equal duration. After averaging over all TIs between and including 600 and 1400 msec, the number of activated voxels and mean t-statistic were no longer statistically lower for the multiple TI sequence than for the single TI experiment.

CONCLUSION

Multiple TI PASL can be used for functional MRI (fMRI) studies, when performing the detection of activated brain regions on data that is averaged over all TIs between 600 and 1400 msec. Subsequently the multi-TI data can be used to quantify cerebral blood flow (CBF) changes upon activation. Additionally, we have shown that single TI PASL fMRI overestimates the CBF changes upon activation due to transit time changes.

Increasing levels of TNFalpha are associated with increased brain perfusion

OBJECTIVE

Recent reports of animal models have shown that growth factors have stimulating effect on brain perfusion via the development of blood vessels. However, studies on the effect of growth factors on brain perfusion in humans are lacking. The aim of our study was to prospectively investigate in humans the relation between growth factors and brain perfusion.

METHODS

We analyzed circulating levels of vascular endothelial growth factor (VEGF), granulocyte-macrophage colony-stimulating growth factor (GM-CSF), tumor necrosis factor alpha (TNFalpha) and basic fibroblast growth factor (bFGF) in 121 consecutive patients (99 men and 22 women, age 58+/-10 years) who were enrolled in a prospective cohort study of patients with symptomatic atherosclerotic disease. In all patients regional cerebral blood flow (rCBF; in mL/min/100g) measurements were performed with arterial spin labeling magnetic resonance imaging. Cerebrovascular risk factors were assessed by means of a questionnaire and physical, ultrasonographic and laboratory examination.

RESULTS

Increasing levels of TNFalpha were significantly associated with a higher rCBF (beta=7.0; 95% confidence interval 0.7; 13.9), independent of the presence of cerebrovascular risk factors. No significant association was found for VEGF, GM-CSF and bFGF.

CONCLUSIONS

Increasing levels of TNFalpha are associated with increased rCBF, independent of the presence of cerebrovascular risk factors.

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.

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.

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.

Effects of oxygen saturation on BOLD and arterial spin labelling perfusion fMRI signals studied in a motor activation task

Effects of oxygen availability on blood oxygenation level dependent (BOLD) and arterial spin labelling (ASL) perfusion functional magnetic resonance imaging (fMRI) signal changes upon motor activation were studied. Mild hypoxic hypoxia was induced by reducing the inspired oxygen content (FIO(2)) to 12%, decreasing blood oxygen saturation (Y) from 0.99 +/- 0.01 to 0.85 +/- 0.03. The fMRI signal characteristics were determined during finger tapping. BOLD activation volume decreased as a function of declining Y in the brain structures involved in execution of the motor task, however, the BOLD signal increase in activated parenchyma was not influenced by Y. ASL fMRI showed that the baseline CBF of 61.8 +/- 3.6 ml/100 g/min was not affected by hypoxic hypoxia. Similar to the BOLD fMRI, the volume of motor cortex areas displaying increase in perfusion by ASL fMRI decreased, but the signal change due to perfusion increase was not influenced in hypoxia. The present fMRI results show distinct patterns of haemodynamic and metabolic responses in the brain to motor task between normoxia and hypoxia. On one hand, neither BOLD nor ASL fMRI signal changes are influenced by hypoxia during motor activation. On the other hand, hypoxia attenuates increase in both BOLD and perfusion fMRI signals upon finger tapping from the levels determined in normoxia. These observations indicate that haemodynamic and metabolic responses may be heterogeneous in brain during execution of motor functions in mild hypoxia.

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.

Heterogeneous oxygen extraction in the visual cortex during activation in mild hypoxic hypoxia revealed by quantitative functional magnetic resonance imaging

Functional magnetic resonance imaging (fMRI) techniques were used to study haemodynamic and metabolic responses in human visual cortex during varying arterial blood oxygen saturation levels (Y(sat), determined by pulse-oximeter) and stimulation with contrast-reversing checkerboards. The visual-evoked potential amplitude remained constant at lowered Y(sat) of 0.82+/-0.03. Similarly, fMRI cerebral blood flow (CBF) responses were unchanged during reduced Y(sat). In contrast, visual cortex volume displaying blood oxygen level-dependent (BOLD) fMRI response decreased as a function of Y(sat), but the BOLD signal change of 3.6%+/-1.4% was constant. Oxygen extraction ratio (OER) during visual activation showed values of 0.26+/-0.03 for normal Y(sat). At lowered Y(sat), two OER patterns were observed. Firstly, a reduced OER of 0.14+/-0.03 in the visual cortex structures showing BOLD in hypoxia was observed. Secondly, signs of much higher OER in other parts of visual cortex were obtained. T2*-weighted magnetic resonance imaging revealed signal increases by 0.8%+/-0.4% with visual activation during lowered Y(sat) in the visual cortex structures, which showed BOLD of 3.6% in magnitude under normoxia. Because the CBF response in the visual cortex was quantitatively similar during stimulation in normoxia and hypoxia, attenuated T2*-weighted signal increase in parts of visual cortex indicated high OER during visual activation in hypoxia, which was close to that encountered in the resting brain. These spatially localised regions of tissue oxygen extraction and metabolism argue for dissociation between CBF and BOLD fMRI signals in mild hypoxia. The findings point to heterogeneity with regard to oxygen requirement and its coupling to the haemodynamic response in the brain.

Quantitative study of changes in oxidative metabolism during visual stimulation using absolute relaxation rates

In the context of quantitative functional MRI (fMRI), deoxyhemoglobin (dHb) content is the essential physiological parameter for calibrating the blood oxygenation level-dependent (BOLD) signal. In studies on humans, the baseline dHb content or its equivalent has been evaluated indirectly by means of carbon dioxide breathing as a physiological reference condition. In this study with normal volunteers, quantitative mapping of baseline dHb content was performed in a direct manner by measuring the reversible contribution of the effective transverse relaxation rate. The BOLD signal change in the visual cortex during 8 Hz flicker visual stimulation was calibrated based on the quantitative map of baseline dHb content. The calibrated relaxation rate change that represents the stimulation-induced fractional change of dHb content decreased by 14% within the activated visual cortex. Simultaneous measurement of cerebral blood flow (CBF) with BOLD showed an increase of 59%. From the calibrated relaxation rate and CBF changes, the cerebral metabolic rate of oxygen (CMRO2) was calculated to increase by 19-28% within the activated visual cortex. The ratio of the CBF increase to the CMRO2 increase was 2-3:1, which agreed well with results of similar quantitative fMRI studies for humans. The method proposed here for quantitative evaluation of the BOLD signal may be applicable not only to fMRI for normal human subjects, but also to physiologically altered or diseased states, because it requires no physiological perturbation.

Regional variation of cerebral blood flow and arterial transit time in the normal and hypoperfused rat brain measured using continuous arterial spin labeling MRI

Continuous arterial spin labeling (CASL) is a noninvasive magnetic resonance (MR) method for measuring cerebral perfusion. In its most widely used form, CASL incorporates a postlabeling delay to minimize the sensitivity of the technique to transit time effects, which otherwise corrupt cerebral blood flow (CBF) quantification. For this delay to work effectively, it must be longer than the longest transit time present in the system. In this work, CASL measurements were made in four coronal slices in the rat brain using a range of postlabeling delays. By doing this, direct estimation of both CBF and arterial transit time (delta(a)) was possible. These measurements were performed in the normal brain and during hypoperfusion induced by occlusion of the common carotid arteries. It was found that, in the normal rat brain, significant regional variation exists for both CBF and delta(a). Mean values of CBF and delta(a) in the selected gray matter regions of interest were 233 mL/100 g min and 266 ms, respectively, with the latter ranging from 100 to 500 ms. Therefore, use of a 500-ms postlabeling delay is suitable for any location in the normal rat brain. After common carotid artery occlusion, CBF decreased and delta(a) increased by regionally dependent amounts. In the sensory cortex, delta(a) increased to a mean value of 740 ms, significantly greater than 500 ms. These results highlight the importance of either (a) determining delta(a) as part of the CASL measurement or (b) knowing the approximate range of values delta(a) is likely to take for a given application, so that the parameters of the CASL sequence can be chosen appropriately.

Cerebral vascular response to hypercapnia: Determination with perfusion MRI at 1.5 and 3.0 Tesla using a pulsed arterial spin labeling technique

PURPOSE

To compare the quantification of cerebral blood flow (CBF) at 1.5 and 3.0 Tesla, under normo- and hypercapnia, and to determine the cerebral vascular response (CVR) of gray matter (GM) to hypercapnia, a pulsed arterial spin labeling technique was used. Additionally, to improve GM CBF quantification a high-resolution GM-mask was applied.

MATERIALS AND METHODS

CBF was determined with the QUIPSS II with thin slice TI1 periodic saturation (Q2TIPS) sequence at 1.5 and 3.0 Tesla in the same group of eight subjects, both under normocapnia and hypercapnia. Absolute GM-CBF maps were calculated using a GM-mask obtained from a high-resolution structural scan by segmentation. The CVR to hypercapnia was derived from the quantitative GM-CBF maps.

RESULTS

For both field strengths, the GM-CBF was significantly higher under hypercapnia compared to normocapnia. For both conditions, there was no significant difference of GM-CBF for 1.5 and 3.0 Tesla; the same applies to the CVR, which was 4.3 and 4.5%/mmHg at 1.5 and 3.0 Tesla, respectively.

CONCLUSION

The method presented allows for the quantification of CBF and CVR in GM at the common clinical field strengths of 1.5 and 3.0 Tesla and could therefore be a useful tool to study these parameters under physiological and pathophysiological conditions.

Altered Flow Territories after Extracranial-Intracranial Bypass Surgery

OBJECTIVE:

To prevent stroke after carotid sacrifice and to augment cerebral perfusion in patients with internal carotid artery (ICA) occlusion, high-flow extracranial-intracranial (EC-IC) bypass operations are performed. Although the function and efficacy of the bypass is monitored during surgery, the postoperative flow through the bypass is significantly lower than the flow in the contralateral ICA. Thus far, it is unknown whether decreased bypass flow is caused by a low tissue perfusion or by a relatively small flow territory.

METHODS:

Seven patients, four with an atherosclerotic ICA occlusion and three with a giant aneurysm of the ICA, were investigated; each underwent a high-flow EC-IC bypass and permanent occlusion of the ICA. Cerebral blood flow was measured with arterial spin labeling perfusion magnetic resonance imaging. Separate flow territory mapping of the EC-IC bypass, contralateral ICA, and posterior circulation was performed with selective arterial spin labeling magnetic resonance imaging.

RESULTS:

No significant difference was found in cerebral blood flow between the hemisphere ipsilateral to the EC-IC bypass (70.9 ± 11.3 ml/min/100 g tissue), contralateral to the EC-IC bypass (71.9 ± 14.3 ml/min/100 g tissue), and comparable findings in 50 healthy control participants (69.1 ± 17.5 ml/min/100 g tissue). Paired analysis of the individual flow territories demonstrated a 15% volume reduction (P = 0.018) in flow territory of the EC-IC bypass compared with the contralateral side.

CONCLUSION:

In the present study, we demonstrate the feasibility of selective arterial spin labeling magnetic resonance imaging for clinical follow-up of patients after high-flow EC/IC bypass surgery, providing both information on flow territories and the level of regional cerebral blood flow.

In vivo flow territory mapping of major brain feeding arteries

The ability to visualize the perfusion territories of major feeding arteries to the brain is important for many clinical applications. Since the work of Duret in 1874 on vascularization of the brain, many textbooks and atlases have shown schematic drawings of the supply areas of the major cerebral arteries. Recent postmortem studies demonstrated that the variability of the cerebral vascular territories is significantly greater than previously assumed. The aim of the present study was to investigate in vivo, the variability of flow territories of major brain feeding arteries. Flow territory mapping of the anterior (internal carotid arteries) and posterior (basilar artery) circulation was performed in 115 (58 +/- 9 years of age) subjects with selective arterial spin labeling MRI. Flow territory maps for the entire population indicated significant variation in flow territories. However, when the subjects are further categorized into groups with a complete circle of Willis, with a missing A1 segment and with a unilateral or bilateral fetal-type posterior cerebral artery, the results showed considerably lower variation within groups. It is therefore concluded that, the variation observed from the entire population is mainly caused by anatomical variants of the circle of Willis. To relate focal brain lesions to underlying flow territories in individual cases, knowledge of the anatomy of the circle of Willis is essential.