Fast, pseudo-continuous arterial spin labeling for functional imaging using a two-coil system

Role of Arterial Spin Labeling (ASL) Images in Parkinson's Disease (PD): A Systematic Review

RATIONALE AND OBJECTIVES

Parkinson's disease is a chronic progressive neurodegenerative disorder with standard structural MRIs often showing no gross abnormalities. Quantitative perfusion MRI modality Arterial Spin Labeling (ASL) is helpful in identifying PD specific perfusion patterns. Absolute Cerebral blood flow (CBF) measurement using ASL provides insights into regional perfusion abnormalities. We reviewed the role of ASL to identify specific brain regions responsible for motor, non-motor symptoms and neurovascular changes observed in PD. Challenges in assessing the blood perfusion level are discussed with future development for improving the evaluation of ASL perfusion maps.

MATERIALS AND METHODS

We included CBF quantification studies using ASL for PD diagnosis. A systematic search was performed in Pubmed, Scopus and Web of Science. The perfusion parameters CBF and arterial arrival time (AAT) measured using ASL were considered for brain region assessment. Clinical aspects of PD have been analyzed using ASL perfusion maps.

RESULTS

The systematic search identified 153 unique records. Thirty articles were selected after verification of inclusion and exclusion criteria. Voxel and region-based analyses in white and gray matter tissues have been performed to identify PD-specific perfusion patterns by reported articles. Predominant brain regions such as basal ganglia sub-regions, frontoparietal network, precuneus, occipital lobe, sensory motor area regions, visual network, which are associated with motor and non-motor symptoms in PD, were identified with CBF hypoperfusion, indicating neuronal loss and cerebrovascular dysfunction.

CONCLUSION

CBF and AAT values derived from ASL can potentially be used as biomarkers to discriminate PD from similar brain-related disorders.

Reliability of task-specific neuronal activation assessed with functional PET, ASL and BOLD imaging

Mapping the neuronal response during cognitive processing is of crucial importance to gain new insights into human brain function. BOLD imaging and ASL are established MRI methods in this endeavor. Recently, the novel approach of functional PET (fPET) was introduced, enabling absolute quantification of glucose metabolism at rest and during task execution in a single measurement. Here, we report test-retest reliability of fPET in direct comparison to BOLD imaging and ASL. Twenty healthy subjects underwent two PET/MRI measurements, providing estimates of glucose metabolism, cerebral blood flow (CBF) and blood oxygenation. A cognitive task was employed with different levels of difficulty requiring visual-motor coordination. Task-specific neuronal activation was robustly detected with all three imaging approaches. The highest reliability was obtained for glucose metabolism at rest. Although this dropped during task performance it was still comparable to that of CBF. In contrast, BOLD imaging yielded high performance only for qualitative spatial overlap of task effects but not for quantitative comparison. Hence, the combined assessment of fPET and ASL offers reliable and simultaneous absolute quantification of glucose metabolism and CBF at rest and task.

Arterial cerebral blood volume-weighted functional MRI using pseudocontinuous arterial spin tagging (AVAST)

PURPOSE

Neurovascular regulation, including responses to neural activation that give rise to the blood oxygenation level-dependent (BOLD) effect, occurs mainly at the arterial and arteriolar level. The purpose of this study is to develop a framework for fast imaging of arterial cerebral blood volume (aCBV) signal suitable for functional imaging studies.

METHODS

A variant of the pseudocontinuous arterial spin tagging technique was developed in order to achieve a contrast that depends on aCBV with little contamination from perfusion signal by taking advantage of the kinetics of the tag through the vasculature. This technique tailors the tagging duration and repetition time for each subject. The proposed technique, called AVAST, is compared empirically with BOLD imaging and standard (perfusion-weighted) arterial spin labeling (ASL) technique, in a motor-visual activation paradigm.

RESULTS

The average Z-scores in the activated area obtained over all the subjects were 4.25, 5.52, and 7.87 for standard ASL, AVAST, and BOLD techniques, respectively. The aCBV contrast obtained from AVAST provided 80% higher average signal-to-noise ratio and 95% higher average contrast-to-noise ratio compared with that of the standard ASL measurements.

CONCLUSION

AVAST exhibits improved activation detection sensitivity and temporal resolution over the standard ASL technique, in functional MRI experiments, while preserving its quantitative nature and statistical advantages. AVAST particularly could be useful in clinical studies of pathological conditions, longitudinal studies of cognitive function, and studies requiring sustained periods of the condition.

Mapping of arterial transit time by intravascular signal selection

The arterial transit time (δa ) is a potentially important physiological parameter which may provide valuable information for the characterization of cerebrovascular diseases. The present study shows that δa can be measured by arterial spin labeling (ASL) applied quasi-continuously in an amplitude-modulated fashion at the human neck. Imaging was performed using short repetition times and excitation flip angles of 90°, which resulted in the selection of an ASL signal of mostly intravascular origin. Model-independent estimates of δa were obtained directly from the temporal shift of the ASL time series. An extended two-compartment perfusion model was developed in order to simulate the basic features of the proposed method and to validate the evaluation procedure. Vascular structures found in human δa maps, such as the circle of Willis or cerebral border zones, hint at the sensitivity of the method to most sizes of arterial vessels. Group-averaged values of δa measured from the carotid bifurcation to the tissue of interest in selected regions of the human brain ranged from 925 ms in the insular cortex to 2000 ms in the thalamic region.

Arterial Spin Labeling (ASL) fMRI: advantages, theoretical constrains, and experimental challenges in neurosciences

Cerebral blood flow (CBF) is a well-established correlate of brain function and therefore an essential parameter for studying the brain at both normal and diseased states. Arterial spin labeling (ASL) is a noninvasive fMRI technique that uses arterial water as an endogenous tracer to measure CBF. ASL provides reliable absolute quantification of CBF with higher spatial and temporal resolution than other techniques. And yet, the routine application of ASL has been somewhat limited. In this review, we start by highlighting theoretical complexities and technical challenges of ASL fMRI for basic and clinical research. While underscoring the main advantages of ASL versus other techniques such as BOLD, we also expound on inherent challenges and confounds in ASL perfusion imaging. In closing, we expound on several exciting developments in the field that we believe will make ASL reach its full potential in neuroscience research.

B0 field inhomogeneity considerations in pseudo-continuous arterial spin labeling (pCASL): effects on tagging efficiency and correction strategy

Pseudo-continuous arterial spin labeling (pCASL) is a very powerful technique to measure cerebral perfusion, which circumvents the problems affecting other continuous arterial spin labeling schemes, such as magnetization transfer and duty cycle. However, some variability in the tagging efficiency of the pCASL technique has been reported. This article investigates the effect of B(0) field inhomogeneity on the tagging efficiency of the pCASL pulse sequence as a possible cause of this variability. Both theory and simulated data predict that the efficiency of pseudo-continuous labeling pulses can be degraded in the presence of off-resonance effects. These findings are corroborated by human in vivo measurements of tagging efficiency. On the basis of this theoretical framework, a method utilizing B(0) field map information is proposed to correct for the possible loss in tagging efficiency of the pCASL pulse sequence. The efficiency of the proposed correction method is evaluated using numerical simulations and in vivo implementation. The data show that the proposed method can effectively recover the lost tagging efficiency and signal-to-noise ratio of pCASL caused by off-resonance effects.

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.

Real-time functional MRI using pseudo-continuous arterial spin labeling

The first implementation of real-time acquisition and analysis of arterial spin labeling-based functional magnetic resonance imaging time series is presented in this article. The implementation uses a pseudo-continuous labeling scheme followed by a spiral k-space acquisition trajectory. Real-time reconstruction of the images, preprocessing, and regression analysis of the functional magnetic resonance imaging data were implemented on a laptop computer interfaced with the MRI scanner. The method allows the user to track the current raw data, subtraction images, and the cumulative t-statistic map overlaid on a cumulative subtraction image. The user is also able to track the time course of individual time courses and interactively selects a region of interest as a nuisance covariate. The pulse sequence allows the user to adjust acquisition and labeling parameters while observing their effect on the image within two successive pulse repetition times. This method is demonstrated by two functional imaging experiments: a simultaneous finger-tapping and visual stimulation paradigm, and a bimanual finger-tapping task.

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.

Challenges to attention: a continuous arterial spin labeling (ASL) study of the effects of distraction on sustained attention

Maintaining attention and performance over time is an essential part of many activities, and effortful cognitive control is required to avoid vigilance decrements and interference from distraction. Regions at or near right middle frontal gyrus (Brodmann's area (BA) 9), as well as in other prefrontal and parietal areas, are often activated in studies of sustained attention (e.g., Cabeza and Nyberg, 2000; Kim et al., 2006; Lim et al., 2010). This activation has often been interpreted as representing the engagement of cognitive control processes. However, such studies are typically implemented at one level of task difficulty, without an experimental manipulation of control demands. The present study used the distractor condition sustained attention task (dSAT), which has been used extensively in animals to determine the role of neuromodulator systems in attentional performance, to test the hypotheses that BA 9 is sensitive to changes in the demand for cognitive control and that this sensitivity reflects an increased engagement of attentional effort. Continuous arterial spin labeling (ASL) was used to measure neural activity in sixteen healthy, young adults performing a sustained attention task under standard conditions and under a distraction condition that provided an experimental manipulation of demands on cognitive control. The distractor impaired behavioral performance and increased activation in right middle frontal gyrus. Larger increases in right middle frontal gyrus activity were associated with greater behavioral vulnerability to the distractor. These findings indicate that while right middle frontal gyrus regions are sensitive to demands for attentional effort and control, they may not be sufficient to maintain performance under challenge. In addition, they demonstrate the sensitivity of ASL methods to variations in task demands, and suggest that the dSAT may be a useful tool for translational cross-species and clinical research.

Quantitative analysis of arterial spin labeling FMRI data using a general linear model

Arterial spin labeling techniques can yield quantitative measures of perfusion by fitting a kinetic model to difference images (tagged-control). Because of the noisy nature of the difference images investigators typically average a large number of tagged versus control difference measurements over long periods of time. This averaging requires that the perfusion signal be at a steady state and not at the transitions between active and baseline states in order to quantitatively estimate activation induced perfusion. This can be an impediment for functional magnetic resonance imaging task experiments. In this work, we introduce a general linear model (GLM) that specifies Blood Oxygenation Level Dependent (BOLD) effects and arterial spin labeling modulation effects and translate them into meaningful, quantitative measures of perfusion by using standard tracer kinetic models. We show that there is a strong association between the perfusion values using our GLM method and the traditional subtraction method, but that our GLM method is more robust to noise.

Complex-valued analysis of arterial spin labeling-based functional magnetic resonance imaging signals

Cerebral blood flow-dependent phase differences between tagged and control arterial spin labeling images are reported. A biophysical model is presented to explain the vascular origin of this difference. Arterial spin labeling data indicated that the phase difference is largest when the arterial component of the signals is preserved but is greatly reduced as the arterial contribution is suppressed by postinversion delays or flow-crushing gradients. Arterial vasculature imaging by saturation data of activation and hypercapnia conditions showed increases in phase accompanying blood flow increases.An arterial spin labeling functional magnetic resonance imaging study yielded significant activation by magnitude-only, phase-only, and complex analyses when preserving the whole arterial spin labeling signal. After suppression of the arterial signal by postinversion delays, magnitude-only and complex models yielded similar activation levels, but the phase-only model detected nearly no activation. When flow crushers were used for arterial suppression, magnitude-only activation was slightly lower and fluctuations in phase were dramatically higher than when postinversion delays were used.Although the complex analysis performed did not improve detection, a simulation study indicated that the complex-valued activation model exhibits combined magnitude and phase detection power and thus maximizes sensitivity under ideal conditions. This suggests that, as arterial spin labeling imaging and image correction methods develop, the complex-valued detection model may become helpful in signal detection.

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

PURPOSE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

Imaging mesial temporal lobe activation during scene encoding: comparison of fMRI using BOLD and arterial spin labeling

Memory encoding is a critical brain function subserved by the hippocampus (HP) and mesial temporal lobe (mTL) structures. Visualization of mTL memory activation with BOLD fMRI is complicated by the presence of static susceptibility gradients in this region. Arterial spin labeled (ASL) perfusion fMRI offers an alternative approach not dependent on susceptibility contrast that instead suffers from lower intrinsic signal-to-noise ratio. An improved ASL perfusion fMRI approach combining pseudo-continuous ASL and a T(2)*-insensitive sequence (GRASE) with background suppression was compared to BOLD fMRI at 3 T during a scene encoding task known to activate the HP. Overall, an approximate sixfold sensitivity increase of ASL fMRI was achieved, with improved coverage in the anterior mTL, while suppression of the static tissue enhanced the stability of the ASL series by a factor of 2.4. Perfusion fMRI using this approach with 4 mm isotropic resolution yielded better localized and stronger group activation maps than BOLD fMRI at a standard resolution of 3 mm isotropic voxels. Increasing the resolution for BOLD to 2.5 mm isotropic produced stronger mTL and hippocampal activation in the group and individual subjects than the ASL technique, due to superior temporal resolution and reduced partial volume effects. Future improvements in ASL spatial and temporal resolution would allow the benefits of both approaches to be combined to further enhance the sensitivity for detecting mTL activation during memory encoding.

Functional imaging with FENSI: flow-enhanced signal intensity

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

Arterial spin labeling for quantitative functional MRI

BOLD effect imaging is very effective for detection and localization of brain activity, and is the dominant functional imaging technique in cognitive psychology. Despite its efficiency to detect and localize active site, the technique does not lend itself easily to quantifiable measurements. A growingly popular alternative is the use of arterial spin labeling (ASL) to obtain perfusion maps as the indicator of cerebral activation. In this paper, the principles and challenges of arterial spin labeling are discussed and the development of a new fast, two-coil pseudo-continuous labeling scheme is presented. The new scheme permits collection of a multi-slice subtraction pair in less than three seconds, depending on the subject's arterial transit times. The theoretical basis of the technique, as well as a model for quantification of perfusion from the ASL data, are presented. Experimental data from functional imaging experiments were collected to demonstrate the technique and its characteristics.

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.

Functional imaging with Turbo-CASL: Transit time and multislice imaging considerations

The optimal use of turbo continuous arterial spin labeling (Turbo-CASL) for functional imaging in the presence of activation-induced transit time (TT) changes was investigated. Functional imaging of a bilateral finger-tapping task showed improved sensitivity for Turbo-CASL as compared to traditional CASL techniques for four of six subjects when scanned at an appropriate repetition time (TR). Both experimental and simulation results suggest that for optimal functional sensitivity with Turbo-CASL, the pulse TR should be set to a value that is 100-200 ms less than the resting-state TT. Simulations were also run to demonstrate the differences in TT sensitivity of different slices within a multislice acquisition, and the signal loss that is expected as the number of slices is increased. Despite the lower baseline ASL signal provided by the Turbo-CASL acquisition, one can achieve equal or improved functional sensitivity due in part to the signal enhancement that accompanies the decrease in TT upon activation. Turbo-CASL is thus a promising technique for functional ASL at higher temporal resolution.

In vivo estimation of the flow-driven adiabatic inversion efficiency for continuous arterial spin labeling: a method using phase contrast magnetic resonance angiography

The accurate quantification of perfusion with arterial spin labeling (ASL) requires consideration of a number of factors, including the efficiency of the inversion and control pulses used for spin labeling. In this study the effects of spin velocity on continuous ASL efficiency when using the amplitude modulated control strategy were investigated using simulations of the Bloch equations. The inversion efficiency was determined in vivo by combining the simulations with phase-contrast velocity mapping data acquired at the level of the tagging plane. Using this novel method, an average inversion efficiency of 69% was calculated for a group of 28 subjects, in good agreement with experimental data reported previously. There was, however, a large range in inversion efficiency measured across the subject group (50-76%), indicating that the velocity dependence of the amplitude modulated control efficiency may introduce additional variability into the perfusion calculations if not properly taken into account.

Estimation efficiency and statistical power in arterial spin labeling fMRI

Arterial spin labeling (ASL) data are typically differenced, sometimes after interpolation, as part of preprocessing before statistical analysis in fMRI. While this process can reduce the number of time points by half, it simplifies the subsequent signal and noise models (i.e., smoothed box-car predictors and white noise). In this paper, we argue that ASL data are best viewed in the same data analytic framework as BOLD fMRI data, in that all scans are modeled and colored noise is accommodated. The data are not differenced, but the control/label effect is implicitly built into the model. While the models using differenced data may seem easier to implement, we show that differencing models fit with ordinary least squares either produce biased estimates of the standard errors or suffer from a loss in efficiency. The main disadvantage to our approach is that non-white noise must be modeled in order to yield accurate standard errors, however, this is a standard problem that has been solved for BOLD data, and the very same software can be used to account for such autocorrelated noise.

Understanding and optimizing the amplitude modulated control for multiple-slice continuous arterial spin labeling

Multiple-slice perfusion imaging by continuous arterial spin labeling (CASL) is made possible by amplitude modulation (AM) of the labeling RF pulse, but perfusion sensitivity is reduced relative to the single-slice technique. A computer model of the Bloch equations for velocity driven adiabatic fast passage was developed to elucidate the compromised sensitivity to perfusion of the AM control technique for CASL. Calculations were performed over ranges of RF pulse amplitude, B1; magnetic field gradient, G; phase, phi, and frequency, f, of the modulation function; velocity, v, and relaxation times, T1 and T2, of blood. It was found that unless f>2piB1, phi determines the performance of the AM control; excessively high B1 or v reduces the efficiency of the AM control; and T1 relaxation dominates if f is too great. In vivo, in rat brain (n=5) at 2.35 T, the sensitivity of the AM technique to perfusion was 70% of the sensitivity of single-slice CASL.

Towards quantification of blood-flow changes during cognitive task activation using perfusion-based fMRI

Multi-slice perfusion-based functional magnetic resonance imaging (p-fMRI) is demonstrated with a color-word Stroop task as an established cognitive paradigm. Continuous arterial spin labeling (CASL) of the blood in the left common carotid artery was applied for all repetitions of the functional run in a quasi-continuous fashion, i.e., it was interrupted only during image acquisition. For comparison, blood oxygen level dependent (BOLD) contrast was detected using conventional gradient-recalled echo (GE) echo planar imaging (EPI). Positive activations in BOLD imaging appeared in p-fMRI as negative signal changes corresponding to an enhanced transport of inverted water spins into the region of interest, i.e., increased cerebral blood flow (CBF). Regional differences between the localization of activations and the sensitivity of p-fMRI and BOLD-fMRI were observed as, for example, in the inferior frontal sulcus and in the intraparietal sulcus. Quantification of CBF changes during cognitive task activation was performed on a multi-subject basis and yielded CBF increases of the order of 20-30%.

CASL fMRI of subcortico-cortical perfusion changes during memory-guided finger sequences

Arterial spin labeling (ASL) perfusion functional magnetic resonance imaging (fMRI) is an attractive alternative to BOLD fMRI. Nevertheless, current ASL fMRI techniques are limited by several factors that hamper more routine applications in humans. One of these factors is restricted brain coverage so that whole-brain ASL fMRI studies have never been reported. The present study tested the ability of a multislice continuous ASL (CASL) fMRI approach using a small surface coil placed on the subject's neck to map changes in regional cerebral blood flow (rCBF) throughout the brain while healthy individuals (N = 15) performed memory-guided sequential finger movements at a mean rate of approximately 0.5 Hz. As predicted by results from a large number of studies, reliable task-related increases in flow were detected across subjects not only in primary and associative cortical areas but also in subcortical brain regions. When normalized to baseline, rCBF increased 31% in the hand representation area (HRA) of left primary motor cortex (M1), 13% in the left supplementary motor area proper (SMA), 10% in the left dorsolateral prefrontal cortex (DLPFC), 10-18% in the bilateral intraparietal sulci, 6% in the HRA of left putamen, 10% in the left thalamus, and 17% in the right anterior cerebellum. In addition to these increases, 6% and 4% decreases in rCBF were detected in the HRA of the right M1 and the bilateral posterior cingulate sulci, respectively. These results demonstrate that perfusion-based fMRI using CASL with a separate labeling coil can now be used to characterize task-related flow changes in most of the brain volume with adequate accuracy and sensitivity.

Input parameter sensitivity analysis and comparison of quantification models for continuous arterial spin labeling

The regional cerebral blood flow (rCBF) values determined using continuous arterial spin labeling (CASL) are subject to several sources of variability, including natural physiologic variations, sensitivity to the input parameters, and the use of different quantification models. To date, a thorough analysis of the impact of input parameters and the choice of quantification model has not been performed. These sources of variability were investigated through computer simulations using bootstrap techniques on actual CASL data. Coefficients of variation for representative single voxels were 6.7% for gray matter and 29% for white matter, and for eight-voxel regions of interest they were 4.5% for gray matter and 23% for white matter. Comparison of nine CASL quantification models showed differences in gray matter rCBF values of up to 42%. An analysis of the sensitivity of the rCBF to input parameters for each of the nine quantification models demonstrated that accurate quantification of the inversion efficiency, tissue and arterial blood longitudinal relaxation times, and transit times were critical in calculating precise rCBF values. The large potential variations in rCBF and the effect of the choice of quantification model suggest that interpreting absolute rCBF values in CASL studies can be challenging and requires great care.