Accelerated 3D-GRASE imaging improves quantitative multiple post labeling delay arterial spin labeling

Recommendations for quantitative cerebral perfusion MRI using multi-timepoint arterial spin labeling: Acquisition, quantification, and clinical applications

Accurate assessment of cerebral perfusion is vital for understanding the hemodynamic processes involved in various neurological disorders and guiding clinical decision-making. This guidelines article provides a comprehensive overview of quantitative perfusion imaging of the brain using multi-timepoint arterial spin labeling (ASL), along with recommendations for its acquisition and quantification. A major benefit of acquiring ASL data with multiple label durations and/or post-labeling delays (PLDs) is being able to account for the effect of variable arterial transit time (ATT) on quantitative perfusion values and additionally visualize the spatial pattern of ATT itself, providing valuable clinical insights. Although multi-timepoint data can be acquired in the same scan time as single-PLD data with comparable perfusion measurement precision, its acquisition and postprocessing presents challenges beyond single-PLD ASL, impeding widespread adoption. Building upon the 2015 ASL consensus article, this work highlights the protocol distinctions specific to multi-timepoint ASL and provides robust recommendations for acquiring high-quality data. Additionally, we propose an extended quantification model based on the 2015 consensus model and discuss relevant postprocessing options to enhance the analysis of multi-timepoint ASL data. Furthermore, we review the potential clinical applications where multi-timepoint ASL is expected to offer significant benefits. This article is part of a series published by the International Society for Magnetic Resonance in Medicine (ISMRM) Perfusion Study Group, aiming to guide and inspire the advancement and utilization of ASL beyond the scope of the 2015 consensus article.

Comparison of ASL and DSC perfusion methods in the evaluation of response to treatment in patients with a history of treatment for malignant brain tumor

OBJECTIVE

Perfusion MRI is of great benefit in the post-treatment evaluation of brain tumors. Interestingly, dynamic susceptibility contrast-enhanced (DSC) perfusion has taken its place in routine examination for this purpose. The use of arterial spin labeling (ASL), a perfusion technique that does not require exogenous contrast material injection, has gained popularity in recent years. The aim of the study was to compare two different perfusion techniques, ASL and DSC, using qualitative and quantitative measurements and to investigate the diagnostic effectiveness of both. The fact that the number of patients is higher than in studies conducted with 3D pseudo-continious ASL (pCASL), the study group is heterogeneous as it consists of patients with both metastases and glial tumors, the use of 3D Turbo Gradient Spin Echo (TGSE), and the inclusion of visual (qualitative) assessment make our study unique.

METHODS

Ninety patients, who were treated for malignant brain tumor, were enrolled in the retrospective study. DSC Cerebral Blood Volume (CBV), Cerebral Blood Flow (CBF) and ASL CBF maps of each case were obtained. In qualitative analysis, the lesions of the cases were visually classified as treatment-related changes (TRC) and relapse/residual mass (RRT). In the quantitative analysis, three regions of interest (ROI) measurements were taken from each case. The average of these measurements was compared with the ROI taken from the contralateral white matter and normalized values (n) were obtained. These normalized values were compared across events.

RESULTS

Uncorrected DSC normalized CBV (nCBV), DSC normalized CBF (nCBF) and ASL nCBF values of RRT cases were higher than those of TRC cases (p < 0.001). DSC nCBV values were correlated with DSC nCBF (r: 0.94, p < 0.001) and correlated with ASL nCBF (r: 0.75, p < 0.001). Similarly, ASL nCBF was positively correlated with DSC nCBF (r: 0.79 p < 0.01). When the ROC curve parameters were evaluated, the cut-off values were determined as 1.211 for DSC nCBV (AUC: 0.95, 93% sensitivity, 82% specificity), 0.896 for DSC nCBF (AUC; 0.95, 93% sensitivity, 82% specificity), and 0.829 for ASL nCBF (AUC: 0.84, 78% sensitivity, 75% specificity). For qualitative evaluation (visual evaluation), inter-observer agreement was found to be good for ASL CBF (0.714), good for DSC CBF (0.790), and excellent for DSC CBV (0.822). Intra-observer agreement was also evaluated. For the first observer, good agreement was found in ASL CBF (0.626, 70% sensitive, 93% specific), in DSC CBF (0.713, 76% sensitive, 95% specific), and in DSC CBV (0.755, 87% sensitive - 88% specific). In the second observer, moderate agreement was found in ASL CBF (0.584, 61% sensitive, 97% specific) and DSC CBF (0.649, 65% sensitive, 100% specific), and excellent agreement in DSC CBV (0.800, 89% sensitive, 90% specific).

CONCLUSION

It was observed that uncorrected DSC nCBV, DSC nCBF and ASL nCBF values were well correlated with each other. In qualitative evaluation, inter-observer and intra-observer agreement was higher in DSC CBV than DSC CBF and ASL CBF. In addition, DSC CBV is found more sensitive, ASL CBF and DSC CBF are found more specific for both observers. From a diagnostic perspective, all three parameters DSC CBV, DSC CBF and ASL CBF can be used, but it was observed that the highest rate belonged to DSC CBV.

Feasibility of high-resolution perfusion imaging using arterial spin labeling MRI at 3 Tesla

Cerebral blood flow (CBF) is a critical physiological parameter of brain health, and it can be non-invasively measured with arterial spin labeling (ASL) MRI. In this study, we evaluated and optimized whole-brain, high-resolution ASL as an alternative to the low-resolution ASL employed in the routine assessment of CBF in both healthy participants and patients. Two high-resolution protocols (i.e., pCASL and FAIR-Q2TIPS (PASL) with 2 mm isotropic voxels) were compared to a default clinical pCASL protocol (3.4 × 3.4 × 4 mm 3), all of whom had an acquisition time of ≈ 5 min. We assessed the impact of high-resolution acquisition on reducing partial voluming and improving sensitivity to the perfusion signal, and evaluated the effectiveness of z-deblurring on the ASL data. We compared the quality of whole-brain ASL acquired using three available head coils with differing number of receive channels (i.e., 20, 32, and 64ch). We found that using higher coil counts (32 and 64ch coils as compared to 20ch) offers improved signal-to-noise ratio (SNR) and acceleration capabilities that are beneficial for ASL imaging at 3 Tesla (3 T). The inherent reduction in partial voluming effects with higher resolution acquisitions improves the resolving power of perfusion without impacting the sensitivity. In conclusion, our results suggest that high-resolution ASL (2 to 2.5 mm isotropic voxels) has the potential to become a new standard for perfusion imaging at 3 T and increase its adoption into clinical research and cognitive neuroscience applications.

Evaluation of 3D stack-of-spiral turbo FLASH acquisitions for pseudo-continuous and velocity-selective ASL-derived brain perfusion mapping

PURPOSE

The most-used 3D acquisitions for ASL are gradient and spin echo (GRASE)- and stack-of-spiral (SOS)-based fast spin echo, which require multiple shots. Alternatively, turbo FLASH (TFL) allows longer echo trains, and SOS-TFL has the potential to reduce the number of shots to even single-shot, thus improving the temporal resolution. Here we compare the performance of 3D SOS-TFL and 3D GRASE for ASL at 3T.

METHODS

The 3D SOS-TFL readout was optimized with respect to fat suppression and excitation flip angles for pseudo-continuous ASL- and velocity-selective (VS)ASL-derived cerebral blood flow (CBF) mapping as well as for VSASL-derived cerebral blood volume (CBV) mapping. Results were compared with 3D GRASE readout on healthy volunteers in terms of perfusion quantification and temporal SNR (tSNR) efficiency. CBF and CBV mapping derived from 3D SOS-TFL-based ASL was demonstrated on one stroke patient, and the potential for single-shot acquisitions was exemplified.

RESULTS

SOS-TFL with a 15° flip angle resulted in adequate tSNR efficiency with negligible image blurring. Selective water excitation was necessary to eliminate fat-induced artifacts. For pseudo-continuous ASL- and VSASL-based CBF and CBV mapping, compared to the employed four-shot 3D GRASE with an acceleration factor of 2, the fully sampled 3D SOS-TFL delivered comparable performance (with a similar scan time) using three shots, which could be further undersampled to achieve single-shot acquisition with higher tSNR efficiency. SOS-TFL had reduced CSF contamination for VSASL-CBF.

CONCLUSION

3D SOS-TFL acquisition was found to be a viable substitute for 3D GRASE for ASL with sufficient tSNR efficiency, minimal relaxation-induced blurring, reduced CSF contamination, and the potential of single-shot, especially for VSASL.

Recent Technical Developments in ASL: A Review of the State of the Art

This review article provides an overview of a range of recent technical developments in advanced arterial spin labeling (ASL) methods that have been developed or adopted by the community since the publication of a previous ASL consensus paper by Alsop et al. It is part of a series of review/recommendation papers from the International Society for Magnetic Resonance in Medicine Perfusion Study Group. Here, we focus on advancements in readouts and trajectories, image reconstruction, noise reduction, partial volume correction, quantification of nonperfusion parameters, fMRI, fingerprinting, vessel selective ASL, angiography, deep learning, and ultrahigh field ASL. We aim to provide a high level of understanding of these new approaches and some guidance for their implementation, with the goal of facilitating the adoption of such advances by research groups and by MRI vendors. Topics outside the scope of this article that are reviewed at length in separate articles include velocity selective ASL, multiple-timepoint ASL, body ASL, and clinical ASL recommendations.

Impaired Neurovascular Function Underlies Poor Neurocognitive Outcomes and Is Associated with Nitric Oxide Bioavailability in Congenital Heart Disease

We use a non-invasive MRI proxy of neurovascular function (pnvf) to assess the ability of the vasculature to supply baseline metabolic demand, to compare pediatric and young adult congenital heart disease (CHD) patients to normal referents and relate the proxy to neurocognitive outcomes and nitric oxide bioavailability. In a prospective single-center study, resting-state blood-oxygen-level-dependent (BOLD) and arterial spin labeling (ASL) MRI scans were successfully obtained from 24 CHD patients (age = 15.4 ± 4.06 years) and 63 normal referents (age = 14.1 ± 3.49) years. Pnvf was computed on a voxelwise basis as the negative of the ratio of functional connectivity strength (FCS) estimated from the resting-state BOLD acquisition to regional cerebral blood flow (rCBF) as estimated from the ASL acquisition. Pnvf was used to predict end-tidal CO2 (P_ETCO2) levels and compared to those estimated from the BOLD data. Nitric oxide availability was obtained via nasal measurements (nNO). Pnvf was compared on a voxelwise basis between CHD patients and normal referents and correlated with nitric oxide availability and neurocognitive outcomes as assessed via the NIH Toolbox. Pnvf was shown as highly predictive of P_ETCO2 using theoretical modeling. Pnvf was found to be significantly reduced in CHD patients in default mode network (DMN, comprising the ventromedial prefrontal cortex and posterior cingulate/precuneus), salience network (SN, comprising the insula and dorsal anterior cingulate), and central executive network (CEN, comprising posterior parietal and dorsolateral prefrontal cortex) regions with similar findings noted in single cardiac ventricle patients. Positive correlations of Pnvf in these brain regions, as well as the hippocampus, were found with neurocognitive outcomes. Similarly, positive correlations between Pnvf and nitric oxide availability were found in frontal DMN and CEN regions, with particularly strong correlations in subcortical regions (putamen). Reduced Pnvf in CHD patients was found to be mediated by nNO. Mediation analyses further supported that reduced Pnvf in these regions underlies worse neurocognitive outcome in CHD patients and is associated with nitric oxide bioavailability. Impaired neuro-vascular function, which may be non-invasively estimated via combined arterial-spin label and BOLD MR imaging, is a nitric oxide bioavailability dependent factor implicated in adverse neurocognitive outcomes in pediatric and young adult CHD.

Regional cortical perfusion increases induced by a 6-month endurance training in young sedentary adults

Physical inactivity is documented as a health risk factor for chronic diseases, accelerated aging, and cognitive impairment. Physical exercise, on the other hand, plays an important role in healthy aging by promoting positive muscular, cardiovascular, and central nervous system adaptions. Prior studies on the effects of exercise training on cerebral perfusion have focused largely on elderly cohorts or patient cohorts, while perfusion effects of exercise training in young sedentary adults have not yet been fully assessed. Therefore, the present study examined the physiological consequence of a 6-month endurance exercise training on brain perfusion in 28 young sedentary adults randomly assigned to an intervention group (IG; regular physical exercise) or a control group (CG; without physical exercise). The IG performed an extensive running interval training three times per week over 6 months. Performance diagnostics and MRI were performed every 2 months, and training intensity was adapted individually. Brain perfusion measurements with pseudo-continuous arterial spin labeling were analyzed using the standard Oxford ASL pipeline. A significant interaction effect between group and time was found for right superior temporal gyrus (STG) perfusion, driven by an increase in the IG and a decrease in the CG. Furthermore, a significant time effect was observed in the right middle occipital region in the IG only. Perfusion increases in the right STG, in the ventral striatum, and in primary motor areas were significantly associated with increases in maximum oxygen uptake (VO_2max). Overall, this study identified region-specific increases in local perfusion in a cohort of young adults that partly correlated with individual performance increases, hence, suggesting exercise dose dependency. Respective adaptations in brain perfusion are discussed in the context of physical exercise-induced vascular plasticity.

Arterial spin labeling MR image denoising and reconstruction using unsupervised deep learning

Arterial spin labeling (ASL) imaging is a powerful magnetic resonance imaging technique that allows to quantitatively measure blood perfusion non-invasively, which has great potential for assessing tissue viability in various clinical settings. However, the clinical applications of ASL are currently limited by its low signal-to-noise ratio (SNR), limited spatial resolution, and long imaging time. In this work, we propose an unsupervised deep learning-based image denoising and reconstruction framework to improve the SNR and accelerate the imaging speed of high resolution ASL imaging. The unique feature of the proposed framework is that it does not require any prior training pairs but only the subject's own anatomical prior, such as T1-weighted images, as network input. The neural network was trained from scratch in the denoising or reconstruction process, with noisy images or sparely sampled k-space data as training labels. Performance of the proposed method was evaluated using in vivo experiment data obtained from 3 healthy subjects on a 3T MR scanner, using ASL images acquired with 44-min acquisition time as the ground truth. Both qualitative and quantitative analyses demonstrate the superior performance of the proposed txtc framework over the reference methods. In summary, our proposed unsupervised deep learning-based denoising and reconstruction framework can improve the image quality and accelerate the imaging speed of ASL imaging.

Reliability and Reproducibility of Hadamard Encoded Pseudo-Continuous Arterial Spin Labeling in Healthy Elderly

The perfusion parameters cerebral blood flow (CBF) and arterial transit time (ATT) measured with arterial spin labeling (ASL) magnetic resonance imaging (MRI) provide valuable essentials to assess the integrity of cerebral tissue. Brain perfusion changes, due to aging, an intervention, or neurodegenerative diseases for example, could be investigated in longitudinal ASL studies with reliable ASL sequences. Generally, pseudo-continuous ASL (pCASL) is preferred because of its larger signal-to-noise ratio (SNR) compared to pulsed ASL (PASL) techniques. Available pCASL versions differ regarding their feature details. To date only little is known about the reliability and reproducibility of CBF and ATT measures obtained with the innovative Hadamard encoded pCASL variant, especially if applied on participants in old age. Therefore, we investigated an in-house developed Hadamard encoded pCASL sequence on a group of healthy elderly at two different 3 Tesla Siemens MRI systems (Skyra and mMR Biograph) and evaluated CBF and ATT reliability and reproducibility for several regions-of-interests (ROI). Calculated within-subject coefficients of variation (wsCV) demonstrated an excellent reliability of perfusion measures, whereas ATT appeared to be even more reliable than CBF [e.g., wsCV(CBF) = 2.9% vs. wsCV(ATT) = 2.3% for a gray matter (GM) ROI on Skyra system]. Additionally, a substantial agreement of perfusion values acquired on both MRI systems with an inter-session interval of 78 ± 17.6 days was shown by high corresponding intra-class correlation (ICC) coefficients [e.g., ICC(CBF) = 0.704 and ICC(ATT) = 0.754 for a GM ROI]. The usability of this novel Hadamard encoded pCASL sequence might improve future follow-up perfusion studies of the aging and/or diseased brain.

Neural signatures of bullying experience and social rejection in teenagers

Relational bullying in schools is one of the most frequent forms of violence and can have severe negative health impact, e.g. depression. Social exclusion is the most prominent form of relational bullying that can be operationalized experimentally. The present study used MR-based perfusion imaging (pCASL) to investigate the neural signatures of social exclusion and its relationship with individually different extent of previous bullying experience. Twenty-four teenagers reporting bullying experience at different extent were scanned during a virtual ball-tossing (Cyberball game). Our findings showed that social exclusion (relative to social inclusion) activated frontal brain areas: sub- and perigenual anterior cingulate cortex (sg/pgACC), left inferior frontal cortex (IFG), and dorsolateral prefrontal cortex. Positive relationship between exclusion-specific signal increase and individually different extents of prior bullying experience was for the first time observed in left IFG and sgACC. This suggests that more frequent prior experience has conditioned greater mentalizing and/or rumination, in order to cope with the situation. While this interpretation remains speculative, the present data show that the experience of being bullied partly sensitizes the neural substrate relevant for the processing of social exclusion.

Non-linear fitting with joint spatial regularization in arterial spin labeling

Multi-Delay single-shot arterial spin labeling (ASL) imaging provides accurate cerebral blood flow (CBF) and, in addition, arterial transit time (ATT) maps but the inherent low SNR can be challenging. Especially standard fitting using non-linear least squares often fails in regions with poor SNR, resulting in noisy estimates of the quantitative maps. State-of-the-art fitting techniques improve the SNR by incorporating prior knowledge in the estimation process which typically leads to spatial blurring. To this end, we propose a new estimation method with a joint spatial total generalized variation regularization on CBF and ATT. This joint regularization approach utilizes shared spatial features across maps to enhance sharpness and simultaneously improves noise suppression in the final estimates. The proposed method is evaluated at three levels, first on synthetic phantom data including pathologies, followed by in vivo acquisitions of healthy volunteers, and finally on patient data following an ischemic stroke. The quantitative estimates are compared to two reference methods, non-linear least squares fitting and a state-of-the-art ASL quantification algorithm based on Bayesian inference. The proposed joint regularization approach outperforms the reference implementations, substantially increasing the SNR in CBF and ATT while maintaining sharpness and quantitative accuracy in the estimates.

Reliability of quantitative transverse relaxation time mapping with [Formula: see text]-prepared whole brain pCASL

Arterial spin labeling (ASL) is increasingly applied for cerebral blood flow mapping, but [Formula: see text] relaxation of the ASL signal magnetization is often ignored, although it may be clinically relevant. To investigate the extent, to which quantitative [Formula: see text] values in gray matter (GM) obtained by pseudocontinuous ASL (pCASL) perfusion MRI can be reproduced, are reliable and a potential neuroscientific biomarker, a prospective study was performed with ten healthy volunteers (5F,28 ± 3y) at a 3 T scanner. A [Formula: see text]-prepared pCASL sequence enabled the measurement of quantitative [Formula: see text] and perfusion maps. [Formula: see text] times were modeled per voxel and analyzed within four GM-regions-of-interest (ROI). The intraclass correlation coefficients (ICCs) of the quantified ASL-[Formula: see text] varied across brain regions. When averaged across subjects and postlabeling delays (PLDs), the ICCs ranged from reasonable values in parietal regions (ICC = 0.56) to smaller values in frontal regions (ICC = 0.36). Corresponding subject-averaged within-subject coefficients of variation (WSCVs) showed good test-retest measurement precision ([Formula: see text] for all PLDs), but more pronounced inter-subject variance. Reliability and precision of quantified ASL-[Formula: see text] were region-, PLD- and subject-specific, showing fair to robust results in occipital, parietal and temporal ROIs. The results give rise to consider the method for future cerebral studies, where variable perfusion or altered [Formula: see text] times are suspected.

Blood-brain barrier permeability measurement by biexponentially modeling whole-brain arterial spin labeling data with multiple T2 -weightings

Blood-brain barrier (BBB) permeability assessment remains of ongoing interest in clinical practice and research. Transitions between intravascular (IV) and extravascular (EV) gray matter (GM) compartments may provide information regarding the microstructural status of the BBB. Due to different transverse relaxation times (T₂ ) of water protons in vessels and GM, it is possible to determine the compartment in which these protons are located. This work presents and investigates the feasibility of a simplified analytical approach for compartmentalizing the proportions of magnetically marked water protons into IV and EV GM components by biexponentially modeling T₂ -weighted arterial spin labeling (ASL) data. Numerous model assumptions were used to stabilize the fit and achieve in vivo applicability. Particularly, transverse relaxation times of IV and EV water protons were determined from the analysis of two supporting T₂ -weighted ASL measurements, utilizing a monoexponential signal model. This stabilized a two-parameter biexponential fit of ASL data with T₂ preparation (PLD = 0.9/1.2/1.5/1.8 s, TE_T2Prep  = 0/30/40/60/80/120/160 ms), which thereby robustly provided estimates of the IV and EV compartment fractions. Experiments were conducted with three healthy volunteers in a 3 T scanner. Averaged over all subjects, the labeled water protons inherit T_2,IV  = 200 ± 18 ms initially and adapt T_2,EV  = 91 ± 2 ms with a longer retention time in cerebral structures. Accordingly, the EVlocated ASL signal fraction rises with increasing PLD from 0.31 ± 0.11 at the shortest PLD of 0.9 s to 0.73 ± 0.02 at the longest PLD of 1.8s. These results indicate a transition of the water protons from IV to EV space. The findings support the potential of biexponential modeling for compartmentalizing ASL spin fractions between IV and EV space. The novel integration of monoexponential parameter estimates stabilizes the two-compartment model fit, suggesting that this technique is suitable for robustly estimating the BBB permeability in vivo.

Motion‐corrected and high‐resolution anatomically assisted (MOCHA) reconstruction of arterial spin labeling MRI

Purpose

A model‐based reconstruction framework is proposed for motion‐corrected and high‐resolution anatomically assisted (MOCHA) reconstruction of arterial spin labeling (ASL) data. In this framework, all low‐resolution ASL control‐label pairs are used to reconstruct a single high‐resolution cerebral blood flow (CBF) map, corrected for rigid‐motion, point‐spread‐function blurring and partial volume effect.

Methods

Six volunteers were recruited for CBF imaging using pseudo‐continuous ASL labeling, two‐shot 3D gradient and spin‐echo sequences and high‐resolution T₁‐weighted MRI. For 2 volunteers, high‐resolution scans with double and triple resolution in the partition direction were additionally collected. Simulations were designed for evaluations against a high‐resolution ground‐truth CBF map, including a simulated hyperperfused lesion and hyperperfusion/hypoperfusion abnormalities. The MOCHA technique was compared with standard reconstruction and a 3D linear regression partial‐volume effect correction method and was further evaluated for acquisitions with reduced control‐label pairs and k‐space undersampling.

Results

The MOCHA reconstructions of low‐resolution ASL data showed enhanced image quality, particularly in the partition direction. In simulations, both MOCHA and 3D linear regression provided more accurate CBF maps than the standard reconstruction; however, MOCHA resulted in the lowest errors and well delineated the abnormalities. The MOCHA reconstruction of standard‐resolution in vivo data showed good agreement with higher‐resolution scans requiring 4‐times and 9‐times longer acquisitions. The MOCHA reconstruction was found to be robust for 4‐times‐accelerated ASL acquisitions, achieved by reduced control‐label pairs or k‐space undersampling.

Conclusion

The MOCHA reconstruction reduces partial‐volume effect by direct reconstruction of CBF maps in the high‐resolution space of the corresponding anatomical image, incorporating motion correction and point spread function modeling. Following further evaluation, MOCHA should promote the clinical application of ASL.

Robust single-shot acquisition of high resolution whole brain ASL images by combining time-dependent 2D CAPIRINHA sampling with spatio-temporal TGV reconstruction

For ASL perfusion imaging in clinical settings the current guidelines recommends pseudo-continuous arterial spin labeling with segmented 3D readout. This combination achieves the best signal to noise ratio with reasonable resolution but is prone to motion artifacts due to the segmented readout. Motion robust single-shot 3D acquisitions suffer from image blurring due to the T2 decay of the sampled signals during the long readout. To tackle this problem, we propose an accelerated 3D-GRASE sequence with a time-dependent 2D-CAIPIRINHA sampling pattern. This has several advantages: First, the single-shot echo trains are shortened by the acceleration factor; Second, the temporal incoherence between measurements is increased; And third, the coil sensitivity maps can be estimated directly from the averaged k-space data. To obtain improved perfusion images from the undersampled time series, we developed a variational image reconstruction approach employing spatio-temporal total-generalized-variation (TGV) regularization. The proposed ASL-TGV method reduced the total acquisition time, improved the motion robustness of 3D ASL data, and the image quality of the cerebral blood flow (CBF) maps compared to those by a standard segmented approach. An evaluation was performed on 5 healthy subjects including intentional movement for 2 subjects. Single-shot whole brain CBF-maps with high resolution3.1 × 3.1 × 3 mm and image quality can be acquired in 1min 46sec. Additionally high quality CBF- and arterial transit time (ATT) -maps from single-shot multi-post-labeling delay (PLD) data can be gained with the proposed method. This method may improve the robustness of 3D ASL in clinical settings, and may be applied for perfusion fMRI.

Robust pCASL perfusion imaging using a 3D Cartesian acquisition with spiral profile reordering (CASPR)

PURPOSE

To improve the robustness of arterial spin-labeled measured perfusion using a novel Cartesian acquisition with spiral profile reordering (CASPR) 3D turbo spin echo (TSE) in the brain and kidneys.

METHODS

The CASPR view ordering followed a pseudo-spiral trajectory on a Cartesian grid, by sampling the center of k-space at the beginning of each echo train of a segmented 3D TSE acquisition. With institutional review board approval and written informed consent, 14 normal subjects (9 brain and 5 kidneys) were scanned with pCASL perfusion imaging using 3D CASPR and compared against 3D linear TSE (brain and kidneys), the established 2D EPI and 3D gradient and spin echo perfusion (brain), and 2D single-shot turbo spin-echo perfusion (kidneys). The SNR and the quantitative perfusion values were compared among different acquisitions.

RESULTS

3D CASPR TSE achieved robust perfusion across all slices compared to 3D linear TSE in the brain and kidneys. Compared to 2D EPI, 3D CASPR TSE showed higher SNR across the brain (P < 0.01), and exhibited good agreement (36.4 ± 4.7 and 36.9 ± 5.3 mL/100 g/min with 2D EPI and 3D CASPR, respectively), and with 3D gradient and spin echo (27.9 ± 7.2 mL/100 g/min). Compared to a single slice 2D single-shot turbo spin-echo acquisition, 3D CASPR TSE achieved robust perfusion across the entire kidneys in similar scan time with comparable quantified perfusion values (154.1 ± 74.6 and 151.7 ± 70.6 mL/100 g/min with 2D single-shot turbo spin-echo and 3D CASPR, respectively).

CONCLUSION

The CASPR view ordering with 3D TSE achieves robust arterial spin-labeled perfusion in the brain and kidneys because of the sampling of the center of k-space at the beginning of each echo train.

Recent Advances in Pediatric Brain, Spine, and Neuromuscular Magnetic Resonance Imaging Techniques

Magnetic resonance imaging (MRI) is a powerful radiologic tool with the ability to generate a variety of proton-based signal contrast from tissues. Owing to this immense flexibility in signal generation, new MRI techniques are constantly being developed, tested, and optimized for clinical utility. In addition, the safe and nonionizing nature of MRI makes it a suitable modality for imaging in children. In this review article, we summarize a few of the most popular advances in MRI techniques in recent years. In particular, we highlight how these new developments have affected brain, spine, and neuromuscular imaging and focus on their applications in pediatric patients. In the first part of the review, we discuss new approaches such as multiphase and multidelay arterial spin labeling for quantitative perfusion and angiography of the brain, amide proton transfer MRI of the brain, MRI of brachial plexus and lumbar plexus nerves (i.e., neurography), and T2 mapping and fat characterization in neuromuscular diseases. In the second part of the review, we focus on describing new data acquisition strategies in accelerated MRI aimed collectively at reducing the scan time, including simultaneous multislice imaging, compressed sensing, synthetic MRI, and magnetic resonance fingerprinting. In discussing the aforementioned, the review also summarizes the advantages and disadvantages of each method and their current state of commercial availability from MRI vendors.

Multi-phase 3D arterial spin labeling brain MRI in assessing cerebral blood perfusion and arterial transit times in children at 3T

BACKGROUND

3D pseudocontinuous arterial spin labeling (pCASL) with a single post-labeling delay time is commonly used to measure cerebral blood flow (CBF). Multi-phase pCASL has been developed to simultaneously estimate CBF and arterial transit time (ATT).

PURPOSE

To evaluate the clinical feasibility of multi-phase 3D pCASL in pediatric patients, and to compare the estimation of ATT and CBF via linear weighted-delay and traditional non-linear iterative curve-fitting routines.

MATERIAL & METHODS

Forty patients (average age: 8.6 y, 5 d-22.4 y) referred for routine brain MRI underwent additional 5-7 min of pCASL scans at 3T using 5 PLDs between 300 and 2300 ms. Data were post-processed by two algorithms for estimating CBF and ATT. Average CBF and ATT values were computed for vascular territories including the anterior, middle and posterior cerebral arteries as well as regions based on the Alberta Stroke Program Early CT Score template. Pearson correlation coefficients and linear regression were used for statistical analysis. The clinical value of multi-phase CASL was evaluated by a neuroradiologist based on asymmetric CBF and ATT maps in patients.

RESULTS

All pCASL scans were successfully completed, generating diagnostic results. CBF computed from weighted-delay and curve-fitting methods agreed strongly, with Pearson correlation coefficients ranging from 0.97-0.99 across the measured regions (p < 0.05). Correlation coefficients for ATT ranged from 0.87-0.96 (p < 0.05). CBF and ATT maps were found to add valuable information to clinical diagnosis in 17 of 40 pediatric patients.

CONCLUSION

Our preliminary results demonstrate the feasibility and potential clinical utility of multi-phase pCASL for simultaneous CBF and ATT quantification in pediatric patients.