Application of regional perfusion imaging to extra-intracranial bypass surgery and severe stenoses

Fast cerebral flow territory mapping using vessel encoded dynamic arterial spin labeling (VE-DASL)

PURPOSE

Whole-brain territory mapping using planning-free vessel-encoded pseudocontinuous arterial-spin-labeling (VE-pCASL) takes approximately 5 min, which is frequently considered too long for standard clinical protocols. In this study, vessel-encoded dynamic-ASL (VE-DASL) is optimized to achieve fast (< 30 s) cerebral flow territory mapping, especially aimed for the acute setting.

METHODS

VE-DASL is based on the creation of a continuous stream of magnetically labeled or unlabeled blood with different encoding patterns for each feeding artery, whose inflow into the brain tissue is monitored continuously. This approach leads to unique signal fluctuation within each flow territory, enabling reconstruction of individual flow territories by means of clustering techniques followed by linear regression.

RESULTS

VE-DASL was implemented and validated both as single slice and whole-brain method. In vivo results showed reasonable agreement with the "gold-standard" reference maps obtained from VE-pCASL. The Dice similarity coefficient which represents the fractional overlap between VE-DASL and "gold-standard" VE-pCASL territories ranged from 83.4% to 87.7% for the right internal cerebral artery (RICA), 81.7% to 83.1% for the left internal cerebral artery (LICA) and 64.3% to 71.8% for the vertebral arteries.

CONCLUSION

VE-DASL has the potential to map the main flow territories with whole-brain coverage in a short scan duration (∼30 s).

Mapping of cerebral perfusion territories using territorial arterial spin labeling: techniques and clinical application

A knowledge of the exact cerebral perfusion territory which is supplied by any artery is of great importance in the understanding and diagnosis of cerebrovascular disease. The development and optimization of territorial arterial spin labeling (T-ASL) MRI techniques in the past two decades have made it possible to visualize and determine the cerebral perfusion territories in individual patients and, more importantly, to do so without contrast agents or otherwise invasive procedures. This review provides an overview of the development of ASL techniques that aim to visualize the general cerebral perfusion territories or the territory of a specific artery of interest. The first efforts of T-ASL with pulsed, continuous and pseudo-continuous techniques are summarized and subsequent clinical studies using T-ASL are highlighted. In the healthy population, the perfusion territories of the brain-feeding arteries are highly variable. This high variability requires special consideration in specific patient groups, such as patients with cerebrovascular disease, stroke, steno-occlusive disease of the large arteries and arteriovenous malformations. In the past, catheter angiography with selective contrast injection was the only available method to visualize the cerebral perfusion territories in vivo. Several T-ASL methods, sometimes referred to as regional perfusion imaging, are now available that can easily be combined with conventional brain MRI examinations to show the relationship between the cerebral perfusion territories, vascular anatomy and brain infarcts or other pathology. Increased availability of T-ASL techniques on clinical MRI scanners will allow radiologists and other clinicians to gain further knowledge of the relationship between vasculature and patient diagnosis and prognosis. Treatment decisions, such as surgical revascularization, may, in the near future, be guided by information provided by T-ASL MRI in close correlation with structural MRI and quantitative perfusion information.

Perfusion territory imaging of intracranial branching arteries - optimization of continuous artery-selective spin labeling (CASSL)

Continuous artery-selective spin labeling (CASSL) is based on a standard continuous arterial spin labeling sequence with adiabatic flow-driven inversion and an amplitude-modulated control experiment, and has been proposed recently as a new method for the noninvasive flow territory mapping of cerebral arteries. Spatial selectivity is achieved by the rotation of a tilted labeling plane about the axis of a selected artery, which restricts the tagging pulses to the same spatial position for the vessel of interest but, for any other adjacent and parallel artery, the locus of resonance will vary in time and saturates the blood at a certain distance to the labeling focus. In numerical simulations and in a volunteer study, the key labeling parameters of CASSL were investigated with the goal of increasing the spatial selectivity whilst maintaining sufficient labeling efficiency, in order to selectively label the blood in small intracranial arteries distal to the circle of Willis. The optimized labeling parameters were employed in vivo and adapted to different vascular geometries. The labeling of small intracranial branches of the anterior, middle and posterior cerebral arteries in close vicinity to other vessels yielded clearly delineated perfusion territories and demonstrated the method's capability for highly selective perfusion measurements.

Superselective pseudocontinuous arterial spin labeling

A new technique for the imaging of flow territories of individual extra- and intracranial arteries is presented. The method is based on balanced pseudocontinuous arterial spin labeling but employs additional time-varying gradients in between the radiofrequency pulses of the long labeling train. The direction of the additional gradient vector is perpendicular to the selected artery and its azimuthal angle is switched after every radiofrequency pulse. The phases of the radiofrequency pulses are adopted to cancel out the phase accrual of the spins at the center of the target vessel due to the extra applied gradients. This results in efficient inversion at the targeted position, whereas elsewhere time-varying phase changes will result in marginal inversion efficiency. By changing the moment of the added gradients, the size of the labeling focus can be adjusted. Influence of the temporal order of the additional gradients on the labeling efficiency and on the selectivity was investigated by simulations and experimental measurements. In a volunteer study, the acquisition of high signal-to-noise ratio flow territory images of small branches of the anterior cerebral artery distal to the circle of Willis was demonstrated. This shows the method's flexibility for dealing with complicated arterial geometries and its ability to superselectively label small intracranial arteries.

Assessment of vascular supply of hypervascular extra-axial brain tumors with 3T MR regional perfusion imaging

BACKGROUND AND PURPOSE

The vascular supply of extra-axial brain tumors provided by the external carotid artery has not been studied with RPI. The purpose of this work was to determine whether RPI assessment is feasible and provides information on the vascular supply of hypervascular extra-axial brain tumors.

MATERIALS AND METHODS

Conventional ASL and RPI studies were performed at 3T in 8 consecutive patients with meningioma. On the basis of MRA results, we performed RPI by placing a selective labeling slab over the external carotid artery. Five patients underwent DSA before surgery. Two neuroradiologists independently evaluated the overall image quality, the degree of tumor perfusion, and the extent of the tumor vascular territory on conventional ASL and RPI.

RESULTS

In overall quality of conventional ASL and RPI, no images interfered with interpretation. In comparisons of the vascular tumor territory identified by the conventional ASL and RPI techniques, the territories coincided in 3 cases, were partially different in 4, and completely different in 1. The interobserver agreement was very good (kappa = 0.82). In 5 patients who underwent DSA, the 4 patients in whom the dominant supply was the external carotid artery were scored as coincided or partially different. The 1 patient in whom the vascular supply was from the internal carotid artery was scored as completely different.

CONCLUSIONS

RPI with selective labeling of the external carotid artery is feasible and may provide information about the vascular supply of hypervascular extra-axial brain tumors.

Pittfalls of MRI measurement of white matter perfusion based on arterial spin labeling

Although arterial spin labeling (ASL) MRI has been successfully applied to measure gray matter (GM) perfusion in vivo, accurate detection of white matter (WM) perfusion has proven difficult. Reported literature values are not consistent with each other or with perfusion measured with other modalities. In this work, the cause of these inconsistencies is investigated. The results suggest that WM perfusion values are substantially affected by the limited image resolution and by signal losses caused by the long transit times in WM, which significantly affect the label. From gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA) bolus-tracking experiments (N=6), it is estimated that the transit time can be several seconds long in deep WM. Furthermore, simulations show that even at a spatial resolution of 7 microl voxel size, contamination by the GM signals can exceed 40% of the actual WM signal. From 10-min long flow-sensitive alternating inversion recovery ASL (FAIR-ASL) measurements at 3T in normal subjects (N=7), using highly sensitive detectors, it is shown that single-voxel (7 mul) deep WM perfusion values have an signal-to-noise ratio (SNR) less than 1. The poor sensitivity and heterogeneous transit time limit the applicability of ASL for measurement of perfusion in WM.

Pattern of regional cerebral blood-flow changes induced by acute heroin administration--a perfusion MRI study

PURPOSE

Although both the subjective and physiological effects of abused psychotropic substances have been characterized, less is known about their effects on brain function. We examined the actions of intravenous diacetylmorphine (heroin), the most widely abused opioid, on regional cerebral blood flow (rCBF), as assessed by perfusion-weighted MR imaging (PWI) in a double-blind and placebo-controlled setting.

MATERIAL AND METHODS

Eight male subjects dependent of diacetylmorphine (mean age 36 years, range: 26 to 44 years), who had participated in a clinical diacetylmorphine maintenance program, underwent PWI with gadolinium injection. At two sessions separated by 2-7 days, the participants were examined 80 s after intravenous administration of either diacetylmorphine or saline. rCBF in four regions of interest (amygdala, vermis of the cerebellum, anterior cingulated cortex and thalamus) was compared with heroin versus placebo.

RESULTS

In the cerebellum, thalamus and cingulated cortex, there were no significant differences in perfusion values between diacetylmorphine and placebo. In the amygdala, perfusion values were 0.8+/-0.4 and 0.5+/-0.2 on the left, and 0.9+/-0.4 and 0.6+/-0.3 on the right, with diacetylmorphine and with placebo, respectively (t-test results were P=0.044 and P=0.033 on the left and right sides, respectively). Other differences in perfusion values between the drug and placebo did not reach statistical significance.

CONCLUSION

Perfusion MRI demonstrated differences in brain hemodynamics induced by drug intake.