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Oliveira ÍAF, Schnabel R, van Osch MJP, van der Zwaag W, Hirschler L. Advancing 7T perfusion imaging by pulsed arterial spin labeling: Using a parallel transmit coil for enhanced labeling robustness and temporal SNR. PLoS One 2024; 19:e0309204. [PMID: 39186519 PMCID: PMC11346640 DOI: 10.1371/journal.pone.0309204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 08/08/2024] [Indexed: 08/28/2024] Open
Abstract
Non-invasive perfusion imaging by Arterial spin labeling (ASL) can be advantageous at Ultra-high field (UHF) MRI, since the image SNR and the T1 relaxation time both increase with the static field. However, ASL implementation, especially at 7T, is not trivial. Especially for ASL, UHF MRI comes with many challenges, mainly due to B1+ inhomogeneities. This study aimed to investigate the effects of different transmit coil configurations on perfusion-weighted imaging at 7T using a flow-sensitive alternating inversion recovery (FAIR) technique with time-resolved frequency offset corrected inversion (TR-FOCI) pulses for labeling and background suppression. We conducted a performance comparison between a parallel transmit (pTx) system equipped with 32 receive (Rx) and 8 transmit (Tx) channels and a standard setup with 32Rx and 2Tx channels. Our findings demonstrate that the pTx system, characterized by a more homogeneous B1 transmit field, resulted in a significantly higher contrast-to-noise ratio, temporal signal-to-noise ratio, and lower coefficient of variance (CoV) than the standard 2Tx setup. Additionally, both setups demonstrated comparable capabilities for functional mapping of the hand region in the motor cortex, achieving reliable results within a short acquisition time of approximately 5 minutes.
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Affiliation(s)
- Ícaro Agenor Ferreira Oliveira
- Spinoza Centre for Neuroimaging, Netherlands Academy for Arts and Sciences, Amsterdam, Netherlands
- Computational Cognitive Neuroscience and Neuroimaging, Netherlands Institute for Neuroscience, Amsterdam, Netherlands
- Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
| | - Robin Schnabel
- Spinoza Centre for Neuroimaging, Netherlands Academy for Arts and Sciences, Amsterdam, Netherlands
| | - Matthias J. P. van Osch
- C.J. Gorter MRI Center, Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Wietske van der Zwaag
- Spinoza Centre for Neuroimaging, Netherlands Academy for Arts and Sciences, Amsterdam, Netherlands
- Computational Cognitive Neuroscience and Neuroimaging, Netherlands Institute for Neuroscience, Amsterdam, Netherlands
| | - Lydiane Hirschler
- C.J. Gorter MRI Center, Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
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2
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Suzuki Y, Clement P, Dai W, Dolui S, Fernández-Seara M, Lindner T, Mutsaerts HJMM, Petr J, Shao X, Taso M, Thomas DL. ASL lexicon and reporting recommendations: A consensus report from the ISMRM Open Science Initiative for Perfusion Imaging (OSIPI). Magn Reson Med 2024; 91:1743-1760. [PMID: 37876299 PMCID: PMC10950547 DOI: 10.1002/mrm.29815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/22/2023] [Accepted: 07/13/2023] [Indexed: 10/26/2023]
Abstract
The 2015 consensus statement published by the International Society for Magnetic Resonance in Medicine (ISMRM) Perfusion Study Group and the European Cooperation in Science and Technology ( COST) Action ASL in Dementia aimed to encourage the implementation of robust arterial spin labeling (ASL) perfusion MRI for clinical applications and promote consistency across scanner types, sites, and studies. Subsequently, the recommended 3D pseudo-continuous ASL sequence has been implemented by most major MRI manufacturers. However, ASL remains a rapidly and widely developing field, leading inevitably to further divergence of the technique and its associated terminology, which could cause confusion and hamper research reproducibility. On behalf of the ISMRM Perfusion Study Group, and as part of the ISMRM Open Science Initiative for Perfusion Imaging (OSIPI), the ASL Lexicon Task Force has been working on the development of an ASL Lexicon and Reporting Recommendations for perfusion imaging and analysis, aiming to (1) develop standardized, consensus nomenclature and terminology for the broad range of ASL imaging techniques and parameters, as well as for the physiological constants required for quantitative analysis; and (2) provide a community-endorsed recommendation of the imaging parameters that we encourage authors to include when describing ASL methods in scientific reports/papers. In this paper, the sequences and parameters in (pseudo-)continuous ASL, pulsed ASL, velocity-selective ASL, and multi-timepoint ASL for brain perfusion imaging are included. However, the content of the lexicon is not intended to be limited to these techniques, and this paper provides the foundation for a growing online inventory that will be extended by the community as further methods and improvements are developed and established.
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Affiliation(s)
- Yuriko Suzuki
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Patricia Clement
- Department of Medical Imaging, Ghent University Hospital, Ghent, Belgium
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Weiying Dai
- State University of New York at Binghamton, Binghamton, NY, USA
| | - Sudipto Dolui
- Department of Radiology, University of Pennsylvania, Philadelphia, USA
| | - Maria Fernández-Seara
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Spain
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | | | - Henk JMM Mutsaerts
- Department of Radiology and Nuclear medicine, Amsterdam Neuroscience, Amsterdam University Medical Center, the Netherlands, Amsterdam
| | - Jan Petr
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, Dresden, Germany
| | - Xingfeng Shao
- Laboratory of FMRI Technology (LOFT), Mark & Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Manuel Taso
- Division of MRI Research, Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - David L Thomas
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, UK
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3
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Kashyap S, Oliveira ÍAF, Uludağ K. Feasibility of high-resolution perfusion imaging using arterial spin labeling MRI at 3 Tesla. Front Physiol 2024; 14:1271254. [PMID: 38235379 PMCID: PMC10791866 DOI: 10.3389/fphys.2023.1271254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/27/2023] [Indexed: 01/19/2024] Open
Abstract
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.
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Affiliation(s)
- Sriranga Kashyap
- Krembil Brain Institute, University Health Network, Toronto, ON, Canada
| | | | - Kâmil Uludağ
- Krembil Brain Institute, University Health Network, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, Republic of Korea
- Department of Biomedical Engineering, Sungkyunkwan University, Suwon, Republic of Korea
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
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Luna LP, Ahmed A, Daftaribesheli L, Deng F, Intrapiromkul J, Lanzman BA, Yedavalli V. Arterial spin labeling clinical applications for brain tumors and tumor treatment complications: A comprehensive case-based review. Neuroradiol J 2023; 36:129-141. [PMID: 35815750 PMCID: PMC10034709 DOI: 10.1177/19714009221114444] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Arterial spin labeling (ASL) is a noninvasive neuroimaging technique that allows for quantifying cerebral blood flow without intravenous contrast. Various neurovascular disorders and tumors have cerebral blood flow alterations. Identifying these perfusion changes through ASL can aid in the diagnosis, especially in entities with normal structural imaging. In addition, complications of tumor treatment and tumor progression can also be monitored using ASL. In this case-based review, we demonstrate the clinical applications of ASL in diagnosing and monitoring brain tumors and treatment complications.
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Affiliation(s)
- Licia P Luna
- Russell H. Morgan Department of
Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MA, USA
| | - Amara Ahmed
- Florida State University College of
Medicine, Tallahassee, FL, USA
| | - Laleh Daftaribesheli
- Russell H. Morgan Department of
Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MA, USA
| | - Francis Deng
- Massachusetts General Hospital and
Harvard Medical School, Boston, MA, USA
| | - Jarunee Intrapiromkul
- Russell H. Morgan Department of
Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MA, USA
| | - Bryan A Lanzman
- Department of Radiology, Stanford University, California, USA
| | - Vivek Yedavalli
- Russell H. Morgan Department of
Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MA, USA
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Liu J, Lin C, Minuti A, Lipton M. Arterial spin labeling compared to dynamic susceptibility contrast MR perfusion imaging for assessment of ischemic penumbra: A systematic review. J Neuroimaging 2021; 31:1067-1076. [PMID: 34388271 DOI: 10.1111/jon.12913] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/23/2021] [Accepted: 07/17/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Dynamic susceptibility contrast (DSC) MR imaging is commonly used to estimate penumbra size in acute ischemic stroke; this technique relies on the administration of gadolinium contrast, which has limited use in certain populations, such as those with impaired renal function or allergies. Arterial spin labeling (ASL) is a relatively new technique that can provide information on cerebral perfusion without need for exogenous contrast agents. This systematic review examines published studies that specifically compared ASL to DSC for assessment of ischemic penumbra. METHODS We searched PubMed, Embase, Web of Science, and the Cochrane Library for papers which compared ASL with DSC for assessment of ischemic penumbra in acute ischemic stroke among adult human populations. Two independent reviewers screened studies using predefined inclusion and exclusion criteria. Study characteristics and findings regarding the utility of ASL compared to DSC for identification of penumbra were then extracted and anlyzed for results and risk of bias. RESULTS Seventeen articles met inclusion and exclusion criteria. Studies compared ASL with DSC on a range of metrics (hypoperfusion, hyperperfusion, mismatch, and reperfusion). Most studies concluded that agreement of ASL with DSC was moderate to very high. A small subset of studies found discrepancy in agreement of ASL with DSC for size or location of perfusion abnormalities. A heterogeneity of perfusion parameters studied for DSC was noted, along with the need for more standardization of research methods. CONCLUSION ASL shows moderate to high agreement with DSC for detection of penumbra among ischemic stroke patients.
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Affiliation(s)
- Jinyuan Liu
- The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Christopher Lin
- The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Aurelia Minuti
- The D. Samuel Gottesman Library, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Michael Lipton
- The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA.,Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA.,Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA.,The Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
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Kashyap S, Ivanov D, Havlicek M, Huber L, Poser BA, Uludağ K. Sub-millimetre resolution laminar fMRI using Arterial Spin Labelling in humans at 7 T. PLoS One 2021; 16:e0250504. [PMID: 33901230 PMCID: PMC8075193 DOI: 10.1371/journal.pone.0250504] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 04/07/2021] [Indexed: 12/02/2022] Open
Abstract
Laminar fMRI at ultra-high magnetic field strength is typically carried out using the Blood Oxygenation Level-Dependent (BOLD) contrast. Despite its unrivalled sensitivity to detecting activation, the BOLD contrast is limited in its spatial specificity due to signals stemming from intra-cortical ascending and pial veins. Alternatively, regional changes in perfusion (i.e., cerebral blood flow through tissue) are colocalised to neuronal activation, which can be non-invasively measured using Arterial Spin Labelling (ASL) MRI. In addition, ASL provides a quantitative marker of neuronal activation in terms of perfusion signal, which is simultaneously acquired along with the BOLD signal. However, ASL for laminar imaging is challenging due to the lower SNR of the perfusion signal and higher RF power deposition i.e., specific absorption rate (SAR) of ASL sequences. In the present study, we present for the first time in humans, isotropic sub-millimetre spatial resolution functional perfusion images using Flow-sensitive Alternating Inversion Recovery (FAIR) ASL with a 3D-EPI readout at 7 T. We show that robust statistical activation maps can be obtained with perfusion-weighting in a single session. We observed the characteristic BOLD amplitude increase towards the superficial laminae, and, in apparent discrepancy, the relative perfusion profile shows a decrease of the amplitude and the absolute perfusion profile a much smaller increase towards the cortical surface. Considering the draining vein effect on the BOLD signal using model-based spatial “convolution”, we show that the empirically measured perfusion and BOLD profiles are, in fact, consistent with each other. This study demonstrates that laminar perfusion fMRI in humans is feasible at 7 T and that caution must be exercised when interpreting BOLD signal laminar profiles as direct representation of the cortical distribution of neuronal activity.
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Affiliation(s)
- Sriranga Kashyap
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Maastricht Brain Imaging Centre (M-BIC), Maastricht University, Maastricht, The Netherlands
- * E-mail: (SK); (DI)
| | - Dimo Ivanov
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Maastricht Brain Imaging Centre (M-BIC), Maastricht University, Maastricht, The Netherlands
- * E-mail: (SK); (DI)
| | - Martin Havlicek
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Laurentius Huber
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Maastricht Brain Imaging Centre (M-BIC), Maastricht University, Maastricht, The Netherlands
| | - Benedikt A. Poser
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Maastricht Brain Imaging Centre (M-BIC), Maastricht University, Maastricht, The Netherlands
| | - Kâmil Uludağ
- Center for Neuroscience Imaging Research, Institute for Basic Science, Sungkyunkwan University, Suwon, South Korea
- Department of Biomedical Engineering, N Center, Sungkyunkwan University, Suwon, South Korea
- Techna Institute & Koerner Scientist in MR Imaging, University Health Network, Toronto, Canada
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Wang K, Shao X, Yan L, Ma SJ, Jin J, Wang DJJ. Optimization of adiabatic pulses for pulsed arterial spin labeling at 7 tesla: Comparison with pseudo-continuous arterial spin labeling. Magn Reson Med 2021; 85:3227-3240. [PMID: 33427349 DOI: 10.1002/mrm.28661] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 12/05/2020] [Accepted: 12/08/2020] [Indexed: 11/05/2022]
Abstract
PURPOSE To optimize and evaluate adiabatic pulses for pulsed arterial spin labeling at ultrahigh field 7 tesla. METHODS Four common adiabatic inversion pulses, including hyperbolic secant, wideband uniform rate smooth truncation, frequency offset corrected inversion, and time-resampled frequency offset corrected inversion pulses, were optimized based on a custom-defined loss function that included labeling efficiency and inversion band uniformity. The optimized pulses were implemented in flow-sensitive alternating inversion recovery sequences and tested on phantom and 11 healthy volunteers with 2 constraints: 1) specific absorption rate normalized; and 2) equal peak RF amplitude, respectively. A pseudo-continuous arterial spin labeling sequence was implemented for comparison. Quantitative metrics such as perfusion and relative labeling efficiency versus residual tissue signal were calculated. RESULTS Among the 4 pulses, the wideband uniform rate smooth truncation pulse yielded the lowest loss in simulation and achieved a good balance between labeling efficiency and residual tissue signal from both phantom and in vivo experiments. Wideband uniform rate smooth truncation-pulsed arterial spin labeling showed significantly higher relative labeling efficiency compared to the other sequences (P < .01), whereas the perfusion signal was increased by 40% when the highest B 1 + amplitude was used. The 4 pulsed arterial spin labeling sequences yielded comparable perfusion signals compared to pseudo-continuous arterial spin labeling but with less than half the specific absorption rate. CONCLUSION Optimized wideband uniform rate smooth truncation pulse with the highest B 1 + amplitude allowed was recommended for 7 tesla pulsed arterial spin labeling.
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Affiliation(s)
- Kai Wang
- Laboratory of FMRI Technology (LOFT), USC Mark & Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Xingfeng Shao
- Laboratory of FMRI Technology (LOFT), USC Mark & Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Lirong Yan
- Laboratory of FMRI Technology (LOFT), USC Mark & Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.,Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Samantha J Ma
- Laboratory of FMRI Technology (LOFT), USC Mark & Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.,Siemens Medical Solutions USA, Inc., Los Angeles, California, USA
| | - Jin Jin
- Laboratory of FMRI Technology (LOFT), USC Mark & Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.,Siemens Healthcare Pty Ltd, Brisbane, Australia
| | - Danny J J Wang
- Laboratory of FMRI Technology (LOFT), USC Mark & Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.,Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Soldozy S, Galindo J, Snyder H, Ali Y, Norat P, Yağmurlu K, Sokolowski JD, Sharifi K, Tvrdik P, Park MS, Kalani MYS. Clinical utility of arterial spin labeling imaging in disorders of the nervous system. Neurosurg Focus 2020; 47:E5. [PMID: 31786550 DOI: 10.3171/2019.9.focus19567] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 09/16/2019] [Indexed: 11/06/2022]
Abstract
Neuroimaging is an indispensable tool in the workup and management of patients with neurological disorders. Arterial spin labeling (ASL) is an imaging modality that permits the examination of blood flow and perfusion without the need for contrast injection. Noninvasive in nature, ASL provides a feasible alternative to existing vascular imaging techniques, including angiography and perfusion imaging. While promising, ASL has yet to be fully incorporated into the diagnosis and management of neurological disorders. This article presents a review of the most recent literature on ASL, with a special focus on its use in moyamoya disease, brain neoplasms, seizures, and migraines and a commentary on recent advances in ASL that make the imaging technique more attractive as a clinically useful tool.
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Spatial coefficient of variation applied to arterial spin labeling MRI may contribute to predict surgical revascularization outcomes in pediatric moyamoya vasculopathy. Neuroradiology 2020; 62:1003-1015. [DOI: 10.1007/s00234-020-02446-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 04/20/2020] [Indexed: 10/24/2022]
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Arterial Spin Labeling and Dynamic Susceptibility Contrast-enhanced MR Imaging for evaluation of arteriovenous shunting and tumor hypoxia in glioblastoma. Sci Rep 2019; 9:8747. [PMID: 31217496 PMCID: PMC6584644 DOI: 10.1038/s41598-019-45312-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 06/05/2019] [Indexed: 12/24/2022] Open
Abstract
Glioblastoma (GBM) is the most common primary malignant brain tumor in adults and carries a dismal prognosis. Significant challenges in the care of patients with GBM include marked vascular heterogeneity and arteriovenous (AV) shunting, which results in tumor hypoxia and inadequate delivery of systemic treatments to reach tumor cells. In this study, we investigated the utility of different MR perfusion techniques to detect and quantify arteriovenous (AV) shunting and tumor hypoxia in patients with GBM. Macrovascular shunting was present in 33% of subjects, with the degree of shunting ranging from (37–60%) using arterial spin labeling perfusion. Among the dynamic susceptibility contrast-enhanced perfusion curve features, there were a strong negative correlation between hypoxia score, DSC perfusion curve recovery slope (r = −0.72, P = 0.018) and angle (r = −0.73, P = 0.015). The results of this study support the possibility of using arterial spin labeling and pattern analysis of dynamic susceptibility contrast-enhanced MR Imaging for evaluation of arteriovenous shunting and tumor hypoxia in glioblastoma.
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