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Lee TJ, Roh HG, Kim HJ, Jeon YS, Ki HJ, Park JJ, Lee HJ, Lee JS, Choi JW, Ryu SY, Jung YJ, Lee SB. Prognostic value of collateral perfusion estimation by arterial spin labeling for acute anterior circulation ischemic stroke. Neuroradiology 2023; 65:1695-1705. [PMID: 37837481 DOI: 10.1007/s00234-023-03233-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/03/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE This study aimed to verify the value of arterial spin labeling (ASL) collateral perfusion estimation for predicting functional outcomes in acute anterior circulation ischemic stroke. METHODS This secondary analysis of an ongoing prospective observational study included data from participants with acute ischemic stroke due to steno-occlusion of the internal carotid artery and/or the middle cerebral artery within 8 h of symptom onset. We compared the collateral map, which is a 5-phase collateral imaging derived from dynamic contrast-enhanced magnetic resonance angiography, and ASL to validate the ASL collateral perfusion estimation. Multiple logistic regression analyses were conducted to identify independent predictors of favorable functional outcomes. RESULTS One hundred forty-eight participants (68 ± 13 years, 96 men) were evaluated. The ASL collateral perfusion grade was positively correlated with the collateral perfusion grade of the collateral map (P < .001). Younger age (OR = 0.53, 95% CI = 0.36-0.78, P = .002), lower baseline NIHSS score (OR = 0.85, 95% CI = 0.78-0.92, P < .001), intermediate ASL collateral perfusion grade (OR = 4.02, 95% CI = 1.43-11.26, P = .008), good ASL collateral perfusion grade (OR = 26.37, 95% CI = 1.06-655.01, P = .046), and successful reperfusion (OR = 5.84, 95% CI = 2.08-16.42, P < .001) were independently associated with favorable functional outcomes. CONCLUSION ASL collateral perfusion estimation provides prognostic information, which can be helpful in guiding management decisions.
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Affiliation(s)
- Taek-Jun Lee
- Department of Neurology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 64 Daeheung-Ro, Jung-Gu, Daejeon, 34943, Republic of Korea
| | - Hong Gee Roh
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Hyun Jeong Kim
- Department of Radiology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Yoo Sung Jeon
- Department of Neurosurgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Hee Jong Ki
- Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Jeong Jin Park
- Department of Neurology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Hyung Jin Lee
- Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jin Woo Choi
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Seon Young Ryu
- Department of Neurology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 64 Daeheung-Ro, Jung-Gu, Daejeon, 34943, Republic of Korea
| | - Yu Jin Jung
- Department of Neurology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 64 Daeheung-Ro, Jung-Gu, Daejeon, 34943, Republic of Korea
| | - Sang Bong Lee
- Department of Neurology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 64 Daeheung-Ro, Jung-Gu, Daejeon, 34943, Republic of Korea.
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Lindner T, Bolar DS, Achten E, Barkhof F, Bastos-Leite AJ, Detre JA, Golay X, Günther M, Wang DJJ, Haller S, Ingala S, Jäger HR, Jahng GH, Juttukonda MR, Keil VC, Kimura H, Ho ML, Lequin M, Lou X, Petr J, Pinter N, Pizzini FB, Smits M, Sokolska M, Zaharchuk G, Mutsaerts HJMM. Current state and guidance on arterial spin labeling perfusion MRI in clinical neuroimaging. Magn Reson Med 2023; 89:2024-2047. [PMID: 36695294 PMCID: PMC10914350 DOI: 10.1002/mrm.29572] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 01/26/2023]
Abstract
This article focuses on clinical applications of arterial spin labeling (ASL) and is part of a wider effort from the International Society for Magnetic Resonance in Medicine (ISMRM) Perfusion Study Group to update and expand on the recommendations provided in the 2015 ASL consensus paper. Although the 2015 consensus paper provided general guidelines for clinical applications of ASL MRI, there was a lack of guidance on disease-specific parameters. Since that time, the clinical availability and clinical demand for ASL MRI has increased. This position paper provides guidance on using ASL in specific clinical scenarios, including acute ischemic stroke and steno-occlusive disease, arteriovenous malformations and fistulas, brain tumors, neurodegenerative disease, seizures/epilepsy, and pediatric neuroradiology applications, focusing on disease-specific considerations for sequence optimization and interpretation. We present several neuroradiological applications in which ASL provides unique information essential for making the diagnosis. This guidance is intended for anyone interested in using ASL in a routine clinical setting (i.e., on a single-subject basis rather than in cohort studies) building on the previous ASL consensus review.
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Affiliation(s)
- Thomas Lindner
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Divya S. Bolar
- Center for Functional Magnetic Resonance Imaging, Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Eric Achten
- Department of Radiology and Nuclear Medicine, Ghent University, Ghent, Belgium
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam University Medical Center, Amsterdam, The Netherlands; Queen Square Institute of Neurology and Centre for Medical Image Computing, University College London, UK
| | | | - John A. Detre
- Department of Neurology, University of Pennsylvania, Philadelphia PA USA
| | - Xavier Golay
- UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Matthias Günther
- (1) University Bremen, Germany; (2) Fraunhofer MEVIS, Bremen, Germany; (3) mediri GmbH, Heidelberg, Germany
| | - Danny JJ Wang
- Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles CA USA
| | - Sven Haller
- (1) CIMC - Centre d’Imagerie Médicale de Cornavin, Place de Cornavin 18, 1201 Genève 1201 Genève (2) Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden (3) Faculty of Medicine of the University of Geneva, Switzerland. Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, P. R. China
| | - Silvia Ingala
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Hans R Jäger
- UCL Queen Square Institute of Neuroradiology, University College London, London, UK
| | - Geon-Ho Jahng
- Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Meher R. Juttukonda
- (1) Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown MA USA (2) Department of Radiology, Harvard Medical School, Boston MA USA
| | - Vera C. Keil
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Hirohiko Kimura
- Department of Radiology, Faculty of Medical sciences, University of Fukui, Fukui, JAPAN
| | - Mai-Lan Ho
- Nationwide Children’s Hospital and The Ohio State University, Columbus, OH, USA
| | - Maarten Lequin
- Division Imaging & Oncology, Department of Radiology & Nuclear Medicine | University Medical Center Utrecht & Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Xin Lou
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Jan Petr
- (1) Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, Dresden, Germany (2) Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Nandor Pinter
- Dent Neurologic Institute, Buffalo, NY, USA. University at Buffalo Neurosurgery, Buffalo, NY, USA
| | - Francesca B. Pizzini
- Radiology Institute, Dept. of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Marion Smits
- (1) Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands (2) The Brain Tumour Centre, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Magdalena Sokolska
- Department of Medical Physics and Biomedical Engineering University College London Hospitals NHS Foundation Trust, UK
| | | | - Henk JMM Mutsaerts
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam University Medical Center, Amsterdam, The Netherlands
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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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