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Woods JG, Achten E, Asllani I, Bolar DS, Dai W, Detre JA, Fan AP, Fernández-Seara M, Golay X, Günther M, Guo J, Hernandez-Garcia L, Ho ML, Juttukonda MR, Lu H, MacIntosh BJ, Madhuranthakam AJ, Mutsaerts HJ, Okell TW, Parkes LM, Pinter N, Pinto J, Qin Q, Smits M, Suzuki Y, Thomas DL, Van Osch MJ, Wang DJJ, Warnert EA, Zaharchuk G, Zelaya F, Zhao M, Chappell MA. Recommendations for quantitative cerebral perfusion MRI using multi-timepoint arterial spin labeling: Acquisition, quantification, and clinical applications. Magn Reson Med 2024; 92:469-495. [PMID: 38594906 PMCID: PMC11142882 DOI: 10.1002/mrm.30091] [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: 08/31/2023] [Revised: 02/09/2024] [Accepted: 03/07/2024] [Indexed: 04/11/2024]
Abstract
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.
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Affiliation(s)
- Joseph G. Woods
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Center for Functional Magnetic Resonance Imaging, Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Eric Achten
- Ghent Institute for Functional and Metabolic Imaging (GIfMI), Ghent University, Ghent, Belgium
| | - Iris Asllani
- Department of Neuroscience, University of Sussex, UK and Department of Biomedical Engineering, Rochester Institute of Technology, USA
| | - Divya S. Bolar
- Center for Functional Magnetic Resonance Imaging, Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Weiying Dai
- Department of Computer Science, State University of New York at Binghamton, Binghamton, NY, USA, 13902
| | - John A. Detre
- Department of Neurology, University of Pennsylvania, 3 Dulles Building, 3400 Spruce Street, Philadelphia, PA 19104 USA
| | - Audrey P. Fan
- Department of Biomedical Engineering, Department of Neurology, University of California Davis, Davis, CA, USA
| | - Maria Fernández-Seara
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Spain; IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Xavier Golay
- UCL Queen Square Institute of Neurology, University College London, London, UK; Gold Standard Phantoms, UK
| | - Matthias Günther
- Imaging Physics, Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
- Departments of Physics and Electrical Engineering, University of Bremen, Bremen, Germany
| | - Jia Guo
- Department of Bioengineering, University of California Riverside, Riverside, CA, USA
| | | | - Mai-Lan Ho
- Department of Radiology, University of Missouri, Columbia, MO, USA. ORCID: 0000-0002-9455-1350
| | - Meher R. Juttukonda
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, USA
- Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Hanzhang Lu
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Bradley J. MacIntosh
- Hurvitz Brain Sciences Program, Centre for Brain Resilience & Recovery, Sunnybrook Research Institute, Toronto, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Canada
- Computational Radiology & Artificial Intelligence unit, Oslo University Hospital, Oslo, Norway
| | - Ananth J. Madhuranthakam
- Department of Radiology and Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Henk-Jan Mutsaerts
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, The Netherlands
| | - Thomas W. Okell
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Laura M. Parkes
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, UK
| | - Nandor Pinter
- Dent Neurologic Institute, Buffalo, New York, USA; University at Buffalo Neurosurgery, Buffalo, New York, USA
| | - Joana Pinto
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Qin Qin
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Marion Smits
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
- Medical Delta, Delft, The Netherlands
- Erasmus MC Cancer Institute, Erasmus MC, Rotterdam, NL
| | - Yuriko Suzuki
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - David L. Thomas
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Matthias J.P. Van Osch
- C.J. Gorter MRI Center, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Danny JJ Wang
- Laboratory of FMRI Technology (LOFT), Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, USA
| | - Esther A.H. Warnert
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
- Erasmus MC Cancer Institute, Erasmus MC, Rotterdam, NL
| | - Greg Zaharchuk
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Fernando Zelaya
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Moss Zhao
- Department of Radiology, Stanford University, Stanford, CA, USA
- Maternal & Child Health Research Institute, Stanford University, Stanford, CA, USA
| | - Michael A. Chappell
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, UK
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Takeuchi K, Isozaki M, Higashino Y, Kosaka N, Kikuta KI, Ishida S, Kanamoto M, Takei N, Okazawa H, Kimura H. The Utility of Arterial Transit Time Measurement for Evaluating the Hemodynamic Perfusion State of Patients with Chronic Cerebrovascular Stenosis or Occlusive Disease: Correlative Study between MR Imaging and 15O-labeled H 2O Positron Emission Tomography. Magn Reson Med Sci 2023; 22:289-300. [PMID: 35545508 PMCID: PMC10449557 DOI: 10.2463/mrms.mp.2020-0123] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 02/07/2022] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To verify whether arterial transit time (ATT) mapping can correct arterial spin labeling-cerebral blood flow (ASL-CBF) values and to verify whether ATT is a parameter that correlates with positron emission tomography (PET)-oxygen extraction fraction (OEF) and PET-mean transit time (MTT). METHODS Eleven patients with unilateral major cerebral artery stenosis or occlusion underwent MRI and PET in the chronic or asymptomatic phase. ASL-MRI acquisitions were conducted with each of two post-label delay (PLD) settings (0.7s and 2.0s) using a pseudo-continuous ASL pulse sequence and 3D-spin echo spiral readout with vascular crusher gradient. ATT maps were obtained using a low-resolution pre-scan approach with five PLD settings. Using the ASL perfusion images and ATT mapping, ATT-corrected ASL-CBF images were obtained. Four kinds of ASL-CBF methods (PLD 0.7s with or without ATT correction and PLD 2.0s with or without ATT correction) were compared to PET-CBF, using vascular territory ROIs. ATT and OEF were compared for all ROIs, unaffected side ROIs, and affected side ROIs, respectively. ATT and MTT were compared by the ratio of the affected side to the unaffected side. Transit time-based ROIs were used for the comparison with ATT. RESULTS Comparing ASL-CBF and PET-CBF, the correlation was higher with ATT correction than without correction, and for a PLD of 2.0s compared with 0.7s. The best correlation was for PLD of 2.0s with ATT correction (R2 = 0.547). ROIs on the affected side showed a low but significant correlation between ATT and PET-OEF (R2 = 0.141). There was a low correlation between the ATT ratio and the MTT ratio (R2 = 0.133). CONCLUSION Low-resolution ATT correction may increase the accuracy of ASL-CBF measurements in patients with unilateral major cerebral artery stenosis or occlusion. In addition, ATT itself might have a potential role in detecting compromised hemodynamic state.
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Affiliation(s)
- Kayo Takeuchi
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, Yoshida-gun, Fukui, Japan
| | - Makoto Isozaki
- Department of Neurosurgery, Faculty of Medical Sciences, University of Fukui, Yoshida-gun, Fukui, Japan
| | - Yoshifumi Higashino
- Department of Neurosurgery, Faculty of Medical Sciences, University of Fukui, Yoshida-gun, Fukui, Japan
| | - Nobuyuki Kosaka
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, Yoshida-gun, Fukui, Japan
| | - Ken-ichiro Kikuta
- Department of Neurosurgery, Faculty of Medical Sciences, University of Fukui, Yoshida-gun, Fukui, Japan
| | - Shota Ishida
- Radiological Center, University of Fukui Hospital, Yoshida-gun, Fukui, Japan
| | - Masayuki Kanamoto
- Radiological Center, University of Fukui Hospital, Yoshida-gun, Fukui, Japan
| | - Naoyuki Takei
- Global MR Applications and Workflow, GE Healthcare, Tokyo, Japan
| | - Hidehiko Okazawa
- Biomedical Imaging Research Center, University of Fukui, Yoshida-gun, Fukui, Japan
| | - Hirohiko Kimura
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, Yoshida-gun, Fukui, Japan
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Fitzgerald B, Yao JF, Hocke LM, Frederick BD, van Niftrik CHB, Tong Y. Using carpet plots to analyze blood transit times in the brain during hypercapnic challenge magnetic resonance imaging. Front Physiol 2023; 14:1134804. [PMID: 36875021 PMCID: PMC9975721 DOI: 10.3389/fphys.2023.1134804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/01/2023] [Indexed: 02/17/2023] Open
Abstract
Blood arrival time and blood transit time are useful metrics in characterizing hemodynamic behaviors in the brain. Functional magnetic resonance imaging in combination with a hypercapnic challenge has been proposed as a non-invasive imaging tool to determine blood arrival time and replace dynamic susceptibility contrast (DSC) magnetic resonance imaging, a current gold-standard imaging tool with the downsides of invasiveness and limited repeatability. Using a hypercapnic challenge, blood arrival times can be computed by cross-correlating the administered CO2 signal with the fMRI signal, which increases during elevated CO2 due to vasodilation. However, whole-brain transit times derived from this method can be significantly longer than the known cerebral transit time for healthy subjects (nearing 20 s vs. the expected 5-6 s). To address this unrealistic measurement, we here propose a novel carpet plot-based method to compute improved blood transit times derived from hypercapnic blood oxygen level dependent fMRI, demonstrating that the method reduces estimated blood transit times to an average of 5.32 s. We also investigate the use of hypercapnic fMRI with cross-correlation to compute the venous blood arrival times in healthy subjects and compare the computed delay maps with DSC-MRI time to peak maps using the structural similarity index measure (SSIM). The strongest delay differences between the two methods, indicated by low structural similarity index measure, were found in areas of deep white matter and the periventricular region. SSIM measures throughout the remainder of the brain reflected a similar arrival sequence derived from the two methods despite the exaggerated spread of voxel delays computed using CO2 fMRI.
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Affiliation(s)
- Bradley Fitzgerald
- Elmore Family School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, United States
| | - Jinxia Fiona Yao
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States
| | - Lia M Hocke
- McLean Imaging Center, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, , United States
| | - Blaise deB Frederick
- McLean Imaging Center, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, , United States
| | | | - Yunjie Tong
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States
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Ozpar R, Dinc Y, Nas OF, Inecikli MF, Parlak M, Hakyemez B. Arterial transit artifacts observed on arterial spin labeling perfusion imaging of carotid artery stenosis patients: What are counterparts on symptomatology, dynamic susceptibility contrast perfusion, and digital subtraction angiography? J Neuroradiol 2022; 50:407-414. [PMID: 36067966 DOI: 10.1016/j.neurad.2022.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 08/17/2022] [Accepted: 08/31/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE To investigate possible relationships between the presence and location of arterial transit artifacts (ATA) and clinical symptoms, digital subtraction angiography (DSA), and dynamic susceptibility contrast (DSC) perfusion imaging abnormalities in patients with carotid artery stenosis (CAS). METHODS Forty-seven patients who underwent arterial spin labeling (ASL) and DSC perfusion imaging in the same period diagnosed with > 50% unilateral internal carotid artery (ICA) stenosis by DSA performed 24 h after perfusion imaging were included. The presence of ATA, localization and hypoperfusion were evaluated using ASL interpretation. Maps derived from DSC perfusion, symptomatology, stenosis rates, and collateralization findings observed in DSA were investigated. Probable relationships were evaluated. RESULTS ATA on ASL were detected in 68.1% (32/47); 40.6% (13/32) of ATAs were observed in the distal middle cerebral artery (MCA) trace, 50% (16/32) in the intracranial ICA and MCA traces, and 9.4% (3/32) in the intracranial ICA trace. When classifications based on the ATA presence and localization was made, qualitative and quantitative CBF, MTT, and TTP abnormalities, symptomatology, stenosis rates, and collateralization findings significantly differed between groups (p < 0.05). CONCLUSION The presence and localization of ATA in patients with CAS may provide essential insights into cerebral hemodynamics and the CAS severity. ATAs observed only in the distal MCA trace may represent early-stage perfusion abnormalities and a moderate level of stenosis. ATA in the ICA trace may related to a more advanced level of perfusion abnormalities, critical stenosis rates, symptom or collateralization presence.
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Affiliation(s)
- Rifat Ozpar
- Department of Radiology, Bursa Uludag University, Faculty of Medicine, Bursa, Turkey.
| | - Yasemin Dinc
- Department of Neurology, Bursa Uludag University, Faculty of Medicine, Bursa, Turkey
| | - Omer Fatih Nas
- Department of Radiology, Bursa Uludag University, Faculty of Medicine, Bursa, Turkey
| | - Mehmet Fatih Inecikli
- Department of Radiology, Bursa Uludag University, Faculty of Medicine, Bursa, Turkey
| | - Mufit Parlak
- Department of Radiology, Bursa Uludag University, Faculty of Medicine, Bursa, Turkey
| | - Bahattin Hakyemez
- Department of Radiology, Bursa Uludag University, Faculty of Medicine, Bursa, Turkey
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Zhao MY, Fan AP, Chen DYT, Ishii Y, Khalighi MM, Moseley M, Steinberg GK, Zaharchuk G. Using arterial spin labeling to measure cerebrovascular reactivity in Moyamoya disease: Insights from simultaneous PET/MRI. J Cereb Blood Flow Metab 2022; 42:1493-1506. [PMID: 35236136 PMCID: PMC9274857 DOI: 10.1177/0271678x221083471] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cerebrovascular reactivity (CVR) reflects the CBF change to meet different physiological demands. The reference CVR technique is PET imaging with vasodilators but is inaccessible to most patients. DSC can measure transit time to evaluate patients suspected of stroke, but the use of gadolinium may cause side-effects. Arterial spin labeling (ASL) is a non-invasive MRI technique for CBF measurements. Here, we investigate the effectiveness of ASL with single and multiple post labeling delays (PLD) to replace PET and DSC for CVR and transit time mapping in 26 Moyamoya patients. Images were collected using simultaneous PET/MRI with acetazolamide. CVR, CBF, arterial transit time (ATT), and time-to-maximum (Tmax) were measured in different flow territories. Results showed that CVR was lower in occluded regions than normal regions (by 68 ± 12%, 52 ± 5%, and 56 ± 9%, for PET, single- and multi-PLD PCASL, respectively, all p < 0.05). Multi-PLD PCASL correlated slightly higher with PET (CCC = 0.36 and 0.32 in affected and unaffected territories respectively). Vasodilation caused ATT to reduce by 4.5 ± 3.1% (p < 0.01) in occluded regions. ATT correlated significantly with Tmax (R2 > 0.35, p < 0.01). Therefore, multi-PLD ASL is recommended for CVR studies due to its high agreement with the reference PET technique and the capability of measuring transit time.
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Affiliation(s)
- Moss Y Zhao
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Audrey P Fan
- Department of Biomedical Engineering, University of California Davis, Davis, CA, USA.,Department of Neurology, University of California Davis, Davis, CA, USA
| | - David Yen-Ting Chen
- Department of Medical Imaging, Taipei Medical University - Shuan-Ho Hospital, New Taipei City.,Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei
| | - Yosuke Ishii
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Michael Moseley
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Gary K Steinberg
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
| | - Greg Zaharchuk
- Department of Radiology, Stanford University, Stanford, CA, USA
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Onkenhout L, Arts T, Ferro D, Oudeman E, van Osch M, Zwanenburg J, Hendrikse J, Kappelle L, Biessels GJ. Perforating artery flow velocity and pulsatility in patients with carotid occlusive disease. A 7 tesla MRI study. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2022; 3:100143. [PMID: 36324413 PMCID: PMC9616320 DOI: 10.1016/j.cccb.2022.100143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 03/31/2022] [Accepted: 04/10/2022] [Indexed: 12/02/2022]
Abstract
Patients with COD show lower perforating artery flow velocity in watershed areas. Reduced perforating artery flow seems to be related to subcortical ischemic burden. Perforating artery function may be relevant for clinical outcome in COD patients.
Patients with carotid occlusive disease express altered hemodynamics in the post-occlusive vasculature and lesions commonly attributed to cerebral small vessel disease (SVD). We addressed the question if cerebral perforating artery flow measures, using a novel 7T MRI technique, are altered and related to SVD lesion burden in patients with carotid occlusive disease. 21 patients were included with a uni- (18) or bilateral (3) carotid occlusion (64±7 years) and 19 controls (65±10 years). Mean flow velocity and pulsatility in the perforating arteries in the semi-oval center (CSO) and basal ganglia (BG), measured with a 2D phase contrast 7T MRI sequence, were compared between patients and controls, and between hemispheres in patients with unilateral carotid occlusive disease. In patients, relations were assessed between perforating artery flow measures and SVD burden score and white matter hyperintensity (WMH) volume. CSO perforating artery flow velocity was lower in patients than controls, albeit non-significant (mean difference [95% confidence interval] 0.08 cm/s [0.00–0.16]; p = 0.053), but pulsatility was similar (0.07 [-0.04–0.18]; p = 0.23). BG flow velocity and pulsatility did not differ between patients and controls (velocity = 0.28 cm/s [-0.32–0.88]; p = 0.34; pulsatility = 0.00 [-0.10–0.11]; p = 0.97). Patients with unilateral carotid occlusive disease showed no significant interhemispheric flow differences. Though non-significant, within patients lower CSO (p = 0.06) and BG (p = 0.11) flow velocity related to larger WMH volume. Our findings suggest that carotid occlusive disease may be associated with abnormal cerebral perforating artery flow and that this relates to SVD lesion burden in these patients, although our observations need corroboration in larger study populations.
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Affiliation(s)
- L.P. Onkenhout
- Department of Neurology, UMCU Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Tine Arts
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3508 GA, the Netherlands
- Corresponding author.
| | - D. Ferro
- Department of Neurology, UMCU Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - E.A. Oudeman
- Department of Neurology, UMCU Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Neurology, OLVG, Amsterdam, the Netherlands
| | - M.J.P. van Osch
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - J.J.M. Zwanenburg
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3508 GA, the Netherlands
| | - J. Hendrikse
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3508 GA, the Netherlands
| | - L.J. Kappelle
- Department of Neurology, UMCU Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - GJ. Biessels
- Department of Neurology, UMCU Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
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van der Plas MCE, Craig M, Schmid S, Chappell MA, van Osch MJP. Validation of the estimation of the macrovascular contribution in multi-timepoint arterial spin labeling MRI using a 2-component kinetic model. Magn Reson Med 2021; 87:85-101. [PMID: 34390279 PMCID: PMC10138741 DOI: 10.1002/mrm.28960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 11/08/2022]
Abstract
PURPOSE In this paper, the ability to quantify cerebral blood flow by arterial spin labeling (ASL) was studied by investigating the separation of the macrovascular and tissue component using a 2-component model. Underlying assumptions of this model, especially the inclusion of dispersion in the analysis, were studied, as well as the temporal resolution of the ASL datasets. METHODS Four different datasets were acquired: (1) 4D ASL angiography to characterize the macrovascular component and to study dispersion modeling within this component, (2) high temporal resolution ASL data to investigate the separation of the 2 components and the effect of dispersion modelling on this separation, (3) low temporal resolution ASL dataset to study the effect of the temporal resolution on the separation of the 2 components, and (4) low temporal resolution ASL data with vascular crushing. RESULTS The model that included a gamma dispersion kernel had the best fit to the 4D ASL angiography. For the high temporal resolution ASL dataset, inclusion of the gamma dispersion kernel led to more signal included in the arterial blood volume map, which resulted in decreased cerebral blood flow values. The arterial blood volume and cerebral blood flow maps showed overall higher arterial blood volume values and lower cerebral blood flow values for the high temporal resolution dataset compared to the low temporal resolution dataset. CONCLUSION Inclusion of a gamma dispersion kernel resulted in better fitting of the model to the data. The separation of the macrovascular and tissue component is affected by the inclusion of a gamma dispersion kernel and the temporal resolution of the ASL dataset.
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Affiliation(s)
- Merlijn C E van der Plas
- C.J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.,Leiden Institute of Brain and Cognition (LIBC), Leiden University Medical Center, Leiden, The Netherlands
| | - Martin Craig
- Radiological Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,Sir Peter Mansfield Imaging Center, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Sophie Schmid
- C.J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.,Leiden Institute of Brain and Cognition (LIBC), Leiden University Medical Center, Leiden, The Netherlands
| | - Michael A Chappell
- Radiological Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,Sir Peter Mansfield Imaging Center, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.,Nottingham Biomedical Research Centre, Queens Medical Centre, University of Nottingham, Nottingham, United Kingdom
| | - Matthias J P van Osch
- C.J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.,Leiden Institute of Brain and Cognition (LIBC), Leiden University Medical Center, Leiden, The Netherlands
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8
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Liu J, Guo ZN, Simpson D, Zhang P, Liu C, Song JN, Leng X, Yang Y. A Data-Driven Approach to Transfer Function Analysis for Superior Discriminative Power: Optimized Assessment of Dynamic Cerebral Autoregulation. IEEE J Biomed Health Inform 2021; 25:909-921. [PMID: 32780704 DOI: 10.1109/jbhi.2020.3015907] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Transfer function analysis (TFA) is extensively used to assess human physiological functions. However, extracting parameters from TFA is not usually optimized for detecting impaired function. In this study, we propose to use data-driven approaches to improve the performance of TFA in assessing blood flow control in the brain (dynamic cerebral autoregulation, dCA). Data were collected from two distinct groups of subjects deemed to have normal and impaired dCA. Continuous arterial blood pressure (ABP) and cerebral blood flow velocity (CBFV) were simultaneously recorded for approximately 10 mins in 82 subjects (including 41 healthy controls) to give 328 labeled samples of the TFA variables. The recordings were further divided into 4,294 short data segments to generate 17,176 unlabeled samples of the TFA variables. We optimized TFA post-processing with a generic semi-supervised learning strategy and a novel semi-supervised stacked ensemble learning (SSEL) strategy for classification into normal and impaired dCA. The generic strategy led to a performance with no significant difference to that of the conventional dCA analysis methods, whereas the proposed new strategy boosted the performance of TFA to an accuracy of 93.3%. To our knowledge, this is the best dCA discrimination performance obtained to date and the first attempt at optimizing TFA through machine learning techniques. Equivalent methods can potentially also be applied to assessing a wide spectrum of other human physiological functions.
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9
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Dynamics of brain perfusion and cognitive performance in revascularization of carotid artery stenosis. NEUROIMAGE-CLINICAL 2019; 22:101779. [PMID: 30903966 PMCID: PMC6431743 DOI: 10.1016/j.nicl.2019.101779] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 02/10/2019] [Accepted: 03/11/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION There is evidence suggesting a detrimental effect of asymptomatic carotid artery stenosis on cognitive function even in the absence of ischemic cerebral lesions. Hypoperfusion has been suggested as pathophysiological mechanism causing cognitive impairment. We aimed to assess cognitive performance and cerebral perfusion changes in patients with carotid artery stenosis without ischemic lesions by arterial spin labeling (ASL) and contrast enhanced (CE) perfusion MRI before and after revascularization therapy. METHODS 17 asymptomatic patients with unilateral high-grade (≥70%) carotid artery stenosis without evidence of structural brain lesions underwent ASL and CE perfusion MRI and cognitive testing (MMSE, DemTect, Clock-Drawing Test, Trail-Making Test, Stroop Test) before and 6-8 weeks after revascularization therapy by endarterectomy or stenting. Multiparametric perfusion maps (ASL: cerebral blood flow (ASL-CBF), bolus arrival time (ASL-BAT); CE: cerebral blood flow (CE-CBF), mean transit time (CE-MTT), cerebral blood volume (CE-CBV)) were calculated and analyzed by vascular territory. Relative perfusion values were calculated. RESULTS Multivariate analysis revealed a significant impact of revascularization therapy on all perfusion measures analyzed. At baseline post-hoc testing showed significant hypoperfusion in MCA borderzones as assessed by ASL-CBF, ASL-BAT, CE-MTT and CE-CBV. All perfusion alterations normalized after revascularization. We did not observe any significant correlation of cognitive test results with perfusion parameters. There was no significant change in cognitive performance after revascularization. CONCLUSION We found evidence of traceable perfusion alterations in patients with high grade carotid artery stenosis in the absence of structural brain lesions, which proved fully reversible after revascularization therapy. In this cohort of asymptomatic patients we did not observe an association of hypoperfusion with cognitive performance.
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Ibaraki M, Nakamura K, Toyoshima H, Takahashi K, Matsubara K, Umetsu A, Pfeuffer J, Kuribayashi H, Kinoshita T. Spatial coefficient of variation in pseudo-continuous arterial spin labeling cerebral blood flow images as a hemodynamic measure for cerebrovascular steno-occlusive disease: A comparative 15O positron emission tomography study. J Cereb Blood Flow Metab 2019; 39:173-181. [PMID: 29869933 PMCID: PMC6311663 DOI: 10.1177/0271678x18781667] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Pseudo-continuous arterial spin labeling (pCASL) is a completely non-invasive method of cerebral perfusion measurement. However, cerebral blood flow (CBF) quantification is hampered by arterial transit artifacts characterized by bright vascular signals surrounded by decreased signals in tissue regions, which commonly appear in patients with reduced cerebral perfusion pressure. The spatial coefficient of variation (CoV) of pCASL CBF images has been proposed as an alternative region-of-interest (ROI)-based hemodynamic measure to predict prolonged arterial transit time (ATT). This retrospective study investigates the utility of spatial CoV by comparison with 15O positron emission tomography (PET). For patients with cerebrovascular steno-occlusive disease ( n = 17), spatial CoV was positively correlated with ATT independently measured by pulsed arterial spin labeling ( r = 0.597, p < 0.001), confirming its role as an ATT-like hemodynamic measure. Comparisons with 15O PET demonstrated that spatial CoV was positively correlated with vascular mean transit time ( r = 0.587, p < 0.001) and negatively correlated with both resting CBF ( r = -0.541, p = 0.001) and CBF response to hypercapnia ( r = -0.373, p = 0.030). ROI-based spatial CoV calculated from single time-point pCASL can potentially detect subtle perfusion abnormalities in clinical settings.
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Affiliation(s)
- Masanobu Ibaraki
- 1 Department of Radiology and Nuclear Medicine, Akita Research Institute of Brain and Blood Vessels, Akita, Japan
| | - Kazuhiro Nakamura
- 1 Department of Radiology and Nuclear Medicine, Akita Research Institute of Brain and Blood Vessels, Akita, Japan
| | - Hideto Toyoshima
- 1 Department of Radiology and Nuclear Medicine, Akita Research Institute of Brain and Blood Vessels, Akita, Japan
| | - Kazuhiro Takahashi
- 1 Department of Radiology and Nuclear Medicine, Akita Research Institute of Brain and Blood Vessels, Akita, Japan
| | - Keisuke Matsubara
- 1 Department of Radiology and Nuclear Medicine, Akita Research Institute of Brain and Blood Vessels, Akita, Japan
| | - Atsushi Umetsu
- 1 Department of Radiology and Nuclear Medicine, Akita Research Institute of Brain and Blood Vessels, Akita, Japan
| | | | | | - Toshibumi Kinoshita
- 1 Department of Radiology and Nuclear Medicine, Akita Research Institute of Brain and Blood Vessels, Akita, Japan
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Henzler C, Zöllner FG, Weis M, Zimmer F, Schoenberg SO, Zahn K, Schaible T, Neff KW. Cerebral Perfusion After Repair of Congenital Diaphragmatic Hernia with Common Carotid Artery Occlusion After ECMO Therapy. ACTA ACUST UNITED AC 2018; 31:557-564. [PMID: 28652420 DOI: 10.21873/invivo.11094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 04/18/2017] [Accepted: 04/20/2017] [Indexed: 01/03/2023]
Abstract
AIM To prospectively evaluate cerebral perfusion after repair of congenital diaphragmatic hernia (CDH) and right-common-carotid-artery (rCCA) occlusion after extracorporeal membrane oxygenation (ECMO) therapy. PATIENTS AND METHODS A total of 29 2-year-old-children with a history of CDH repair underwent cerebral magnetic resonance perfusion imaging. In 14 patients, the rCCA was occluded after ECMO therapy. Fifteen patients with CDH without ECMO served as controls. Regional cerebral-blood-flow (rCBF) was measured cortically and subcortically in both hemispheres and compared intra-individually and between both groups. RESULTS Patients with rCCA-occlusion showed intra-individual side differences between hemispheres, with significantly lower subcortical perfusion of the right hemisphere and reduced cortical perfusion. In one-third of patients with rCCA-occlusion, rCBF of the right-hemisphere was reduced by more than 20% when compared to the left hemisphere. Despite intra-individual side differences, mean rCBF in patients with rCCA occlusion was not reduced compared to controls. CONCLUSION Beside intra-individual side differences, overall right hemisphere perfusion is sufficient after rCCA-occlusion due to collateral blood supply.
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Affiliation(s)
- Claudia Henzler
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Frank G Zöllner
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Meike Weis
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Fabian Zimmer
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Stefan O Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Katrin Zahn
- Department of Pediatric Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Thomas Schaible
- Department of Neonatology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - K Wolfgang Neff
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
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Jann K, Hauf M, Kellner Weldon F, El Koussy M, Kiefer C, Federspiel A, Schroth G. Implication of cerebral circulation time in intracranial stenosis measured by digital subtraction angiography on cerebral blood flow estimation measured by arterial spin labeling. Diagn Interv Radiol 2017; 22:481-8. [PMID: 27411297 DOI: 10.5152/dir.2016.15204] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Arterial spin labeling (ASL) magnetic resonance imaging to assess cerebral blood flow (CBF) is of increasing interest in basic research and in diagnostic applications, since ASL provides similar information to positron emission tomography about perfusion in vascular territories. However, in patients with steno-occlusive arterial disease (SOAD), CBF as measured by ASL might be underestimated due to delayed bolus arrival, and thus increased spin relaxation. We aimed to estimate the extent to which bolus arrival time (BAT) was delayed in patients with SOAD and whether this resulted in underestimation of CBF. METHODS BAT was measured using digital subtraction angiography (DSA) in ten patients with high-grade stenosis of the middle carotid artery (MCA). Regional CBF was assessed with pseudocontinuous ASL. RESULTS BATs were nonsignificantly prolonged in the stenotic hemisphere 4.1±2.0 s compared with the healthy hemisphere 3.3±0.9 s; however, there were substantial individual differences on the stenotic side. CBF in the anterior and posterior MCA territories were significantly reduced on the stenotic hemisphere. Severe stenosis was correlated with longer BAT and lower quantified CBF. CONCLUSION ASL-based perfusion measurement involves a race between the decay of the spins and the delivery of labeled blood to the region of interest. Special caution is needed when interpreting CBF values quantified in individuals with altered blood flow and delayed circulation times. However, from a clinician's point of view, an accentuation of hypoperfusion (even if caused by underestimation of CBF due to prolonged BATs) might be desirable since it indexes potentially harmful physiologic deficits.
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Affiliation(s)
- Kay Jann
- Department of Psychiatric Neurophysiology, University Hospital of Psychiatry and University of Bern, Bern, Switzerland.
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Hara S, Tanaka Y, Ueda Y, Hayashi S, Inaji M, Ishiwata K, Ishii K, Maehara T, Nariai T. Noninvasive Evaluation of CBF and Perfusion Delay of Moyamoya Disease Using Arterial Spin-Labeling MRI with Multiple Postlabeling Delays: Comparison with 15O-Gas PET and DSC-MRI. AJNR Am J Neuroradiol 2017; 38:696-702. [PMID: 28209582 DOI: 10.3174/ajnr.a5068] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 11/09/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Arterial spin-labeling MR imaging with multiple postlabeling delays has a potential to evaluate various hemodynamic parameters. To clarify whether arterial spin-labeling MR imaging can identify CBF and perfusion delay in patients with Moyamoya disease, we compared arterial spin-labeling, DSC, and 15O-gas PET in terms of their ability to identify these parameters. MATERIALS AND METHODS Eighteen patients with Moyamoya disease (5 men, 13 women; ages, 21-55 years) were retrospectively analyzed. CBF values of pulsed continuous arterial spin-labeling using 2 postlabeling delays (short arterial spin-labeling, 1525 ms; delayed arterial spin-labeling, 2525 ms) were compared with CBF values measured by 15O-gas PET. All plots were divided into 2 groups by the cutoff of time-based parameters (the time of the maximum observed concentration, TTP, MTT, delay of MTT to cerebellum, and disease severity [symptomatic or not]). The ratio of 2 arterial spin-labeling CBFs (delayed arterial spin-labeling CBF to short arterial spin-labeling CBF) was compared with time-based parameters: time of the maximum observed concentration, TTP, and MTT. RESULTS The short arterial spin-labeling-CBF values were significantly correlated with the PET-CBF values (r = 0.63; P = .01). However, the short arterial spin-labeling-CBF value dropped in the regions with severe perfusion delay. The delayed arterial spin-labeling CBF overestimated PET-CBF regardless of the degree of perfusion delay. Delayed arterial spin-labeling CBF/short arterial spin-labeling CBF was well correlated with the time of the maximum observed concentration, TTP, and MTT (ρ = 0.71, 0.64, and 0.47, respectively). CONCLUSIONS Arterial spin-labeling using 2 postlabeling delays may detect PET-measured true CBF and perfusion delay in patients with Moyamoya disease. Provided its theoretic basis and limitations are considered, noninvasive arterial spin-labeling could be a useful alternative for evaluating the hemodynamics of Moyamoya disease.
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Affiliation(s)
- S Hara
- From the Department of Neurosurgery (S.H., Y.T., Y.U., S.H., M.I., T.M., T.N.), Tokyo Medical and Dental University, Tokyo, Japan
| | - Y Tanaka
- From the Department of Neurosurgery (S.H., Y.T., Y.U., S.H., M.I., T.M., T.N.), Tokyo Medical and Dental University, Tokyo, Japan
| | - Y Ueda
- From the Department of Neurosurgery (S.H., Y.T., Y.U., S.H., M.I., T.M., T.N.), Tokyo Medical and Dental University, Tokyo, Japan
| | - S Hayashi
- From the Department of Neurosurgery (S.H., Y.T., Y.U., S.H., M.I., T.M., T.N.), Tokyo Medical and Dental University, Tokyo, Japan
| | - M Inaji
- From the Department of Neurosurgery (S.H., Y.T., Y.U., S.H., M.I., T.M., T.N.), Tokyo Medical and Dental University, Tokyo, Japan
- Research Team for Neuroimaging (M.I., K. Ishiwata, K. Ishii, T.N.), Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - K Ishiwata
- Research Team for Neuroimaging (M.I., K. Ishiwata, K. Ishii, T.N.), Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - K Ishii
- Research Team for Neuroimaging (M.I., K. Ishiwata, K. Ishii, T.N.), Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - T Maehara
- From the Department of Neurosurgery (S.H., Y.T., Y.U., S.H., M.I., T.M., T.N.), Tokyo Medical and Dental University, Tokyo, Japan
| | - T Nariai
- From the Department of Neurosurgery (S.H., Y.T., Y.U., S.H., M.I., T.M., T.N.), Tokyo Medical and Dental University, Tokyo, Japan
- Research Team for Neuroimaging (M.I., K. Ishiwata, K. Ishii, T.N.), Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
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Cerebrovascular reactivity in the caudate nucleus, lentiform nucleus and thalamus in patients with carotid artery disease. J Neuroradiol 2016; 44:143-150. [PMID: 27743788 DOI: 10.1016/j.neurad.2016.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 07/09/2016] [Accepted: 07/18/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND PURPOSE To assess the effect of unilateral large vessel disease upon the cerebral hemodynamic autoregulatory status in the basal ganglia of patients with steno-occlusive internal carotid artery (ICA) disease. MATERIALS AND METHODS Twenty-five healthy volunteers and 38 patients with a unilateral symptomatic steno-occlusive ICA lesion and were investigated; 20 with a stenosis >50% and 18 with an occlusion. Cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) were assessed with pseudo-continuous arterial spin labeling (ASL) magnetic resonance (MR) imaging before and after administration of acetazolamide. RESULTS When compared to controls, the CVR in patients with ICA stenosis was significantly lower in the middle cerebral artery (MCA) territory (P<0.05), and in the caudate (P<0.05) and lentiform nucleus (P<0.05) of the hemisphere ipsilateral to the stenosis. The CVR in the caudate nucleus contralateral to the stenosis was significantly lower (P<0.05) as well. In patients with ICA occlusion, the CVR in the hemisphere ipsilateral to the occlusion as well as in the contralateral hemisphere was significantly lower in the MCA territory (P<0.05), the caudate (P<0.05) and lentiform nucleus (P<0.05), and in the thalamus (P<0.05). CONCLUSION Perfusion ASL MR imaging shows impaired cerebral hemodynamic autoregulation of the basal ganglia in patients with steno-occlusive ICA disease both in the hemisphere ipsilateral as well as in the hemisphere contralateral to the stenosis or occlusion.
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Chen G, Lei D, Ren J, Zuo P, Suo X, Wang DJJ, Wang M, Zhou D, Gong Q. Patterns of postictal cerebral perfusion in idiopathic generalized epilepsy: a multi-delay multi-parametric arterial spin labelling perfusion MRI study. Sci Rep 2016; 6:28867. [PMID: 27374369 PMCID: PMC4931466 DOI: 10.1038/srep28867] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 06/06/2016] [Indexed: 02/05/2023] Open
Abstract
The cerebral haemodynamic status of idiopathic generalized epilepsy (IGE) is a very complicated process. Little attention has been paid to cerebral blood flow (CBF) alterations in IGE detected by arterial spin labelling (ASL) perfusion magnetic resonance imaging (MRI). However, the selection of an optimal delay time is difficult for single-delay ASL. Multi-delay multi-parametric ASL perfusion MRI overcomes the limitations of single-delay ASL. We applied multi-delay multi-parametric ASL perfusion MRI to investigate the patterns of postictal cerebral perfusion in IGE patients with absence seizures. A total of 21 IGE patients with absence seizures and 24 healthy control subjects were enrolled. IGE patients exhibited prolonged arterial transit time (ATT) in the left superior temporal gyrus. The mean CBF of IGE patients was significantly increased in the left middle temporal gyrus, left parahippocampal gyrus and left fusiform gyrus. Prolonged ATT in the left superior temporal gyrus was negatively correlated with the age at onset in IGE patients. This study demonstrated that cortical dysfunction in the temporal lobe and fusiform gyrus may be related to epileptic activity in IGE patients with absence seizures. This information can play an important role in elucidating the pathophysiological mechanism of IGE from a cerebral haemodynamic perspective.
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Affiliation(s)
- Guangxiang Chen
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.,Department of Radiology, Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan Province, China
| | - Du Lei
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Jiechuan Ren
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Panli Zuo
- Siemens Healthcare, MR Collaborations NE Asia, Beijing, China
| | - Xueling Suo
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | | | - Meiyun Wang
- Department of Radiology, Henan Provincial People's Hospital &the People's Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Dong Zhou
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
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Akiyama T, Morioka T, Shimogawa T, Haga S, Sayama T, Kanazawa Y, Murao K, Arakawa S. Arterial Spin-Labeling Magnetic Resonance Perfusion Imaging with Dual Postlabeling Delay in Internal Carotid Artery Steno-occlusion: Validation with Digital Subtraction Angiography. J Stroke Cerebrovasc Dis 2016; 25:2099-108. [PMID: 27339943 DOI: 10.1016/j.jstrokecerebrovasdis.2016.06.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 05/08/2016] [Accepted: 06/05/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Arterial spin-labeling magnetic resonance perfusion imaging (ASL-MRI) allows noninvasive measurement of cerebral blood flow (CBF) but depends on the arterial transit time (ATT). With the commonly used single postlabeling delay (PLD) of 1.5 seconds, slow flow through collateral vessels may be underestimated. We used both 1.5 and 2.5 seconds to overcome this problem. We validated these PLD settings by measuring the ATT and identifying the angiographic circulation using digital subtraction angiography (DSA). METHODS We retrospectively selected 5 patients with unilateral occlusion or stenosis of the internal carotid artery (ICA) in whom ASL-MRI showed low CBF with 1.5-second PLD in the target area and improved CBF with 2.5-second PLD. We then compared the ASL-MRI findings visually with DSA findings at 1.5 and 2.5 seconds after injection of the contrast. When arterial transit artifacts (ATAs), attributed to stagnant intravascular spin-labeled blood, were observed, DSA findings were analyzed visually at 4.5 seconds. RESULTS DSA revealed that the hypovascular area seen at 1.5 seconds was improved via the primary and secondary collaterals and delayed anterograde flow at 2.5 seconds. Serpiginous or round-shaped ATAs, which appeared in nearly the same configuration on dual PLD ASL-MRI, were attributed to stagnant collaterals and flow in the M2 portion of the middle cerebral artery and ICA during the late venous phase. CONCLUSIONS Use of dual PLD times was validated by the DSA findings. ATA detection using the dual PLDs also differentiated well-developed and stagnant collateral vessels from focal hyperperfusion.
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Affiliation(s)
- Tomoaki Akiyama
- Department of Neurosurgery, Kyushu Rosai Hospital, Kitakyushu, Japan; Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takato Morioka
- Department of Neurosurgery, Kyushu Rosai Hospital, Kitakyushu, Japan; Department of Neurosurgery, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Takafumi Shimogawa
- Department of Neurosurgery, Kyushu Rosai Hospital, Kitakyushu, Japan; Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Neurosurgery, Fukuoka Children's Hospital, Fukuoka, Japan.
| | - Sei Haga
- Department of Neurosurgery, Kyushu Rosai Hospital, Kitakyushu, Japan
| | - Tetsuro Sayama
- Department of Neurosurgery, Kyushu Rosai Hospital, Kitakyushu, Japan; Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuka Kanazawa
- Department of Cerebrovascular Disease, Kyushu Rosai Hospital, Kitakyushu, Japan
| | - Kei Murao
- Department of Cerebrovascular Disease, Kyushu Rosai Hospital, Kitakyushu, Japan
| | - Shuji Arakawa
- Department of Cerebrovascular Disease, Kyushu Rosai Hospital, Kitakyushu, Japan
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Lyu J, Ma N, Liebeskind DS, Wang DJJ, Ma L, Xu Y, Wang T, Miao Z, Lou X. Arterial Spin Labeling Magnetic Resonance Imaging Estimation of Antegrade and Collateral Flow in Unilateral Middle Cerebral Artery Stenosis. Stroke 2016; 47:428-33. [PMID: 26732570 DOI: 10.1161/strokeaha.115.011057] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 11/30/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND PURPOSE Three-dimensional pseudocontinuous arterial spin labeling with multiple postlabeling delays has been used to assess cerebral blood flow (CBF). We used this modality to estimate antegrade and collateral flow in patients with unilateral middle cerebral artery stenosis. METHODS Consecutive patients with unilateral middle cerebral artery 50% to 99% stenosis at 2 centers underwent pseudocontinuous arterial spin labeling with a postlabeling delays of 1.5 and 2.5 s. Mean CBF of bilateral middle cerebral artery territory at the postlabeling delays 1.5 and 2.5 s was measured. Early-arriving flow proportion was defined as (CBF 1.5 s at lesion side/CBF 2.5 s at normal side)×100%. Late-arriving retrograde flow proportion was defined as ([CBF 2.5 s-CBF 1.5 s] at lesion side-[CBF 2.5 s-CBF 1.5 s] at normal side)/CBF 2.5 s at normal side×100%. Antegrade and collateral scales were evaluated in patients with conventional angiography. Spearman correlation coefficients were calculated between early-arriving flow and late-arriving retrograde flow proportions on arterial spin labeling and antegrade and collateral scales on conventional angiography, respectively. RESULTS Forty-one patients (46.0±12.0 years) were enrolled. The mean early-arriving flow proportion was 78.3±14.9%. The mean late-arriving retrograde flow proportion was 16.1±10.2%. In 21 patients with conventional angiography, Spearman correlation coefficient was 0.53 (95% confidence interval, 0.11-0.79) between antegrade grade and early-arriving flow proportion (P=0.01) and 0.81 (95% confidence interval, 0.56-0.92) between collateral grade and late-arriving retrograde flow proportion (P<0.0001). CONCLUSIONS Three-dimensional pseudocontinuous arterial spin labeling with 2 postlabeling delays may provide an empirical approach for estimating antegrade and collateral flow in patients with unilateral middle cerebral artery stenosis. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT02479243.
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Affiliation(s)
- Jinhao Lyu
- From the Department of Radiology, Chinese PLA General Hospital, Beijing, China (J.L., L.M., Y.X., T.W., X.L.); Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China (N.M., Z.M.); and Department of Neurology, UCLA Stroke Center, Los Angeles (D.S.L., D.J.J.W.)
| | - Ning Ma
- From the Department of Radiology, Chinese PLA General Hospital, Beijing, China (J.L., L.M., Y.X., T.W., X.L.); Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China (N.M., Z.M.); and Department of Neurology, UCLA Stroke Center, Los Angeles (D.S.L., D.J.J.W.)
| | - David S Liebeskind
- From the Department of Radiology, Chinese PLA General Hospital, Beijing, China (J.L., L.M., Y.X., T.W., X.L.); Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China (N.M., Z.M.); and Department of Neurology, UCLA Stroke Center, Los Angeles (D.S.L., D.J.J.W.)
| | - Danny J J Wang
- From the Department of Radiology, Chinese PLA General Hospital, Beijing, China (J.L., L.M., Y.X., T.W., X.L.); Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China (N.M., Z.M.); and Department of Neurology, UCLA Stroke Center, Los Angeles (D.S.L., D.J.J.W.)
| | - Lin Ma
- From the Department of Radiology, Chinese PLA General Hospital, Beijing, China (J.L., L.M., Y.X., T.W., X.L.); Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China (N.M., Z.M.); and Department of Neurology, UCLA Stroke Center, Los Angeles (D.S.L., D.J.J.W.)
| | - Yang Xu
- From the Department of Radiology, Chinese PLA General Hospital, Beijing, China (J.L., L.M., Y.X., T.W., X.L.); Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China (N.M., Z.M.); and Department of Neurology, UCLA Stroke Center, Los Angeles (D.S.L., D.J.J.W.)
| | - Ting Wang
- From the Department of Radiology, Chinese PLA General Hospital, Beijing, China (J.L., L.M., Y.X., T.W., X.L.); Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China (N.M., Z.M.); and Department of Neurology, UCLA Stroke Center, Los Angeles (D.S.L., D.J.J.W.)
| | - Zhongrong Miao
- From the Department of Radiology, Chinese PLA General Hospital, Beijing, China (J.L., L.M., Y.X., T.W., X.L.); Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China (N.M., Z.M.); and Department of Neurology, UCLA Stroke Center, Los Angeles (D.S.L., D.J.J.W.).
| | - Xin Lou
- From the Department of Radiology, Chinese PLA General Hospital, Beijing, China (J.L., L.M., Y.X., T.W., X.L.); Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China (N.M., Z.M.); and Department of Neurology, UCLA Stroke Center, Los Angeles (D.S.L., D.J.J.W.).
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Gómez-Choco M, Schreiber SJ, Weih M, Doepp F, Valdueza JM. Delayed Transcranial Echo-Contrast Bolus Arrival in Unilateral Internal Carotid Artery Stenosis and Occlusion. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:1827-1834. [PMID: 25890887 DOI: 10.1016/j.ultrasmedbio.2015.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 02/11/2015] [Accepted: 03/12/2015] [Indexed: 06/04/2023]
Abstract
Some patients with internal carotid artery (ICA) occlusion or stenosis are at risk of developing a hemodynamic stroke. Transcranial ultrasonography using an echo-contrast bolus technique might be able to assess the extent of hemodynamic compromise. We describe a transcranial Doppler sonographic method that analyzes the differences in echo-contrast bolus arrival between both middle cerebral arteries after intravenous echo-contrast application. Ten patients with 50%-79% ICA stenosis, 10 patients with 80%-99% ICA stenosis and 22 patients with ICA occlusion were studied and compared with 15 age-matched controls. There were significant increases in delayed filling of the middle cerebral artery in both 80%-99% stenoses and occlusions compared with controls. The extent of the observed delays did not correlate with vasomotor reactivity. Echo-contrast bolus arrival time can be used to gain additional information on the intracranial hemodynamic effects of extracranial carotid artery disease that seems to be independent of the established ultrasound indices.
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Affiliation(s)
| | | | | | - Florian Doepp
- Department of Neurology, University Hospital Charité, Berlin, Germany
| | - José M Valdueza
- Neurological Center, Segeberger Kliniken, Bad Segeberg, Germany.
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Liu Y, Zeng X, Wang Z, Zhang N, Fan D, Yuan H. Different post label delay cerebral blood flow measurements in patients with Alzheimer's disease using 3D arterial spin labeling. Magn Reson Imaging 2015; 33:1019-1025. [PMID: 26113261 DOI: 10.1016/j.mri.2015.05.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 02/14/2015] [Accepted: 05/01/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate cerebral blood flow (CBF) in patients with Alzheimer's disease (AD) using a three-dimensional pseudocontinuous arterial spin labeling (PCASL). We aimed to study the effects of different post label delay on the resulting CBF maps and to investigate the characteristics and clinical applications of brain perfusion. MATERIALS AND METHODS Sixteen AD patients and nineteen healthy control subjects were recruited. 3D PCASL was performed using a 3.0 T MR scanner. ASL was performed twice with different post label delays (PLD). Comparisons of CBF were made between AD patients and healthy control subjects respectively with PLD of 1.5 s and PLD of 2.5 s. Relationship between the CBF values and cognition was investigated using correlation analysis. A receiver operating characteristic (ROC) curve was generated for CBF measurements in posterior cingulate region. RESULT AD patients with PLD of 1.5 s showed lower CBF values primarily in bilateral temporal lobes, precuneus, middle and posterior cingulate gyri, left inferior parietal gyrus, left angular gyrus and left superior frontal gyrus. Lowered cerebral values were also observed in similar regions with PLD of 2.5 s, but the clusters of voxel were smaller. CBF values were associated with cognition scores in most of gyri mentioned above. CONCLUSION Hypoperfusion areas were observed in AD patients. PLD of 1.5s was sufficient to display CBF. Considering the complicated AD pathology, multiple PLDs are strongly recommended.
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Affiliation(s)
- Ying Liu
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Xiangzhu Zeng
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Zheng Wang
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Na Zhang
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Dongsheng Fan
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Huishu Yuan
- Department of Radiology, Peking University Third Hospital, Beijing, China.
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Calibrated MRI to evaluate cerebral hemodynamics in patients with an internal carotid artery occlusion. J Cereb Blood Flow Metab 2015; 35:1015-23. [PMID: 25712500 PMCID: PMC4640248 DOI: 10.1038/jcbfm.2015.14] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Revised: 12/29/2014] [Accepted: 01/09/2015] [Indexed: 01/29/2023]
Abstract
The purpose of this study was to assess whether calibrated magnetic resonance imaging (MRI) can identify regional variances in cerebral hemodynamics caused by vascular disease. For this, arterial spin labeling (ASL)/blood oxygen level-dependent (BOLD) MRI was performed in 11 patients (65±7 years) and 14 controls (66±4 years). Cerebral blood flow (CBF), ASL cerebrovascular reactivity (CVR), BOLD CVR, oxygen extraction fraction (OEF), and cerebral metabolic rate of oxygen (CMRO2) were evaluated. The CBF was 34±5 and 36±11 mL/100 g per minute in the ipsilateral middle cerebral artery (MCA) territory of the patients and the controls. Arterial spin labeling CVR was 44±20 and 53±10% per 10 mm Hg ▵EtCO2 in patients and controls. The BOLD CVR was lower in the patients compared with the controls (1.3±0.8 versus 2.2±0.4% per 10 mm Hg ▵EtCO2, P<0.01). The OEF was 41±8% and 38±6%, and the CMRO2 was 116±39 and 111±40 μmol/100 g per minute in the patients and the controls. The BOLD CVR was lower in the ipsilateral than in the contralateral MCA territory of the patients (1.2±0.6 versus 1.6±0.5% per 10 mmHg ▵EtCO2, P<0.01). Analysis was hampered in three patients due to delayed arrival time. Thus, regional hemodynamic impairment was identified with calibrated MRI. Delayed arrival artifacts limited the interpretation of the images in some patients.
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Viallon M, Cuvinciuc V, Delattre B, Merlini L, Barnaure-Nachbar I, Toso-Patel S, Becker M, Lovblad KO, Haller S. State-of-the-art MRI techniques in neuroradiology: principles, pitfalls, and clinical applications. Neuroradiology 2015; 57:441-67. [PMID: 25859832 DOI: 10.1007/s00234-015-1500-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 02/04/2015] [Indexed: 12/20/2022]
Abstract
This article reviews the most relevant state-of-the-art magnetic resonance (MR) techniques, which are clinically available to investigate brain diseases. MR acquisition techniques addressed include notably diffusion imaging (diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI), and diffusion kurtosis imaging (DKI)) as well as perfusion imaging (dynamic susceptibility contrast (DSC), arterial spin labeling (ASL), and dynamic contrast enhanced (DCE)). The underlying models used to process these images are described, as well as the theoretic underpinnings of quantitative diffusion and perfusion MR imaging-based methods. The technical requirements and how they may help to understand, classify, or follow-up neurological pathologies are briefly summarized. Techniques, principles, advantages but also intrinsic limitations, typical artifacts, and alternative solutions developed to overcome them are discussed. In this article, we also review routinely available three-dimensional (3D) techniques in neuro MRI, including state-of-the-art and emerging angiography sequences, and briefly introduce more recently proposed 3D quantitative neuro-anatomy sequences, and new technology, such as multi-slice and multi-transmit imaging.
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Affiliation(s)
- Magalie Viallon
- CREATIS, UMR CNRS 5220 - INSERM U1044, INSA de Lyon, Université de Lyon, Lyon, France,
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22
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Assessment of collateral flow in patients with cerebrovascular disorders. J Neuroradiol 2014; 41:234-42. [DOI: 10.1016/j.neurad.2013.11.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 11/05/2013] [Accepted: 11/13/2013] [Indexed: 11/21/2022]
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MacIntosh BJ, Swardfager W, Robertson AD, Tchistiakova E, Saleem M, Oh PI, Herrmann N, Stefanovic B, Lanctôt KL. Regional cerebral arterial transit time hemodynamics correlate with vascular risk factors and cognitive function in men with coronary artery disease. AJNR Am J Neuroradiol 2014; 36:295-301. [PMID: 25147198 DOI: 10.3174/ajnr.a4094] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Arterial transit time is the time needed for blood to travel from large arteries to capillaries, as estimated from arterial spin-labeling MR imaging. The purpose of this study was to determine whether vascular risk factors and cognitive performance are related to regional differences in cerebral arterial transit time in patients with coronary artery disease who are at risk for cognitive decline. MATERIALS AND METHODS Arterial transit time was estimated from multiple postlabel delay pseudocontinuous arterial spin-labeling images obtained from 29 men with coronary artery disease. Tests of memory, attention, processing speed, and executive function were administered. Principal component analysis was used to create separate models of cognition and vascular risk, which were related to brain regions through voxelwise analyses of arterial transit time maps. RESULTS Principal component analysis identified 2 components of vascular risk: 1) "pressor" (age, systolic blood pressure, and pulse pressure) and 2) "obesity" (body fat percentage and body mass index). Obesity was inversely related to arterial transit time in the posterior cingulate, precuneus, lateral occipital cortices, middle temporal gyrus, and frontal pole (P corrected < .05), whereas pressor was not significant. Cognitive scores were factored into a single component. Poor performance was inversely related to precuneus arterial transit time (P corrected < .05). The average arterial transit time in regions identified by obesity was associated with poorer cognitive function (r(2) = 0.21, t = -2.65, P = .01). CONCLUSIONS Altered cerebral hemodynamics, notably in nodal structures of the default mode network, may be one way that vascular risk factors impact cognition in patients with coronary artery disease.
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Affiliation(s)
- B J MacIntosh
- From the Canadian Partnership for Stroke Recovery (B.J.M., W.S., A.D.R., E.T., N.H., B.S., K.L.L.) Physical Sciences (B.J.M., B.S.) Departments of Medical Biophysics (B.J.M., E.T., B.S.,)
| | - W Swardfager
- From the Canadian Partnership for Stroke Recovery (B.J.M., W.S., A.D.R., E.T., N.H., B.S., K.L.L.) Neuropsychopharmacology Research Group (W.S., M.S., N.H., K.L.L.), Sunnybrook Research Institute, Toronto, Ontario, Canada Pharmacology/Toxicology (K.L.L., W.S.)
| | - A D Robertson
- From the Canadian Partnership for Stroke Recovery (B.J.M., W.S., A.D.R., E.T., N.H., B.S., K.L.L.)
| | - E Tchistiakova
- From the Canadian Partnership for Stroke Recovery (B.J.M., W.S., A.D.R., E.T., N.H., B.S., K.L.L.) Departments of Medical Biophysics (B.J.M., E.T., B.S.,)
| | - M Saleem
- Neuropsychopharmacology Research Group (W.S., M.S., N.H., K.L.L.), Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - P I Oh
- Toronto Rehabilitation Institute (P.I.O., K.L.L.), Toronto, Ontario, Canada
| | - N Herrmann
- From the Canadian Partnership for Stroke Recovery (B.J.M., W.S., A.D.R., E.T., N.H., B.S., K.L.L.) Neuropsychopharmacology Research Group (W.S., M.S., N.H., K.L.L.), Sunnybrook Research Institute, Toronto, Ontario, Canada Psychiatry (N.H., K.L.L.), University of Toronto, Toronto, Ontario, Canada
| | - B Stefanovic
- From the Canadian Partnership for Stroke Recovery (B.J.M., W.S., A.D.R., E.T., N.H., B.S., K.L.L.) Physical Sciences (B.J.M., B.S.) Departments of Medical Biophysics (B.J.M., E.T., B.S.,)
| | - K L Lanctôt
- From the Canadian Partnership for Stroke Recovery (B.J.M., W.S., A.D.R., E.T., N.H., B.S., K.L.L.) Neuropsychopharmacology Research Group (W.S., M.S., N.H., K.L.L.), Sunnybrook Research Institute, Toronto, Ontario, Canada Pharmacology/Toxicology (K.L.L., W.S.) Psychiatry (N.H., K.L.L.), University of Toronto, Toronto, Ontario, Canada Toronto Rehabilitation Institute (P.I.O., K.L.L.), Toronto, Ontario, Canada
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Intravoxel incoherent motion perfusion imaging in acute stroke: initial clinical experience. Neuroradiology 2014; 56:629-35. [DOI: 10.1007/s00234-014-1370-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 04/10/2014] [Indexed: 10/25/2022]
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Strother MK, Anderson MD, Singer RJ, Du L, Moore RD, Shyr Y, Ladner TR, Arteaga D, Day MA, Clemmons PF, Donahue MJ. Cerebrovascular collaterals correlate with disease severity in adult North American patients with Moyamoya disease. AJNR Am J Neuroradiol 2014; 35:1318-24. [PMID: 24651814 DOI: 10.3174/ajnr.a3883] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Cerebrovascular collaterals have been increasingly recognized as predictive of clinical outcomes in Moyamoya disease in Asia. The aim of this study was to characterize collaterals in North American adult patients with Moyamoya disease and to assess whether similar correlations are valid. MATERIALS AND METHODS Patients with Moyamoya disease (n = 39; mean age, 43.5 ±10.6 years) and age- and sex-matched control subjects (n = 33; mean age, 44.3 ± 12.0 years) were graded via angiography. Clinical symptoms of stroke or hemorrhage were graded separately by imaging. Correlations between collateralization and disease severity, measured by the modified Suzuki score, were evaluated in patients with Moyamoya disease by fitting a regression model with clustered ordinal multinomial responses. RESULTS The presence of leptomeningeal collaterals (P = .008), dilation of the anterior choroidal artery (P = .01), and the posterior communicating artery/ICA ratio (P = .004) all correlated significantly with disease severity. The presence of infarct or hemorrhage and posterior steno-occlusive disease did not correlate significantly with the modified Suzuki score (P = .1). Anterior choroidal artery changes were not specific for hemorrhage. Patients with Moyamoya disease were statistically more likely than controls to have higher posterior communicating artery/ICA ratios and a greater incidence of leptomeningeal collaterals. CONCLUSIONS As with Moyamoya disease in Asian patients, the presence of cerebrovascular collaterals correlated with the modified Suzuki score for disease severity in North American patients with Moyamoya disease. However, anterior choroidal artery changes, which correlated with increased rates of hemorrhage in Asian studies, were not specific to hemorrhage in North Americans.
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Affiliation(s)
- M K Strother
- From the Departments of Radiology and Radiological Sciences (M.K.S., M.D.A., R.D.M., T.R.L., D.A., M.A.D., P.F.C., M.J.D.)
| | - M D Anderson
- From the Departments of Radiology and Radiological Sciences (M.K.S., M.D.A., R.D.M., T.R.L., D.A., M.A.D., P.F.C., M.J.D.)
| | - R J Singer
- Section of Neurosurgery (R.J.S.), Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - L Du
- Vanderbilt Center for Quantitative Sciences (L.D., Y.S.); Vanderbilt University School of Medicine, Nashville, Tennessee
| | - R D Moore
- From the Departments of Radiology and Radiological Sciences (M.K.S., M.D.A., R.D.M., T.R.L., D.A., M.A.D., P.F.C., M.J.D.)
| | - Y Shyr
- Vanderbilt Center for Quantitative Sciences (L.D., Y.S.); Vanderbilt University School of Medicine, Nashville, Tennessee
| | - T R Ladner
- From the Departments of Radiology and Radiological Sciences (M.K.S., M.D.A., R.D.M., T.R.L., D.A., M.A.D., P.F.C., M.J.D.)
| | - D Arteaga
- From the Departments of Radiology and Radiological Sciences (M.K.S., M.D.A., R.D.M., T.R.L., D.A., M.A.D., P.F.C., M.J.D.)
| | - M A Day
- From the Departments of Radiology and Radiological Sciences (M.K.S., M.D.A., R.D.M., T.R.L., D.A., M.A.D., P.F.C., M.J.D.)
| | - P F Clemmons
- From the Departments of Radiology and Radiological Sciences (M.K.S., M.D.A., R.D.M., T.R.L., D.A., M.A.D., P.F.C., M.J.D.)
| | - M J Donahue
- From the Departments of Radiology and Radiological Sciences (M.K.S., M.D.A., R.D.M., T.R.L., D.A., M.A.D., P.F.C., M.J.D.)Neurology (M.J.D.)Psychiatry (M.J.D)Physics and Astronomy (M.J.D.)
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Wolf ME, Layer V, Gregori J, Griebe M, Szabo K, Gass A, Hennerici MG, Günther M, Kern R. Assessment of Perfusion Deficits in Ischemic Stroke Using 3D-GRASE Arterial Spin Labeling Magnetic Resonance Imaging with Multiple Inflow Times. J Neuroimaging 2013; 24:453-9. [DOI: 10.1111/jon.12064] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Marc E. Wolf
- Department of Neurology; Universitätsmedizin Mannheim; University of Heidelberg; Mannheim Germany
| | - Vanessa Layer
- Department of Neurology; Universitätsmedizin Mannheim; University of Heidelberg; Mannheim Germany
| | | | - Martin Griebe
- Department of Neurology; Universitätsmedizin Mannheim; University of Heidelberg; Mannheim Germany
- mediri GmbH; Heidelberg Germany
- Fraunhofer MEVIS - Institute for Medical Image Computing; Bremen Germany
- FB 1; Universität Bremen; Bremen Germany
| | - Kristina Szabo
- Department of Neurology; Universitätsmedizin Mannheim; University of Heidelberg; Mannheim Germany
| | - Achim Gass
- Department of Neurology; Universitätsmedizin Mannheim; University of Heidelberg; Mannheim Germany
| | - Michael G. Hennerici
- Department of Neurology; Universitätsmedizin Mannheim; University of Heidelberg; Mannheim Germany
| | - Matthias Günther
- Department of Neurology; Universitätsmedizin Mannheim; University of Heidelberg; Mannheim Germany
- mediri GmbH; Heidelberg Germany
- Fraunhofer MEVIS - Institute for Medical Image Computing; Bremen Germany
- FB 1; Universität Bremen; Bremen Germany
| | - Rolf Kern
- Department of Neurology; Universitätsmedizin Mannheim; University of Heidelberg; Mannheim Germany
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Hartkamp NS, Petersen ET, De Vis JB, Bokkers RPH, Hendrikse J. Mapping of cerebral perfusion territories using territorial arterial spin labeling: techniques and clinical application. NMR IN BIOMEDICINE 2013; 26:901-912. [PMID: 22807022 DOI: 10.1002/nbm.2836] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 06/12/2012] [Accepted: 06/17/2012] [Indexed: 06/01/2023]
Abstract
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.
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Affiliation(s)
- Nolan S Hartkamp
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
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Jann K, Orosz A, Dierks T, Wang DJJ, Wiest R, Federspiel A. Quantification of network perfusion in ASL cerebral blood flow data with seed based and ICA approaches. Brain Topogr 2013; 26:569-80. [PMID: 23508714 DOI: 10.1007/s10548-013-0280-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 03/07/2013] [Indexed: 10/27/2022]
Abstract
Independent component analysis (ICA) or seed based approaches (SBA) in functional magnetic resonance imaging blood oxygenation level dependent (BOLD) data became widely applied tools to identify functionally connected, large scale brain networks. Differences between task conditions as well as specific alterations of the networks in patients as compared to healthy controls were reported. However, BOLD lacks the possibility of quantifying absolute network metabolic activity, which is of particular interest in the case of pathological alterations. In contrast, arterial spin labeling (ASL) techniques allow quantifying absolute cerebral blood flow (CBF) in rest and in task-related conditions. In this study, we explored the ability of identifying networks in ASL data using ICA and to quantify network activity in terms of absolute CBF values. Moreover, we compared the results to SBA and performed a test-retest analysis. Twelve healthy young subjects performed a fingertapping block-design experiment. During the task pseudo-continuous ASL was measured. After CBF quantification the individual datasets were concatenated and subjected to the ICA algorithm. ICA proved capable to identify the somato-motor and the default mode network. Moreover, absolute network CBF within the separate networks during either condition could be quantified. We could demonstrate that using ICA and SBA functional connectivity analysis is feasible and robust in ASL-CBF data. CBF functional connectivity is a novel approach that opens a new strategy to evaluate differences of network activity in terms of absolute network CBF and thus allows quantifying inter-individual differences in the resting state and task-related activations and deactivations.
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Affiliation(s)
- Kay Jann
- Department of Psychiatric Neurophysiology, University Hospital of Psychiatry, University of Bern, Bolligenstrasse 111, 3000, Bern 60, Switzerland,
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Kamano H, Yoshiura T, Hiwatashi A, Abe K, Togao O, Yamashita K, Honda H. Arterial spin labeling in patients with chronic cerebral artery steno-occlusive disease: correlation with (15)O-PET. Acta Radiol 2013; 54:99-106. [PMID: 23091237 DOI: 10.1258/ar.2012.120450] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Heterogeneity of arterial transit time due to cerebral artery steno-occlusive lesions hampers accurate regional cerebral blood flow measurement by arterial spin labeling (ASL). PURPOSE To assess the feasibility of regional cerebral blood flow measurement by ASL with multiple-delay time sampling in patients with steno-occlusive diseases by comparing with positron emission tomography (PET), and to determine whether regional arterial transit time measured by this ASL technique is correlated with regional mean transit time, a PET index of perfusion pressure. MATERIAL AND METHODS Sixteen patients with steno-occlusive diseases received both ASL and (15)O-PET. The mean regional cerebral blood flow measured by ASL and PET, regional arterial transit time by ASL, and regional mean transit time by PET were obtained by a region-of-interest analysis. Correlation between regional cerebral blood flow by ASL and that by PET, and correlation between regional arterial transit time by ASL and regional mean transit time by PET were tested using Pearson's correlation coefficient for both absolute and relative values. A multivariate regression analysis was performed to test whether regional arterial transit time by ASL was a significant contributor in modeling regional mean transit time by PET after controlling the effect of regional cerebral blood flow by ASL. RESULTS A significant positive correlation was found between regional cerebral blood flow by ASL and that by PET for both absolute (r = 0.520, P < 0.0001) and relative (r = 0.691, P < 0.0001) values. A significant positive correlation was found between regional arterial transit time by ASL and regional mean transit time by PET both for absolute (r = 0.369, P = 0.0002) and relative (r = 0.443, P < 0.0001) values. The regression analysis revealed that regional arterial transit time by ASL was a significant contributor in modeling regional mean transit time by PET after controlling regional cerebral blood flow by ASL (P = 0.0011). CONCLUSION The feasibility of regional cerebral blood flow measurement using ASL with multiple-delay time sampling was confirmed in patients with cerebral artery steno-occlusive diseases. Moreover, it was suggested that mapping of regional arterial transit time has the potential to detect hemodynamic impairment.
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Affiliation(s)
| | | | | | | | - Osamu Togao
- Department of Molecular Imaging and Diagnosis, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Oldag A, Goertler M, Bertz AK, Schreiber S, Stoppel C, Heinze HJ, Kopitzki K. Assessment of cortical hemodynamics by multichannel near-infrared spectroscopy in steno-occlusive disease of the middle cerebral artery. Stroke 2013; 43:2980-5. [PMID: 23091122 DOI: 10.1161/strokeaha.112.656710] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE In a pilot study we evaluated near-infrared spectroscopy as to its potential benefit in monitoring patients with steno-occlusive disease of a major cerebral artery for alterations in cortical hemodynamics. METHODS Cortical maps of time-to-peak (TTP) in 10 patients unilaterally affected by severe stenosis or occlusion of the middle cerebral artery were acquired by multichannel near-infrared spectroscopy after bolus application of indocyanine green. Hemodynamic manifestations were assessed by comparison between affected and unaffected hemisphere and evaluated for common constituents by principal component analysis. In one patient, TTP values were compared with those obtained by dynamic susceptibility contrast imaging. RESULTS TTP was increased on the affected hemisphere in 9 patients. Mean difference in TTP between hemispheres was 0.44 second (P<0.05) as compared with a mean lateral difference of 0.12 second found in a control group of 10 individuals. In group analysis a significant rise in TTP was found in the distribution of the affected middle cerebral artery, whereas principal component analysis suggests augmentation of hemodynamic effects toward the border zones as a dominant pattern. A linear correlation of 0.61 between TTP values determined by dynamic susceptibility contrast MRI and near-infrared spectroscopy was found to be statistically significant (P<0.001). CONCLUSIONS Multichannel near-infrared spectroscopy might facilitate detection of disease-related hemodynamic changes as yet only accessible by tomographic imaging modalities. Being indicative for hypoperfusion and collateral flow increased values of TTP, as found to a varying extent in the present patient group, might be of clinical relevance.
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Affiliation(s)
- Andreas Oldag
- Department of Neurology, Otto-von-Guericke University, Madgeburg, Germany
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Macintosh BJ, Marquardt L, Schulz UG, Jezzard P, Rothwell PM. Hemodynamic alterations in vertebrobasilar large artery disease assessed by arterial spin-labeling MR imaging. AJNR Am J Neuroradiol 2012; 33:1939-44. [PMID: 22555580 PMCID: PMC7964632 DOI: 10.3174/ajnr.a3090] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 01/30/2012] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE VB artery stenosis is associated with a high risk of recurrent ischemic events, and knowledge about the hemodynamic relevance of VB stenosis is important for clinical decision making. In this study, multiple inflow pulsed ASL MR imaging was assessed for its ability to measure CBF and ATT in patients with VB disease. MATERIALS AND METHODS ASL was performed on a 3T MR imaging scanner in 41 participants. Twenty-one patients had a history of ischemic events in the VB circulation (14 men, 7 women, age 66 ± 11 years). Clinical data and CE-MRA were used to classify VB disease severity. Twenty age-matched adults were controls. Group and within-VB analyses were performed. Mean CBF and ATT values in the ROIs were adjusted by excluding voxels that did not produce a reliable ASL estimate. RESULTS CBF was reduced (P < .003) in patients compared with controls, which was significant after excluding voxels with a poor fit. Differences in ATT between patients and controls were not significant after voxel correction. There was a strong correlation between CBF and ATT among patients. Finally, ATT was significantly correlated with VB disease severity (P = .026). CONCLUSIONS Multiple inflow ASL distinguished patients with VB disease from age matched-controls. VB disease rating was associated with prolonged ATT downstream. ASL may have diagnostic potential among patients in whom risk of intervention is high.
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Affiliation(s)
- B J Macintosh
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, England.
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McVerry F, Liebeskind DS, Muir KW. Systematic review of methods for assessing leptomeningeal collateral flow. AJNR Am J Neuroradiol 2012; 33:576-82. [PMID: 22135128 DOI: 10.3174/ajnr.a2794] [Citation(s) in RCA: 159] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The importance of LMF in the outcome after acute ischemic stroke is increasingly recognized, but imaging presents a wide range of options for identification of collaterals and there is no single system for grading collateral flow. The aim of this study was to systematically review the literature on the available methods for measuring LMF adequacy. MATERIALS AND METHODS We performed a systematic review of Ovid, MEDLINE, and Embase databases for studies in which flow in the leptomeningeal collateral vessels was evaluated. Imaging technique, grading scale, and reliability assessment for collateral flow measurement were recorded. RESULTS We found 81 publications describing 63 methods for grading collateral flow on the basis of conventional angiography (n = 41), CT (n = 7), MR imaging (n = 9), and transcranial Doppler (n = 6). Inter- and/or intraobserver agreement was assessed in only 8 publications. CONCLUSIONS There is inconsistency in how LMF is graded, with a variety of grading scales and imaging modalities being used. Consistency in evaluating collateral flow at baseline is required for the impact of collateral flow to be fully appreciated.
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Affiliation(s)
- F McVerry
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
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Detre JA, Rao H, Wang DJJ, Chen YF, Wang Z. Applications of arterial spin labeled MRI in the brain. J Magn Reson Imaging 2012; 35:1026-37. [PMID: 22246782 DOI: 10.1002/jmri.23581] [Citation(s) in RCA: 224] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Accepted: 12/15/2011] [Indexed: 01/18/2023] Open
Abstract
Perfusion provides oxygen and nutrients to tissues and is closely tied to tissue function while disorders of perfusion are major sources of medical morbidity and mortality. It has been almost two decades since the use of arterial spin labeling (ASL) for noninvasive perfusion imaging was first reported. While initial ASL magnetic resonance imaging (MRI) studies focused primarily on technological development and validation, a number of robust ASL implementations have emerged, and ASL MRI is now also available commercially on several platforms. As a result, basic science and clinical applications of ASL MRI have begun to proliferate. Although ASL MRI can be carried out in any organ, most studies to date have focused on the brain. This review covers selected research and clinical applications of ASL MRI in the brain to illustrate its potential in both neuroscience research and clinical care.
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Affiliation(s)
- John A Detre
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Gevers S, Heijtel D, Ferns SP, van Ooij P, van Rooij WJ, van Osch MJ, van den Berg R, Nederveen AJ, Majoie CB. Cerebral perfusion long term after therapeutic occlusion of the internal carotid artery in patients who tolerated angiographic balloon test occlusion. AJNR Am J Neuroradiol 2011; 33:329-35. [PMID: 22081677 DOI: 10.3174/ajnr.a2776] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Therapeutic carotid occlusion is an established technique for treatment of large and giant aneurysms of the ICA, in patients with synchronous venous filling on angiography during BTO. Concern remains that hemodynamic alterations after permanent occlusion will predispose the patient to new ischemic injury in the ipsilateral hemisphere. The purpose of this study was to assess whether BTO with synchronous venous filling is associated with normal CBF long term after carotid sacrifice. MATERIALS AND METHODS Eleven patients were included (all women; mean age, 50.5 years; mean follow-up, 38.5 months). ASL with single and multiple TIs was used to assess CBF and its temporal characteristics. Selective ASL was used to assess actual territorial contribution of the ICA and BA. Collateral flow via the AcomA or PcomA or both was determined by time-resolved 3D PCMR. Paired t tests were used to compare CBF and timing parameters between hemispheres. RESULTS Absolute CBF values were within the normal range. There was no significant CBF difference between hemispheres ipsilateral and contralateral to carotid sacrifice (49.4 ± 11.2 versus 50.1 ± 10.1 mL/100 g/min). Arterial arrival time and trailing edge time were significantly prolonged on the occlusion side (816 ± 119 ms versus 741 ± 103 ms, P = .001; and 1765 ± 179 ms versus 1646 ± 190 ms, P < .001). Two patients had collateral flow through the AcomA only and were found to have increased timing parameters compared with 9 patients with mixed collateral flow through both the AcomA and PcomA. CONCLUSIONS In this small study, patients with synchronous venous filling during BTO had normal CBF long term after therapeutic ICA occlusion.
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Affiliation(s)
- S Gevers
- Department of Radiology, Academisch Medisch Centrum, Amsterdam, The Netherlands.
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Cheng XQ, Tian JM, Zuo CJ, Liu J, Zhang Q, Lu GM. Quantitative perfusion computed tomography measurements of cerebral hemodynamics: correlation with digital subtraction angiography identified primary and secondary cerebral collaterals in internal carotid artery occlusive disease. Eur J Radiol 2011; 81:1224-30. [PMID: 21435812 DOI: 10.1016/j.ejrad.2011.02.046] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 02/24/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND The aim of the present study was to assess hemodynamic variations in symptomatic unilateral internal carotid artery occlusion (ICAO) patients with primary collateral flow via circle of Willis or secondary collateral flow via ophthalmic artery and/or leptomeningeal collaterals. METHODS Thirty-eight patients with a symptomatic unilateral ICAO were enrolled in the study. Based on digital subtraction angiography (DSA) findings, patients were classified into 2 groups: primary collateral (n = 14) and secondary collateral (n = 24) groups. Collateral flow hemodynamics were investigated with perfusion computed tomography (PCT) by measuring the cerebral blood flow (CBF), cerebral blood volume (CBV) and time to peak (TTP) in the hemispheres ipsilateral and contralateral to ICAO. Based on the measurements, the ipsilateral to contralateral ratio for each parameter was calculated and compared. RESULTS Irrespective of the collateral patterns, ipsilateral CBF was not significantly different from that of the contralateral hemisphere (P = 0.285); ipsilateral CBV and TTP was significantly increased compared with those of the contralateral hemisphere (P=0.000 and P = 0.000 for CBV and TTP, respectively). Furthermore, patients with secondary collaterals had significantly larger ipsilateral-to-contralateral ratios for both CBV (rCBV, P = 0.0197) and TTP (rTTP, P = 0.000) than those of patients with only primary collaterals. These two groups showed no difference in ipsilateral-to-contralateral ratio for CBF (rCBF, P = 0.312). CONCLUSION Patients with symptomatic unilateral ICAO in our study were in an autoregulatory vasodilatation status. Moreover, secondary collaterals in ICAO patients were correlated with ipsilateral CBV and delayed TTP that suggested severe hemodynamic impairment, presumably increasing the risk of ischemic events.
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Affiliation(s)
- Xiao-Qing Cheng
- Department of Medical Imaging, Nanjing Jingling Hospital of PLA, 305 Zhong shan nan Road, Bai xia, Nanjing 210002, PR China.
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Challenges for Non-Invasive Brain Perfusion Quantification Using Arterial Spin Labeling. Neuroradiol J 2011; 24:77-83. [DOI: 10.1177/197140091102400112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 01/03/2011] [Indexed: 11/15/2022] Open
Abstract
Arterial Spin Labeling (ASL) sequences for perfusion Magnetic Resonance Imaging (MRI) have recently become available to be used in the clinical practice, offering a completely noninvasive technique for the quantitative evaluation of brain perfusion. Despite its great potential, ASL perfusion imaging still presents important methodological challenges before its incorporation in routine protocols. Specifically, in some pathological conditions in which the cerebrovascular dynamics is altered, the standard application of ASL may lead to measurement errors. In these cases, it would be possible to estimate perfusion, as well as arterial transit times, by collecting images at multiple time points and then fitting a mathematical model to the data. This approach can be optimized by selecting a set of optimal imaging time points and incorporating knowledge about the physiological distributions of the parameters into the model estimation procedures. In this study, we address the challenges that arise in the measurement of brain perfusion using PASL, due to variations in the arterial transit times, by estimating the errors produced using different types of acquisitions and proposing methods for minimizing such errors. We show by simulation that multiple inversion time ASL acquisitions are expected to reduce measurement errors relative to standard approaches. In data collected from a group of subjects, we further observed reduced inter-subject variability in perfusion measurements when using a multiple versus single inversion time acquisitions. Both measurement errors and variability were further reduced if optimized acquisition and analysis techniques were employed.
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Lanzman RS, Kröpil P, Schmitt P, Bi X, Gliem M, Miese FR, Hänggi D, Kamp M, Scherer A, Turowski B, Blondin D. Nonenhanced ECG-gated time-resolved 4D steady-state free precession (SSFP) MR angiography (MRA) for assessment of cerebral collateral flow: comparison with digital subtraction angiography (DSA). Eur Radiol 2011; 21:1329-38. [PMID: 21225268 DOI: 10.1007/s00330-010-2051-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2010] [Revised: 11/06/2010] [Accepted: 11/12/2010] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To evaluate a nonenhanced time-resolved 4D SSFP MRA for dynamic visualization of intracranial collateral blood flow. METHODS 22 patients (59.0 ± 11.8 years) with steno-occlusive disease of brain-supplying arteries were included in this study. 4D SSFP MRA of the intracranial arteries was acquired with 15 temporal phases and a temporal resolution of 115 ms using 1.5 T MR. Cerebral DSA served as the reference standard and was available in all patients. RESULTS Nonenhanced 4D SSFP MRA allowed for detailed dynamic visualization of blood flow in the circle of Willis and its branches in 21 of 22 (95.5%) patients. Collateral flow was excluded with both 4D SSFP MRA and DSA in 4 patients. In 17 patients, DSA detected anterior collateral flow (n = 8), posterior collateral flow via the right (n = 8) and left (n = 7) posterior communicating artery as well as patent EC-IC bypasses (n = 8). 29 of 31 collateral flow pathways were visualized by 4D SSFP MRA. As compared to DSA, 4D SSFP MRA showed a high sensitivity (92.3%), specificity (100%), positive predictive value (100%) and negative predictive value (95.2%) for visualization of intracranial collateral flow. CONCLUSIONS 4D SSFP MRA is a promising non-invasive imaging technique for dynamic visualization of intracranial collateral flow.
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Affiliation(s)
- Rotem Shlomo Lanzman
- Department of Radiology, University Hospital Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
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MacIntosh BJ, Lindsay AC, Kylintireas I, Kuker W, Günther M, Robson MD, Kennedy J, Choudhury RP, Jezzard P. Multiple inflow pulsed arterial spin-labeling reveals delays in the arterial arrival time in minor stroke and transient ischemic attack. AJNR Am J Neuroradiol 2010; 31:1892-4. [PMID: 20110375 DOI: 10.3174/ajnr.a2008] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Our purpose was to use multiple inflow pulsed ASL to investigate whether hemodynamic AAT information is sensitive to hemispheric asymmetry in acute ischemia. The cohorts included 15 patients with acute minor stroke or TIA and 15 age-matched controls. Patients were scanned by using a stroke MR imaging protocol at a median time of 74 hours. DWI lesion volumes were small and functional impairment was low; however, perfusion abnormalities were evident. Prolonged AAT values were more likely to reside in the affected hemisphere (significant when compared with controls, P < .048). An advantage of this ASL technique is the ability to use AAT information in addition to CBF to characterize ischemia.
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Affiliation(s)
- B J MacIntosh
- Department of Clinical Neurology, University of Oxford, Oxfordshire, United Kingdom.
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Petcharunpaisan S, Ramalho J, Castillo M. Arterial spin labeling in neuroimaging. World J Radiol 2010; 2:384-98. [PMID: 21161024 PMCID: PMC2999014 DOI: 10.4329/wjr.v2.i10.384] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 08/27/2010] [Accepted: 09/03/2010] [Indexed: 02/06/2023] Open
Abstract
Arterial spin labeling (ASL) is a magnetic resonance imaging technique for measuring tissue perfusion using a freely diffusible intrinsic tracer. As compared with other perfusion techniques, ASL offers several advantages and is now available for routine clinical practice in many institutions. Its noninvasive nature and ability to quantitatively measure tissue perfusion make ASL ideal for research and clinical studies. Recent technical advances have increased its sensitivity and also extended its potential applications. This review focuses on some basic knowledge of ASL perfusion, emerging techniques and clinical applications in neuroimaging.
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Chappell MA, MacIntosh BJ, Donahue MJ, Günther M, Jezzard P, Woolrich MW. Separation of macrovascular signal in multi-inversion time arterial spin labelling MRI. Magn Reson Med 2010; 63:1357-65. [PMID: 20432306 DOI: 10.1002/mrm.22320] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Arterial spin labeling (ASL) provides a noninvasive method to measure brain perfusion and is becoming an increasingly viable alternative to more invasive MR methods due to improvements in acquisition, such as the use of a three-dimensional GRASE readout. A potential source of error in ASL measurements is signal arising from intravascular blood that is destined for more distal tissue. This is typically suppressed using diffusion gradients in many ASL sequences. However, several problems exist with this approach, such as the choice of cutoff velocity and gradient direction and incompatibility with certain readout modules. An alternative approach is to explicitly model the intravascular signal. This study exploits this approach by using multi-inversion time ASL data with a recently developed model-fitting method. The method employed permits the intravascular contribution to be discarded in voxels where there is no support in the data for its inclusion, thereby addressing the issue of overfitting. It is shown by comparing data with and without flow suppression, and by comparing the intravascular contribution in GRASE ASL data to MR angiographic images, that the model-fitting approach can provide a viable alternative to flow suppression in ASL where suppression is either not feasible or not desirable.
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Affiliation(s)
- Michael A Chappell
- Centre for Functional MRI of the Brain, University of Oxford, John Radcliffe Hospital, Headington, Oxford, UK.
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Tavares A, Caldas JG, Castro CC, Puglia P, Frudit ME, Barbosa LA. Changes in perfusion-weighted magnetic resonance imaging after carotid angioplasty with stent. Interv Neuroradiol 2010; 16:161-9. [PMID: 20642890 DOI: 10.1177/159101991001600207] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Accepted: 03/28/2010] [Indexed: 11/16/2022] Open
Abstract
Carotid artery stenosis due to arteriosclerosis increases the risk of cerebral ischemia via embolic phenomena or reduced blood flow. The changes in cerebral perfusion that may occur after treatment are not clearly understood. This study evaluated the changes in cerebral microcirculation following carotid angioplasty with stenting (CAS) under cerebral protection with filters using ultrafast gradient echo (GRE) perfusion weighted imaging (PWI) with magnetic resonance imaging (MRI). Prospectively, 21 cervical carotid stenosis patients, mean age 69.95 years, underwent MRI 12 h before and 72 h after CAS. PWI parameters were collected for statistical analysis: cerebral blood volume (CBV), mean transit time (MTT) and time to peak (TTP). Statistical analysis was applied to absolute parameters and to values normalized against those from the contralateral parenchyma. The main finding of this study was improved hemodynamics for the normalized data after CAS, shown by reduced MTT (p<0.001) and TTP (p=0.019) in the territory fed by the middle cerebral artery ipsilateral to the CAS. Absolute data showed increased blood volume in the cerebral hemispheres after CAS, which was more accentuated on the stent side (p=0.016) than the contralateral side (p=0.029). Early improvements in cerebral perfusion, mainly seen in the normalized data, were clearly demonstrated in the timing parameters - TTP & MTT - after CAS.
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Affiliation(s)
- A Tavares
- Universidade de São Paulo, São Paulo, Brazil.
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MacIntosh BJ, Filippini N, Chappell MA, Woolrich MW, Mackay CE, Jezzard P. Assessment of arterial arrival times derived from multiple inversion time pulsed arterial spin labeling MRI. Magn Reson Med 2010; 63:641-7. [PMID: 20146233 DOI: 10.1002/mrm.22256] [Citation(s) in RCA: 104] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The purpose of this study was to establish a normal range for the arterial arrival time (AAT) in whole-brain pulsed arterial spin labeling (PASL) cerebral perfusion MRI. Healthy volunteers (N = 36, range: 20 to 35 years) provided informed consent to participate in this study. AAT was assessed in multiple brain regions, using three-dimensional gradient and spin echo (GRASE) pulsed arterial spin labeling at 3.0 T, and found to be 641 +/- 95, 804 +/- 91, 802 +/- 126, and 935 +/- 108 ms in the temporal, parietal, frontal, and occipital lobes, respectively. Mean gray matter AAT was found to be 694 +/- 89 ms for females (N = 15), which was significantly shorter than for men, 814 +/- 192 ms (N = 21; P < 0.0003), and significant after correcting for brain volume (P < 0.001). Significant AAT sex differences were also found using voxelwise permutation testing. An atlas of AAT values across the healthy brain is presented here and may be useful for future experiments that aim to quantify cerebral blood flow from ASL data, as well as for clinical comparisons where disease pathology may lead to altered AAT. Pulsed arterial spin labeling signals were simulated using an identical sampling scheme as the empiric study and revealed AAT can be estimated robustly when simulated arrival times are well beyond the normal range.
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Affiliation(s)
- Bradley J MacIntosh
- FMRIB Centre, Department of Clinical Neurology, University of Oxford, John Radcliffe Hospital, Oxford, UK.
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Yoshiura T, Hiwatashi A, Yamashita K, Ohyagi Y, Monji A, Takayama Y, Nagao E, Kamano H, Noguchi T, Honda H. Simultaneous measurement of arterial transit time, arterial blood volume, and cerebral blood flow using arterial spin-labeling in patients with Alzheimer disease. AJNR Am J Neuroradiol 2009; 30:1388-93. [PMID: 19342545 DOI: 10.3174/ajnr.a1562] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral hemodynamics abnormality in Alzheimer disease (AD) is not fully understood. Our aim was to determine whether regional hypoperfusion due to AD is associated with abnormalities in regional arterial blood volume (rABV) and regional arterial transit time (rATT) as measured by quantitative arterial spin-labeling (ASL) with multiple-delay time sampling. MATERIALS AND METHODS Nineteen patients with AD (9 men and 10 women; mean age, 74.5 +/- 8.6 years) and 22 cognitively healthy control subjects (11 men and 11 women; mean age, 72.8 +/- 6.8 years) were studied by using a quantitative ASL method with multiple-delay time sampling. From the ASL data, maps of regional cerebral blood flow (rCBF), rABV, and rATT were generated. A region of hypoperfusion due to AD was determined by statistical parametric mapping (SPM) analysis. Mean rCBF, rABV, and rATT values within the hypoperfused region were compared between the AD and control groups. RESULTS Despite the significantly lower rCBF (P = .0004) in patients with AD (27.8 +/- 7.1 mL/100 g/min) in comparison with control subjects (36.7 +/- 6.3 mL/100 g/min), no significant difference in rATT was observed between the control (0.48 +/- 0.09 seconds) and AD (0.47 +/- 0.10 seconds) groups. Mean rABV was lower in the AD group (0.22 +/- 0.10%) than in the control group (0.27 +/- 0.12%), though the difference did not reach the level of statistical significance. CONCLUSIONS Our results revealed that regional hypoperfusion in AD is not associated with rATT prolongation, suggesting that the mechanism of hypoperfusion is distinct from that in cerebrovascular diseases.
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Affiliation(s)
- T Yoshiura
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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