Abstract
Objectives
To present a multi-delay pseudo-continuous ASL (pCASL) protocol that offers simultaneous measurements of cerebral blood flow (CBF) and arterial transit time (ATT), and to study correlations between multi-delay pCASL and CT perfusion in moyamoya disease.
Methods
A 4 post-labeling delay (PLD) pCASL protocol was applied on 17 patients with moyamoya disease who also underwent CT perfusion imaging. ATT was estimated using the multi-delay protocol and included in the calculation of CBF. ASL and CT perfusion images were rated for lesion severity/conspicuity. Pearson correlation coefficients were calculated across voxels between the two modalities in grey and white matter of each subject respectively and between normalized mean values of ASL and CT perfusion measures in major vascular territories.
Results
Significant associations between ASL and CT perfusion were detected using subjective ratings, voxel-wise analysis in grey and white matter and region of interest (ROI)-based analysis of normalized mean perfusion. The correlation between ASL CBF and CT perfusion was improved using the multi-delay pCASL protocol compared to CBF acquired at a single PLD of 2 s (P < 0.05).
Conclusions
There is a correlation between perfusion data from ASL and CT perfusion imaging in patients with moyamoya disease. Multi-delay ASL can improve CBF quantification, which could be a prognostic imaging biomarker in patients with moyamoya disease.
Key Points
• Simultaneous measurements of CBF and ATT can be achieved using multi-delay pCASL.
• Multi-delay ASL was compared with CT perfusion in patients with moyamoya disease.
• Statistical analyses showed significant associations between multi-delay ASL and CT perfusion.
• Multi-delay ASL can improve CBF quantification in moyamoya disease.
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Abbreviations
- ACA:
-
Anterior cerebral artery
- ATT:
-
Arterial transit time
- bSVD:
-
Block-circulant singular-value decomposition
- CBF:
-
Cerebral blood flow
- CBFmean :
-
Mean of the estimated CBF at each PLD
- CBF2,000 :
-
CBF calculated using the typical PLD of 2,000 ms
- CBV:
-
Cerebral blood volume
- CTP:
-
CT perfusion
- GRASE:
-
Gradient and spin echo
- MRI:
-
Magnetic resonance imaging
- MCA:
-
Middle cerebral artery
- pCASL:
-
Pseudo-continuous arterial spin labeling
- PLD:
-
Post-labeling delay
- ROI:
-
Region of interest
References
Alsop DC, Detre JA, Grossman M (2000) Assessment of cerebral blood flow in Alzheimer’s disease by spin-labeled magnetic resonance imaging. Ann Neurol 47:93–100
Detre JA, Alsop DC, Vives LR, Maccotta L, Teener JW, Raps EC (1998) Noninvasive MRI evaluation of cerebral blood flow in cerebrovascular disease. Neurology 50:633–641
Chalela JA, Alsop DC, Gonzalez-Atavales JB, Maldjian JA, Kasner SE, Detre JA (2000) Magnetic resonance perfusion imaging in acute ischemic stroke using continuous arterial spin labeling. Stroke 31:680–687
Calamante F, Gadian DG, Connelly A (2002) Quantification of perfusion using bolus tracking magnetic resonance imaging in stroke: assumptions, limitations, and potential implications for clinical use. Stroke 33:1146–1151
MacIntosh BJ, Lindsay AC, Kylintireas I et al (2010) Multiple inflow pulsed arterial spin-labeling reveals delays in the arterial arrival time in minor stroke and transient ischemic attack. AJNR 31:1892–1894
Wintermark M, Sesay M, Barbier E et al (2005) Comparative overview of brain perfusion imaging techniques. Stroke 36:e83–e99
Kang KH, Kim HS, Kim SY (2008) Quantitative cerebrovascular reserve measured by acetazolamide-challenged dynamic CT perfusion in ischemic adult moyamoya disease: initial experience with angiographic correlation. AJNR 29:1487–1493
Smith WS, Roberts HC, Chuang NA et al (2003) Safety and feasibility of a CT protocol for acute stroke: combined CT, CT angiography, and CT perfusion imaging in 53 consecutive patients. AJNR 24:688–690
Calamante F, Ganesan V, Kirkham FJ et al (2001) MR perfusion imaging in moyamoya syndrome: potential implications for clinical evaluation of occlusive cerebrovascular disease. Stroke 32:2810–2816
Wang DJJ, Alger JR, Qiao JX et al (2013) Multi-delay multi-parametric arterial spin-labeled perfusion MRI in acute ischemic stroke–comparison with dynamic susceptibility contrast enhanced perfusion imaging. NeuroImage Clin 3:1–7
Fernandez-Seara MA, Edlow BL, Hoang A, Wang J, Feinberg DA, Detre JA (2008) Minimizing acquisition time of arterial spin labeling at 3 T. Magn Reson Med 59:1467–1471
Suzuki J, Kodama N (1983) Moyamoya disease: a review. Stroke 14:104–109
Dai W, Robson PM, Shankaranarayanan A, Alsop DC (2012) Reduced resolution transit delay prescan for quantitative continuous arterial spin labeling perfusion imaging. Magn Reson Med 67:1252–1265
Wang J, Zhang Y, Wolf RL, Roc AC, Alsop DC, Detre JA (2005) Amplitude-modulated continuous arterial spin-labeling 3.0-T perfusion MR imaging with a single coil: feasibility study. Radiology 235:218–228
Kidwell CS, Jahan R, Gornbein J et al (2013) A trial of imaging selection and endovascular treatment for ischemic stroke. N Engl J Med 368(10):914–923
Wintermark M, Maeder TJP, Schnyder P, Meuli R (2001) Quantitative assessment of regional cerebral blood flows by perfusion CT studies at low injection rates: a critical review of the underlying theoretical models. Eur Radiol 11:1220–1230
Wang DJ, Alger JR, Qiao JX et al (2012) The value of arterial spin-labeled perfusion imaging in acute ischemic stroke: comparison with dynamic susceptibility contrast-enhanced MRI. Stroke 43:1018–1024
Tatu L, Moulin T, Bogousslavsky J, Duvernoy H (1998) Arterial territories of the human brain: cerebral hemispheres. Neurology 50:1699–1708
Ye FQ, Berman KF, Ellmore T et al (2000) H(2)(15)O PET validation of steady-state arterial spin tagging cerebral blood flow measurements in humans. Magn Reson Med 44:450–456
Noguchi T, Kawashima M, Nishihara M, Hirai T, Matsushima T, Irie H (2013) Arterial spin-labeling MR imaging in moyamoya disease compared with clinical assessments and other MR imaging finings. Eur J Radiol 82:e840–e847
Zaharchuk G, Do HM, Marks MP, Rosenberg J, Moseley ME, Steinberg GK (2011) Arterial spin-labeling MRI can identify the presence and intensity of collateral perfusion in patients with moyamoya disease. Stroke 42:2485–2491
Qiu D, Straka M, Zun Z, Bammer R, Moseley ME, Zaharchuk G (2012) CBF measurements using multidelay pseudocontinuous and velocity-selective arterial spin labeling in patients with long arterial transit delays: comparison with xenon CT CBF. J Magn Reson Imaging 36:110–119
Chen J, Licht DJ, Smith SE et al (2009) Arterial spin labeling perfusion MRI in pediatric arterial ischemic stroke: initial experiences. J Magn Reson Imaging 29(2):282–290
Zaharchuk G (2011) Arterial spin label imaging of acute ischemic stroke and transient ischemic attack. Neuroimaging Clin N Am 21(2):285–301
Zaharchuk G, Bammer R, Straka M et al (2009) Arterial spin-label imaging in patients with normal bolus perfusion-weighted MR imaging findings: pilot identification of the borderzone sign. Radiology 252(3):797–807
Kudo K, Sasaki M, Yamada K et al (2010) Differences in CT perfusion maps generated by different commercial software: quantitative analysis by using identical source data of acute stroke patients. Radiology 254:200–209
Acknowledgement
The scientific guarantor of this publication is Rong Xue. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This study has received funding from the Ministry of Science and Technology (MOST) of China (grant number 2012CB825500, 2010IM030800), National Nature Science Foundation of China (NSFC) (grant number 30830101, 91132302, 90820307), CAS Knowledge Innovation Project (grant number KSCX2-YW-R-259), CAS Strategic Priority Research Program (grant number XDB02010001, XDB02050001) and US NIH grants (R01-MH080892, R01-NS081077 and R01-EB014922). No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. No study subjects or cohorts have been previously reported. Methodology: prospective, cross sectional study, multicenter study.
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Wang, R., Yu, S., Alger, J.R. et al. Multi-delay arterial spin labeling perfusion MRI in moyamoya disease–comparison with CT perfusion imaging. Eur Radiol 24, 1135–1144 (2014). https://doi.org/10.1007/s00330-014-3098-9
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DOI: https://doi.org/10.1007/s00330-014-3098-9