Feasibility Of Arterial Spin Labeling Research Articles

Pseudo-continuous arterial spin labeling with short post-labeling delay time sensitively reflects the hemodynamics of symptomatic patients with permanent large vessel occlusion before and after revascularization.

This study evaluated the feasibility of arterial spin labeling (ASL) for diagnosing hemodynamic stroke due to permanent anterior circulation large vessel occlusion. Three-dimensional pseudo-continuous ASL data at two post-labeling delay (PLD) times (1.5 and 2.5s) in patients with unilateral permanent middle cerebral artery (MCA) segment 1 (M1) or internal cerebral artery (ICA) occlusion were acquired during routine magnetic resonance angiography. Sixty-one patients with symptomatic occlusion (M1, 24; ICA, 37) and 69 patients with asymptomatic occlusion (M1, 21; ICA, 48) were enrolled. Regions of interest were automatically placed in the MCA region using a template. The respective scans were compared with asymptomatic M1 or ICA occlusion scans. The ratio of signal intensity (occlusion side/non-occlusion side) in the perfusion area of MCA (asymmetry index [AI]) was compared between both groups. In both PLD groups, AI was significantly lower in symptomatic patients than in asymptomatic patients. The receiver operating characteristic curve showed moderate capacity for the prediction of symptomatic AI in both groups (area under the curve, 0.739 and 0.712, respectively). As a result of extracranial-intracranial bypass operation in 28 symptomatic (M1, eight; ICA, 20) patients, AI was significantly higher postoperatively in the PLD 1.5s group than in the PLD 2.5s group. In symptomatic patients with permanent large vessel occlusion, the signal intensity ratio of pseudo-continuous ASL with short PLD sensitively reflects the hemodynamics before and after revascularization; therefore, this technique may be an alternative method in situations where PET or SPECT cannot be performed.

Using arterial spin labeling blood flow and its histogram analysis to distinguish early-stage nasopharyngeal carcinoma from lymphoid hyperplasia.

To investigate the feasibility of arterial spin labeling (ASL) blood flow (BF) and its histogram analysis to distinguish early-stage nasopharyngeal carcinoma (NPC) from nasopharyngeal lymphoid hyperplasia (NPLH).Sixty-three stage T1 NPC patients and benign NPLH patients underwent ASL on a 3.0-T magnetic resonance imaging system. BF histogram parameters were derived automatically, including the mean, median, maximum, minimum, kurtosis, skewness, and variance. Absolute values were obtained for skewness and kurtosis (absolute value of skewness [AVS] and absolute value of kurtosis [AVK], respectively). The Mann–Whitney U test, receiver operating characteristic curve, and multiple logistic regression models were used for statistical analysis.The mean, maximum, and variance of ASL BF values were significantly higher in early-stage NPC than in NPLH (all P < 0.0001), while the median and AVK values of early-stage NPC were also significantly higher than those of NPLH (all P < 0.001). No significant difference was found between the minimum and AVS values in early-stage NPC compared with NPLH (P = 0.125 and P = 0.084, respectively). The area under the curve (AUC) of the maximum was significantly higher than those of the mean and median (P < 0.05). The AUC of variance was significantly higher than those of the other parameters (all P < 0.05). Multivariate analysis showed that variance was the only independent predictor of outcome (P < 0.05).ASL BF and its histogram analysis could distinguish early-stage NPC from NPLH, and the variance value was a unique independent predictor.

Can Arterial Spin Labeling Perfusion Imaging be Used to Differentiate Nasopharyngeal Carcinoma From Nasopharyngeal Lymphoma?

Differentiating nasopharyngeal carcinoma (NPC) from nasopharyngeal lymphoma (NPL) is useful for deciding the appropriate treatment. However, the diagnostic accuracy of current imaging methods is low. To explore the feasibility of arterial spin labeling (ASL) perfusion imaging in the qualitative and quantitative differentiation between NPC and NPL to improve the diagnosis of malignancies in the nasopharynx. Retrospective. Ninety seven patients: NPC (65 cases) and NPL (32 cases), histologically confirmed. 3T/3D fast spin echo pseudo-continuous ASL imaging with spiral readout scheme, 3D inverse recovery- fast spoiled gradient recalled echo brain volume (BRAVO) imaging. Cerebral blood flow (CBF) images from ASL perfusion imaging were assessed by three radiologists. Each tumor was visually scored based on CBF images. Intratumoral CBF and intramuscular CBF values were obtained from intratumoral and lateral pterygoid muscle areas, respectively. Through dividing intratumoral CBF by intramuscular CBF, normalized CBF (nCBF) was further calculated. Fleiss's kappa and intraclass correlation coefficients (ICCs) were used to assess interobserver agreement among the three readers. The Mann-Whitney U-test was used to compare visual scoring, and an unpaired t-test was performed to compare CBF value between the NPC and NPL groups. The area under the curve (AUC) value was used to quantify the diagnostic ability of each parameter. Good interobserver agreements were validated by high Fleiss's kappa and ICC values (all >0.80). NPCs showed significantly higher visual scores than NPLs (P < 0.05). Both intratumoral CBF and nCBF in NPC were significantly higher than those in NPL (both P < 0.05). Intratumoral CBF showed the highest AUC of 0.861 (P < 0.05) in differentiating NPC (n = 65) from NPL (n = 32), while the AUCs of nCBF and visual scoring were 0.847 and 0.753, respectively. For the diagnosis of distinguishing NPC from NPL, ASL perfusion imaging demonstrated high diagnostic efficiency. 3 TECHNICAL EFFICACY STAGE: 2.

7T bone perfusion imaging of the knee using arterial spin labeling MRI.

To evaluate the feasibility of arterial spin labeling (ASL) imaging of epiphyseal bone marrow in the distal femoral condyle of the knee at 7T MRI. The knees of 7 healthy volunteers were imaged with ASL using a 7T whole body MRI scanner and a28-channel knee coil. ASL imaging used a flow-sensitive alternating inversion recovery method for labeling and a single-shot fast spin echo sequence for image readout. ASL imaging with a single oblique transverse slice was performed at 2 slice positions in the distal femoral condyle. Blood flow was measured in 2 regions of interest: the epiphyseal bone marrow and the overlying patellofemoral cartilage. To analyze perfusion SNR, 200 noise images were also acquired using the same ASL imaging protocol with RF pulses turned off. Knee bone marrow perfusion imaging was successfully performed with all volunteers. The overall mean of blood flow in the knee bone marrow was 32.90 ± 2.41 mL/100 g/min, and the blood flow was higher at the more distal slice position. We observed significant B0 and inhomogeneities, which need to be addressed in the future to improve the quality of ASL imaging and increase the reliability of knee bone marrow perfusion measurements. Bone marrow perfusion imaging of the distal femoral condyle is feasible using ASL at 7T. Further technical development is needed to improve the ASL method to overcome existing challenges.

Significance of arterial spin labeling perfusion and susceptibility weighted imaging changes in patients with transient ischemic attack: a prospective cohort study

BackgroundIn a prospective cohort of patients with transient ischemic attack (TIA), we investigated usefulness and feasibility of arterial spin labeling (ASL) perfusion and susceptibility weighted imaging (SWI) alone and in combination with standard diffusion weighted (DWI) imaging in subacute diagnostic work-up. We investigated rates of ASL and SWI changes and their potential correlation to lasting infarction 8 weeks after ictus.MethodsPatients with TIA underwent 3T-MRI including DWI, ASL and SWI within 72 h of symptom onset. We defined lasting infarction as presence of 8-week MRI T2-fluid attenuated inversion recovery (FLAIR) hyperintensity or atrophy in the area of initial DWI-lesion.ResultsWe included 116 patients. Diffusion and perfusion together identified more patients with ischemia than either alone (59% vs. 40%, p < 0.0001). The presence of both diffusion and perfusion lesions had the highest rate of 8-week gliosis scars, 65% (p < 0.0001). In white matter, DWI-restriction was the determinant factor for scar development. However, in cortical gray matter half of lesions with perfusion deficit left a scar, while lesions without perfusion change rarely resulted in scars (56% versus 21%, p = 0.03). SWI lesions were rare (6%) and a subset of perfusion lesions. SWI-lesions with DWI-lesions were all located in cortical gray matter and showed high scar rate.ConclusionsASL perfusion increased ischemia detection in patients with TIA, and was most useful in conjunction with DWI. ASL was fast, robust and useful in a subacute clinical diagnostic setting. SWI had few positive findings and did not add information.Trial Registration.http://www.clinicaltrials.gov. Unique Identifier NCT01531946, prospectively registered February 9, 2012.

OP04 * QUANTITATIVE MEASUREMENT OF BLOOD FLOW IN PAEDIATRIC BRAIN TUMOURS - A COMPARATIVE STUDY OF DYNAMIC SUSCEPTIBILITY CONTRAST AND MULTI-TIMEPOINT ARTERIAL SPIN LABEL IMAGING

INTRODUCTION: Arterial spin labeling (ASL) is a MR technique that allows for noninvasive quantification of cerebral blood flow (CBF). This technique, predominately used in research, has seen significant technical developments in the last few years that have led to more clinical applications. Currently, the main MR method used to provide perfusion measures in brain tumours is dynamic susceptibility contrast (DSC). DSC traces the signal changes caused by the transit of a bolus of gadolinium contrast agent. ASL has the advantage of not requiring bolus injection of contrast. We have performed a comparative study of DSC and multi-timepoint ASL in paediatric brain tumours (PBT). METHOD: Data from a total of 19 PBT patients (mean age: 9 ± 5 years; 10 females, 9 males) were included in the analyses for this study. Data used were from first presentation scans performed before any surgical intervention. Comparisons of the quantitative measures of CBF and blood arrival time between the two techniques were carried out to test the feasibility of ASL to provide useful quantification measures of CBF in PBT. RESULTS: DSC measurements of tumour blood flow showed a significant decrease in flow in comparison with normal brain, but this is not seen with ASL. There was a strong correlation between ASL and DSC measures of blood flow in normal brain (r = 0.65, p = 0.009), but not in tumour blood flow (r = 0.33, p = 0.2). CONCLUSION: This study demonstrates the feasibility and potential utility of ASL as a non-invasive technique for measuring blood flow in PBT. However, there is a discrepancy between ASL and DSC measures, that may be due to leakage of gadolinium contrast, reflecting the abnormal characteristics of tumour blood vessels in PBT.

Simultaneous PET/MR imaging of the brain: feasibility of cerebral blood flow measurements with FAIR-TrueFISP arterial spin labeling MRI

Hybrid positron emission tomography/magnetic resonance imaging (PET/MRI) with simultaneous data acquisition promises a comprehensive evaluation of cerebral pathophysiology on a molecular, anatomical, and functional level. Considering the necessary changes to the MR scanner design the feasibility of arterial spin labeling (ASL) is unclear. To evaluate whether cerebral blood flow imaging with ASL is feasible using a prototype PET/MRI device. ASL imaging of the brain with Flow-sensitive Alternating Inversion Recovery (FAIR) spin preparation and true fast imaging in steady precession (TrueFISP) data readout was performed in eight healthy volunteers sequentially on a prototype PET/MRI and a stand-alone MR scanner with 128 × 128 and 192 × 192 matrix sizes. Cerebral blood flow values for gray matter, signal-to-noise and contrast-to-noise ratios, and relative signal change were compared. Additionally, the feasibility of ASL as part of a clinical hybrid PET/MRI protocol was demonstrated in five patients with intracerebral tumors. Blood flow maps showed good delineation of gray and white matter with no discernible artifacts. The mean blood flow values of the eight volunteers on the PET/MR system were 51 ± 9 and 51 ± 7 mL/100 g/min for the 128 × 128 and 192 × 192 matrices (stand-alone MR, 57 ± 2 and 55 ± 5, not significant). The value for signal-to-noise (SNR) was significantly higher for the PET/MRI system using the 192 × 192 matrix size (P < 0.01), the relative signal change (δS) was significantly lower for the 192 × 192 matrix size (P = 0.02). ASL imaging as part of a clinical hybrid PET/MRI protocol could successfully be accomplished in all patients in diagnostic image quality. ASL brain imaging is feasible with a prototype hybrid PET/MRI scanner, thus adding to the value of this novel imaging technique.

Feasibility of arterial spin labeling on a 1T open MRI scanner

To determine the clinical feasibility of arterial spin labeling (ASL) on a 1T open bore scanner. First, the optimal postlabeling delay (PLD) at 1T was determined (n = 5), with and without vascular crushing. Second, the effect of different labeling approaches (pseudo-continuous ASL [pCASL] vs. pulsed ASL [PASL]), background suppression (BSup) and readout options (GRASE vs. EPI) was investigated (n = 9). Each effect was quantified by calculating the signal-to-noise ratio (SNR), convergence, and number of significant gray matter (GM) voxels in the ASL images. Finally, an example of an obese volunteer who could not have been scanned in a cylindrical scanner is presented. The optimal PLDs were found to be 1300 msec for pCASL with and without vascular crushing. pCASL labeling outperformed PASL labeling in terms of convergence, anatomical correspondence between GM and perfusion maps, and SNR (P < 0.05). BSup appeared to have no additional value on the convergence, anatomical GM correspondence, and SNR (P > 0.05). EPI readout yielded a slightly better convergence, while the SNR of the GRASE readout was higher (P < 0.05). ASL on 1T is clinically feasible using state-of-the-art sequences that were primarily developed for higher field strengths.

Feasibility of measuring prostate perfusion with arterial spin labeling

Prostate perfusion has the potential to become an important pathophysiological marker for the monitoring of disease progression or the assessment of the therapeutic response of prostate cancer. The feasibility of arterial spin labeling, an MRI approach for the measurement of perfusion without an exogenous contrast agent, is demonstrated in the prostate for the first time. Although various arterial spin labeling methods have been demonstrated previously in highly perfused organs, such as the brain and kidneys, the prospect of obtaining such measurements in the prostate is challenging because of the relatively low blood flow, long transit times, susceptibility-induced image distortion and local motion. However, despite these challenges, this study demonstrates that, with a whole-body transmit coil and external receiver array, global prostate perfusion can be measured with arterial spin labeling at 3 T. In five healthy subjects with a mean age of 44 years, the mean total prostate blood flow was measured to be 25.8 ± 7.1 mL/100 cm(3) /min, with an estimated bolus duration and arterial transit time of 884 ± 209 ms and 721 ± 131 ms, respectively.

Arterial spin labeling MR imaging for characterisation of renal masses in patients with impaired renal function: initial experience

To retrospectively evaluate the feasibility of arterial spin labeling (ASL) magnetic resonance imaging (MRI) for the assessment of vascularity of renal masses in patients with impaired renal function. Between May 2007 and November 2008, 11/67 consecutive patients referred for MRI evaluation of a renal mass underwent unenhanced ASL-MRI due to moderate-to-severe chronic or acute renal failure. Mean blood flow in vascularised and non-vascularised lesions and the relation between blood flow and final diagnosis of malignancy were correlated with a 2-sided homogeneous variance t-test and the Fisher Exact Test, respectively. A p value <0.05 was considered statistically significant. Seventeen renal lesions were evaluated in 11 patients (8 male; mean age = 70 years) (range 57-86). The median eGFR was 24 mL/min/1.73 m(2) (range 7-39). The average blood flow of 11 renal masses interpreted as ASL-positive (134 +/- 85.7 mL/100 g/min) was higher than that of 6 renal masses interpreted as ASL-negative (20.5 +/- 8.1 mL/100 g/min)(p = 0.015). ASL-positivity correlated with malignancy (n = 3) or epithelial atypia (n = 1) at histopathology or progression at follow up (n = 7). ASL detection of vascularity in renal masses in patients with impaired renal function is feasible and seems to indicate neoplasia although the technique requires further evaluation. Arterial spin labeling may help to characterise renal masses in patients with renal failure Detection of blood flow on ASL in a renal mass supports the presence of a neoplasm Renal masses with high blood-flow levels on ASL seem to progress rapidly.

Mapping Brain Function Using a 30-Day Interval between Baseline and Activation: A Novel Arterial Spin Labeling fMRI Approach

By comparing hemodynamic signals acquired immediately before and during activation, functional magnetic resonance imaging (fMRI) is well suited for mapping acute changes in brain function. However, it remains unclear whether fMRI can map functional changes over longer periods. Here, we address this issue by empirically testing the feasibility of arterial spin labeling (ASL) fMRI to detect changes in cerebral blood flow (CBF) with baseline and task separated by 1 month. To increase the sensitivity of the method, we applied an algorithm that yielded flow density (CBFd) images that were independent of tissue content. To increase the accuracy, we developed a technique that generated arterial transit time at each voxel, independently. Results showed that activation changes in CBFd during the same session were statistically the same as across 30 days. The activation CBFd on day-30 was 34% (motor) and 25% (visual) higher than the respective baselines of 83 and 107 mL/100 g/min obtained on day-1. Furthermore, the signal-to-noise ratio of the CBFd measurement was 2.1 and 2.9 times higher than that of the conventional CBF for within-subject and across-subjects comparisons, respectively (n=9 healthy young subjects). Taken together, these results indicate that CBFd measure could be better suited than net CBF to map long-term changes in brain function.

A Comparative Study of Perfusion Measurement in Brain Tumours at 3 Tesla MR: Arterial Spin Labeling versus Dynamic Susceptibility Contrast-Enhanced MRI

Purpose: To prove the feasibility of arterial spin labeling (ASL) to explore brain tumors by comparing dynamic susceptibility contrast-enhanced MRI to ASL at 3T MR. Materials and Methods: Twenty-seven patients were included presenting 9 gliomas, 10 metastases and 8 meningiomas. All were explored by a pseudo-continuous ASL and dynamic susceptibility contrast-enhanced T2* perfusion sequence. Two neuroradiologists analyzed the cerebral blood flow (CBF) maps to assess feasibility, examination quality and quantitative comparison. The Spearman nonparametric correlation test and the Bland-Altman graphic test were used to analyze our quantitative results. Results: 92% of ASL CBF maps were informative. ASL detected all lesions as well as dynamic susceptibility contrast-enhanced MRI. Both sequences provide relative quantitative CBF values closely correlated. Conclusion: On a 3T MR unit, ASL is a good alternative to dynamic susceptibility contrast-enhanced MRI when contrast medium is contraindicated or intravenous injection is not possible. Its results on relative CBF parameters are similar to contrast-injected perfusion.

Magnetic resonance spin-labeling perfusion imaging of synovitis in inflammatory arthritis at 3.0 T

The aim of this study was to test the feasibility of arterial spin labeling (ASL) perfusion imaging of synovitis in inflammatory joint diseases on a clinical 3.0 T whole-body scanner. Fifteen patients (geometric mean 47 years, range 8-69 years) with different types of inflammatory arthritis of the finger or wrist joints participated in the study. In addition to conventional spin-echo and dynamic contrast-enhanced FLASH3D sequences, a novel spin-labeling technique (FAIR-TrueFISP) for quantitative assessment of tissue perfusion was applied. Perfusion maps were calculated pixel-wise by means of the extended Bloch equations. Perfusion maps showed good image quality with clear visualization of hyperaemia in synovitis. The computed perfusion maps corresponded best to subtraction images of the dynamic series from 30 to 60 s after contrast-medium injection. The quantitative perfusion values of synovitis showed a good correlation with the disease activity. Perfusion values for inflamed synovium in phase of high activity were up to 230 ml/100 g tissue/min. The proposed modality allows for the assessment of disease activity in arthritis without the application of contrast-medium offering a new tool for therapy monitoring. As the technique provides quantitative information on hyperaemia, it potentially offers new insights in the pathophysiology of arthritic diseases.

Arterial spin labeling blood flow magnetic resonance imaging for the characterization of metastatic renal cell carcinoma 1

This study sought to assess the feasibility of arterial spin labeling (ASL) blood flow (BF) magnetic resonance imaging (MRI) for the study of metastatic renal cell carcinoma (RCC) in the body, where the respiratory, cardiac, and peristaltic motions present challenges when applying ASL. ASL was performed using a background-suppressed single-section flow-alternating inversion recovery (FAIR) preparation and a single-shot fast spin-echo imaging sequence on a 3.0-T whole body imager. Tumor BF was evaluated for 26 patients with RCC metastatic to the liver, bone, lung, or lymph nodes before VEGF receptor inhibitor therapy. Two cases with tumor size change after treatment were also scanned 1 month after therapy. For validation, kidney cortex BF in five normal volunteers was measured with the same technique and compared with literature values. ASL was successfully performed in all normal volunteers and in 20 of 26 patients. The six failures resulted from a systematic error, which can be avoided in future studies. For normal volunteers, measured kidney cortex BF was 275 +/- 14 mL/min/100 g, a value consistent with the literature. ASL determined tumor BF averaged across tumor volume and subjects was 194 mL/min/100 g (intersubject SD = 100), resulting in high perfusion signal and conspicuity of lesions. Bright signal was also seen in large vessels and occasionally in bowel. In the two cases studied 1 month after therapy, ASL perfusion changes were consistent with tumor size changes. With background suppression, ASL MRI is a feasible method for quantifying BF in patients with renal cell carcinoma. This technique may be useful for evaluating tumor response to antiangiogenic agents.

Pediatric perfusion imaging using pulsed arterial spin labeling.

To test the feasibility of pediatric perfusion imaging using a pulsed arterial spin labeling (ASL) technique at 1.5 T. ASL perfusion imaging was carried out on seven neurologically normal children and five healthy adults. The signal-to-noise ratio (SNR) of the perfusion images along with T1, M(0), arterial transit time, and the temporal fluctuation of the ASL image series were measured and compared between the two age groups. In addition, ASL perfusion magnetic resonance (MR) was performed on three children with neurologic disorder. In the cohort of neurologically normal children, a 70% increase in the SNR of the ASL perfusion images and a 30% increase in the absolute cerebral blood flow compared to the adult data were observed. The measures of ASL SNR, T1, and M(0) were found to decrease linearly with age. Transit time and temporal fluctuation of the ASL perfusion image series were not significantly different between the two age groups. The feasibility of ASL in the diagnosis of pediatric neurologic disease was also illustrated. ASL is a promising tool for pediatric perfusion imaging given the unique and reciprocal benefits in terms of safety and image quality.