A pictorial review of brain arterial spin labelling artefacts and their potential remedies in clinical studies

Jaganmohan, Deepasree; Pan, Somnath; Kesavadas, Chandrasekharan

doi:10.1177/1971400920977031

Cited by 14 publications

(13 citation statements)

References 22 publications

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“…14 Arterial spin labelling (ASL), which is a non-invasive MRI technique, may also be a good alternative; however, it has the drawback of having numerous artifacts. 15 In this case, the patient could remain at rest during distal flow blockage during the first angioplasty, but not during CAS. This phenomenon might be due to a decrease in collateral flow via the external carotid artery or leptomeningeal anastomosis, attenuated dilation of the cerebral artery, or a combination of both.…”

Section: Discussionmentioning

confidence: 87%

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Stepwise improvement in limb shaking achieved by staged angioplasty for severe carotid stenosis

et al. 2021

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Cerebral hyperperfusion syndrome is a rare but severe complication of carotid artery stenting or carotid endarterectomy. Staged angioplasty is reportedly an effective strategy to avoid cerebral hyperperfusion syndrome. We encountered a case of internal carotid artery stenosis with a rare clinical presentation of limb shaking that was successfully improved by staged angioplasty. To our knowledge, there are no reported cases of limb shaking treated with staged angioplasty. A 76-year-old woman presented with continuous chorea in her left lower limb and shoulder. Medical examination revealed a tiny cerebral infarction in the right corona radiata and severe right internal carotid artery stenosis. Angiography showed near occlusion of the right internal carotid artery. Staged angioplasty was performed to avoid the risk of cerebral hyperperfusion syndrome. The first angioplasty resulted in an expanded diameter of 2.5 mm and was followed by definitive carotid artery stenting using a closed-cell stent 3.5 weeks later. Limb shaking improved in a stepwise manner along with an improvement in internal carotid artery stenosis and distal flow state with no signs of cerebral hyperperfusion syndrome. Patients with internal carotid artery stenosis or occlusion presenting with limb shaking have been suggested to have impaired cerebrovascular reactivity, which is also thought to be a risk factor for cerebral hyperperfusion syndrome. The stepwise improvement in limb shaking observed in this case supports the idea that the pathophysiology of limb shaking is related to cerebral haemodynamic impairment. Measures to prevent cerebral hyperperfusion syndrome, including staged angioplasty, should be actively considered in patients with limb shaking because the symptoms themselves suggest severe hypoperfusion.

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Section: Discussionmentioning

confidence: 87%

“…14 Arterial spin labelling (ASL), which is a non-invasive MRI technique, may also be a good alternative; however, it has the drawback of having numerous artifacts. 15…”

Section: Discussionmentioning

confidence: 99%

Stepwise improvement in limb shaking achieved by staged angioplasty for severe carotid stenosis

et al. 2021

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“…Recent pictorial review highlights the technical pitfalls in ASL, their diagnostic utility and imaging interpretations. 5…”

Section: Discussionmentioning

confidence: 99%

Arterial Spin Labelling Patterns in Acute Large Vessel Occlusion Stroke

Nedunchelian

Varadharajan

Keerthy

et al. 2021

Journal of Stroke Medicine

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Background: Arterial spin labelling (ASL) is a noncontrast, magnetic resonance perfusion technique which can provide information about the parenchymal perfusion status and collaterals in acute stroke. Its role in the setting of large vessel occlusion (LVO) is underutilized due to the limited availability of magnetic resonance imaging (MRI) in the emergency settings. However, it might serve as an useful adjunct to other perfusion modalities in future. Objective: To study ASL perfusion patterns in anterior circulation LVO stroke and evaluate the presence of arterial transit artefacts (ATA) as a surrogate marker of collaterals. Methods: We performed a retrospective analysis of our mechanical thrombectomy database over the last 2 years for acute stroke cases in which ASL perfusion as part of MRI was performed. ASL perfusion patterns in acute LVO stroke were reviewed, with respect to presence of ATA and diffusion-weighted imaging (DWI)-ASL mismatch. Inter-rater reliability was analyzed between 2 readers of varying experience. Baseline variables were analyzed between those with and without ATA. Results: Out of 95 patients, 78 had anterior circulation occlusions, among which 27 had ASL. Type I (with ATAs) was seen in 11 patients and all of these had DWI mismatch. Type II (without ATAs) was seen in 16 patients. Of these, 15 had mismatch with DWI and only 1 had no mismatch. Inter-rater reliability for the detection of ATA on ASL was substantial (Cohen’s k—0.64). No statistical significance was noted between ATA and clinical outcomes. Conclusion: ASL patterns vary amongst patients with LVO stroke and can be classified based on the presence of ATA since resulting DWI mismatch actually indicates a pseudo-perfusion deficit.

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“…Considered as a reliable physiological marker of neuronal activity [11e13], ASL is a noninvasive fMRI technique which does not use a radioactive agent but rather arterial water as an endogenous tracer providing stable absolute quantification of regional cerebral blood flow (rCBF) [14]. ASL is quantitative, stable over time, and less variable across subjects [15], which makes it a specific, useful noninvasive method to measure rCBF in clinical studies [16]. Earlier research, applying covariance analytical approaches on structural anatomical brain data, has shown that baseline cortical morphological abnormality patterns between different regions of interest (ROIs) can increase clinical outcome prediction accuracy on an individual basis [17,18].…”

Section: Introductionmentioning

confidence: 99%

Individual interregional perfusion between the left dorsolateral prefrontal cortex stimulation targets and the subgenual anterior cortex predicts response and remission to aiTBS treatment in medication-resistant depression: The influence of behavioral inhibition

Baeken

2022

Brain Stimulation

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A pictorial review of brain arterial spin labelling artefacts and their potential remedies in clinical studies

Cited by 14 publications

References 22 publications

Stepwise improvement in limb shaking achieved by staged angioplasty for severe carotid stenosis

Stepwise improvement in limb shaking achieved by staged angioplasty for severe carotid stenosis

Arterial Spin Labelling Patterns in Acute Large Vessel Occlusion Stroke

Individual interregional perfusion between the left dorsolateral prefrontal cortex stimulation targets and the subgenual anterior cortex predicts response and remission to aiTBS treatment in medication-resistant depression: The influence of behavioral inhibition

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