Background and Purpose
Quantitative CBF usage as a biomarker for cognitive impairment and disease progression in MS is potentially a powerful tool for longitudinal patient monitoring. Dynamic Susceptibility contrast perfusion with Bookend T1-calibration (Bookend Technique) and pseudo-continuous Arterial Spin Labeling have recently been used for CBF quantification in relapsing-remitting MS. The non-invasive nature of pseudo-continuous Arterial Spin Labeling is advantageous over gadolinium-based techniques, but correlation between the techniques is not well established in the context of MS.
Materials and Methods
We compared pseudo-continuous Arterial Spin Labeling CBF to the Bookend technique in a prospective cohort of 19 healthy controls, 19 relapsing-remitting MS subjects without cognitive impairment and 20 relapsing-remitting MS subjects with cognitive impairment on a voxel-wise and Brodmann regional basis. Linear Pearson correlation, SNR and coefficient of variation were quantified.
Results
Voxel-wise paired T-tests revealed no significant CBF differences between techniques after normalization of global mean intensities. Highest Pearson correlations were observed in deep GM structures (average r = 0.71 basal ganglia, and r = 0.65 thalamus) but remained robust for cortical GM, WM and WML (average r = 0.51, 0.53, 0.54 respectively). Lower Pearson correlations were observed for CL (average r=0.23). Brodmann regional correlations were significant for all groups. All correlations were maintained in healthy controls and in RRMS disease. Highest SNR was present in Bookend perfusion while the highest coefficient of variation was present in WML.
Conclusion
Agreement between pseudo-continuous Arterial Spin Labeling and Bookend technique CBF measurements is demonstrated in healthy controls and relapsing-remitting MS patients