Diagnostic and prognostic benefit of arterial spin labeling in subacute stroke

Abstract

Background and Purpose Brain perfusion measurement in the subacute phase of stroke may support therapeutic decisions. We evaluated whether arterial spin labeling (ASL), a noninvasive perfusion imaging technique based on magnetic resonance imaging (MRI), adds diagnostic and prognostic benefit to diffusion‐weighted imaging (DWI) in subacute stroke. Methods In a single‐center imaging study, patients with DWI lesion(s) in the middle cerebral artery (MCA) territory were included. Onset to imaging time was ≤7 days and imaging included ASL and DWI sequences. Qualitative (standardized visual analysis) and quantitative perfusion analyses (region of interest analysis) were performed. Dichotomized early outcome (modified Rankin Scale [mRS] 0–2 vs. 3–6) was analyzed in two logistic regression models. Model 1 included DWI lesion volume, age, vascular pathology, admission NIHSS, and acute stroke treatment as covariates. Model 2 added the ASL‐based perfusion pattern to Model 1. Receiver‐operating‐characteristic (ROC) and area‐under‐the‐curve (AUC) were calculated for both models to assess their predictive power. The likelihood‐ratio‐test compared both models. Results Thirty‐eight patients were included (median age 70 years, admission NIHSS 4, onset to imaging time 67 hr, discharge mRS 2). Qualitative perfusion analysis yielded additional diagnostic information in 84% of the patients. In the quantitative analysis, AUC for outcome prediction was 0.88 (95% CI 0.77–0.99) for Model 1 and 0.97 (95% CI 0.91–1.00) for Model 2. Inclusion of perfusion data significantly improved performance and outcome prediction ( p = 0.002) of stroke imaging. Conclusions In patients with subacute stroke, our study showed that adding perfusion imaging to structural imaging and clinical data significantly improved outcome prediction. This highlights the usefulness of ASL and noninvasive perfusion biomarkers in stroke diagnosis and management.

Joint estimation and correction of motion and geometric distortion in segmented arterial spin labeling

“…Four 3D GRASE label/control pairs were acquired with a total matrix size of 96 × 96 × 8 and three Cartesian segments of size 96 × 32 × 8 each, yielding the same nominal resolution of (3.1 × 3.1 × 5) mm 3 . The total acquisition time was 1:48 minutes.…”

“…The total acquisition time was 1:48 minutes. Other imaging parameters were TR/TE = 4500 ms/23.9 ms, bandwidth = 2264 HZ/Px, and FOV = (300 × 300 × 40) mm 3 . For both 3DGP and 3D GRASE acquisition, a labeling duration/postlabeling delay of 1800 ms/1800 ms was applied.…”

“…Valuable information regarding tumors, 1 Alzheimer's disease, 2 and stroke 3,4 can be provided by assessment of brain perfusion. Arterial spin labeling (ASL) MRI allows noninvasive measurement and quantification of cerebral blood flow by magnetically inverting the inflowing blood, using it as endogenous tracer.…”

Penumbra quantification from MR SWI‐DWI mismatch and its comparison with MR ASL PWI‐DWI mismatch in patients with acute ischemic stroke

“…Many MR-based stroke protocols tend to avoid dynamic susceptibility contrast (DSC) perfusion-based penumbra assessment due to gadoliniumcontrast injection. 21,22 Other standard alternatives, non-contrast 3D arterial spin-labelling (ASL) and pseudo-continuous ASL (pCASL), have previously been explored, 21,23,24 as these allow estimation of the penumbra using cerebral blood flow (CBF). Haller et al 25 have reported perfusion deficit (low to absent CBF signal) as the most common finding in acute ischemic stroke.…”

Addition of arterial spin-labelled MR perfusion to conventional brain MRI: clinical experience in a retrospective cohort study

“…[7][8][9] Twenty-five years after its introduction and with significant advances in sequence design, hardware technology and postprocessing techniques, ASL has become readily available for routine clinical practice in recent years. 10 11 In particular, ASL has shown promising results in the assessment of acute neurological disorders such as stroke, [12][13][14][15][16] transient ischaemic attack (TIA), 17 18 seizure, 19 20 migraine headaches, 21 as well as various neuropsychiatric diseases such as major depressive disorder, 22 23 Alzheimer's dementia [24][25][26] and Parkinson's disease. [27][28][29][30] In this study, we aimed to investigate additional findings from ASL imaging Open access compared with routine unenhanced brain MRI scan in a hospital setting.…”