Multidelay Arterial Spin Labeling Versus Computed Tomography Perfusion in Penumbra Volume of Acute Ischemic Stroke

Abstract

Background: Multidelay arterial spin labeling (ASL) is a novel perfusion method of ASL, with arterial transit time (ATT) calculated by multiple postlabeling delays to correct cerebral blood flow (CBF). We verify the accuracy of multidelay ASL in evaluating the ischemic penumbra and perfusion levels in patients with acute ischemic stroke, compared with computed tomography perfusion (CTP). Methods: Patients with acute ischemic stroke with anterior circulation large vessel occlusion received baseline CTP, multidelay ASL, and diffusion-weighted imaging (DWI) in succession. Multidelay ASL image was processed to reconstruct ATT, CBF without ATT correction, and CBF corrected by ATT. The consistency of hypoperfusion and ischemic penumbra volume calculated by CTP and multidelay ASL were quantified by intraclass correlation coefficient (ICC) in 2-way mixed effects, absolute agreement, and single measure. Wilcoxon signed-rank test was used to compare the difference in penumbra volume between CTP, corrected ASL, and uncorrected ASL. Results: Thirty patients were included. Hypoperfusion volume based on multidelay ASL with different thresholds were 117.95 (87.77–151.49) mL for corrected relative CBF<40%, 130.29 (85.99–249.37) mL for CBF corrected by ATT<20 mL·100g -1 ·min -1 , no statistical difference ( P >0.05) compared with the volume of CTP, and consistency was almost excellent (ICC, 0.91) and substantial consistent (ICC, 0.727). The volumes of ischemic penumbra were 91.00 (42.68–125.27) mL for corrected relative CBF<40%-DWI, 108.94 (62.03–150.86) mL for CBF corrected by ATT<20 mL·100 g -1 ·min -1 -DWI, which showed no statistical difference compared with the penumbra volume of CTP ( P >0.05). The consistency was excellent (ICC, 0.822) and moderate (ICC, 0.501), respectively. The volume of uncorrected relative CBF <40%-DWI was 209.57 (123.21–292.45) mL, statistically larger than corrected relative CBF <40%-DWI ( P <0.001) and CTP ( P <0.001). The volume of uncorrected CBF<20 mL·100g -1 ·min -1 -DWI was 186.23 (86.56–298.22) mL, statistically larger than CBF corrected by ATT<20 mL·100g -1 ·min -1 -DWI ( P <0.001) and CTP( P <0.001). Conclusions: The volume of ischemic penumbra determined by CBF/DWI mismatch based on multidelay ASL is consistent with CTP. The penumbra volume calculated by CBF adjusted by ATT is more accurate.

The novel imaging methods in diagnosis and assessment of cerebrovascular diseases: an overview

“…Still, there are some technologies under intense research that have great potential for clinical application. For instance, a prospective study conducted by Ma and colleagues cleared up the threshold of multidelay arterial spin labeling (MDASL) in penumbra volume of acute ischemic stroke, which has brought this technology closer to large-scale clinical applications ( 138 ). Moreover, the future of cerebrovascular disease management holds great promise with potential advancements in imaging technology, the integration of AI algorithms, the utilization of multimodal imaging techniques, and the adoption of personalized medicine approaches.…”

Thrombectomy with and without computed tomography perfusion imaging for large-vessel occlusion stroke in the extended time window: a meta-analysis of randomized clinical trials

“…Underestimation of the infarct tends to allow the patient to be included in endovascular treatment to restore lost neurological function but may increase the potential risk of reperfusion bleeding ( 23 ). In contrast, overestimating the final infarct core and selecting patients for reperfusion treatment based on the concept of CTP mismatch may exclude patients who may benefit from reperfusion ( 13 , 24 ). Moreover, there remained discrepancies in the time-consuming image processing by various software, which may delay the time for patients to receive treatment ( 21 , 22 ).…”