Quantitative arterial spin labeling magnetic resonance imaging analysis of reversible cerebral vasoconstriction syndrome: A case series

Abstract

Objective: This study aimed to quantify chronological cerebral blood flow (CBF) changes using arterial spin labeling (ASL) magnetic resonance imaging in patients with reversible cerebral vasoconstriction syndrome (RCVS).Background: Quantitative ASL analyses in RCVS have not been well described in the literature.Methods: Quantification of ASL using an automated region-of-interest placement software and a 5-point visual scale of vasoconstriction severity was performed in five RCVS patients. The association between CBF changes and RCVS-related complications was evaluated.Results: Quantitative ASL revealed variable patterns of decreasing CBF in the first week, followed by subsequent increases. Notably, arterial vasoconstriction paradoxically progressed despite an increase in CBF from the first to the second week; this increase was relatively higher in patients with both cortical subarachnoid hemorrhage and posterior reversible encephalopathy syndrome. Conclusions:Quantitative ASL revealed that CBF initially decreased and subsequently increased, especially in the second week. These changes may serve as surrogate imaging markers for RCVS-related complications, and could further contribute to understanding the pathology of RCVS. K E Y W O R D S arterial spin labeling magnetic resonance imaging, cerebral blood flow, cortical subarachnoid hemorrhage, posterior reversible encephalopathy syndrome, reversible cerebral vasoconstriction syndrome How to cite this article: Kano Y, Inui S, Uchida Y, et al. Quantitative arterial spin labeling magnetic resonance imaging analysis of reversible cerebral vasoconstriction syndrome: A

Headache Attributed to Reversible Cerebral Vasoconstriction Syndrome (RCVS)

“…Arterial spin labeling (ASL) is a perfusion MR technique, which enables cerebral blood flow (CBF) evaluation, without the need for gadolinium injection [80]. According to Kano et al, ASL can infer vasoconstriction in distal vessels "hidden" from MRA by detecting areas of hypoperfusion [94]. In this study, vasoconstriction reached its peak in the second week with subsequent gradual normalization.…”

Reversible cerebral vasoconstriction syndrome: review of neuroimaging findings

“…Arterial spin labeling (ASL) is a perfusion MR technique, which enables cerebral blood flow (CBF) evaluation, without the need of Gadolinium injection [ 49 ]. Kano et al performed ASL in five patients with RCVS, and it showed higher sensitivity than MR angiography in detecting hypoperfusion [ 50 ]. Vasoconstriction reached its peak in the second week with subsequent gradual normalization [ 50 ].…”

“…Kano et al performed ASL in five patients with RCVS, and it showed higher sensitivity than MR angiography in detecting hypoperfusion [ 50 ]. Vasoconstriction reached its peak in the second week with subsequent gradual normalization [ 50 ]. Furthermore, it showed a centripetal progression, beginning from distal arteries and affecting the central vessels later.…”

“…Furthermore, it showed a centripetal progression, beginning from distal arteries and affecting the central vessels later. In the area where PRES and SAH were present, CBF was lower than in other regions of the brain, probably because of breakdown of autoregulation [ 50 ].…”

A case report of reversible cerebral vasoconstriction syndrome with thunderclap headache significantly exacerbated in the supine position and alleviated in the standing position

“…Sympathetic nervous system hyperactivity causes cerebral vascular dysregulation, which progresses from the peripheral small arteries to the middle and large arteries [ 1 ]. Cerebral perfusion is reduced owing to stenosis of the distal cerebral arteries [ 2 ]. Hypoperfusion causes leptomeningeal artery hyperdilation and causes headache [ 3 – 5 ].…”