MR Imaging of Individual Perfusion Reorganization Using Superselective Pseudocontinuous Arterial Spin-Labeling in Patients with Complex Extracranial Steno-Occlusive Disease

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Super selective pseudocontinuous arterial spin-labeling with a circular labeling spot enabling selective vessel labeling was added to routine imaging in a prospective pilot study in 50 patients with extracranial steno-occlusive disease. The detected vessel occlusions/stenoses and perfusion patterns corresponded between cerebral DSA and super selective pseudocontinuous ASL maps in all cases. Perfusion deficits on DSC-CBF maps significantly correlated with those on super selective pseudocontinuous ASL maps. The authors conclude that super selective pseudocontinuous ASL is a robust technique for regional brain perfusion imaging, suitable for the noninvasive diagnostics of individual patient perfusion patterns.

Abstract

Figure 3 from paper
Illustration of individual perfusion patterns in 2 different patients with similar chronic high-grade (>70%) right bifurcation ICA stenosis. The red arrows indicate the stenosis in patient 1 (a) and patient 2 (A). Both patients had patent AcomAs and bilateral PcomAs. Nonselective labeling in b and B shows no significant perfusion deficits. These patients did not have any infarct lesions. Labeling was performed for the right ICA, left ICA, and right VA in both patients (the left VA was hypoplastic in both cases). In patient 1 (upper row), the stenotic right ICA (c) continues to provide perfusion to the right cerebral hemisphere; The left ICA (d) and right VA (e) do not collateralize. In patient 2 (bottom row), right ICA perfusion is diminished (C) and supplies only the MCA territory; the anterior and posterior territories are perfused by recruitment of the left ICA (D) and right VA (E). These cases illustrate situations in which the individual perfusion pattern is not predictable: Even though extracranial stenoses and circle of Willis anatomies are similar, the perfusion patterns are different.

BACKGROUND AND PURPOSE

Patients with multiple stenoses or occlusions of the extracranial arteries require an individualized diagnostic approach. We evaluated the feasibility and clinical utility of a novel MR imaging technique for regional perfusion imaging in this patient group.

MATERIALS AND METHODS

Superselective pseudocontinuous arterial spin-labeling with a circular labeling spot enabling selective vessel labeling was added to routine imaging in a prospective pilot study in 50 patients (10 women, 70.05 ± 10.55 years of age) with extracranial steno-occlusive disease. Thirty-three had infarct lesions. DSC-MR imaging was performed in 16/50 (32%), and cerebral DSA, in 12/50 patients (24%). Vascular anatomy and the distribution of vessel stenoses and occlusions were defined on sonography and TOF-MRA. Stenoses were classified according to the NASCET criteria. Infarct lesions and perfusion deficits were defined on FLAIR and DSC-MR imaging, respectively. Individual perfusion patterns were defined on the superselective pseudocontinuous arterial spin-labeling maps and were correlated with vascular anatomy and infarct lesion localization.

RESULTS

The superselective pseudocontinuous arterial spin-labeling imaging sequence could be readily applied by trained technicians, and the additional scan time of 12.7 minutes was well-tolerated by patients. The detected vessel occlusions/stenoses and perfusion patterns corresponded between cerebral DSA and superselective pseudocontinuous arterial spin-labeling maps in all cases. Perfusion deficits on DSC-CBF maps significantly correlated with those on superselective pseudocontinuous arterial spin-labeling maps (Pearson r = 0.9593, P < .01). Individual collateral recruitment patterns were not predictable from the vascular anatomy in 71% of our patients.

CONCLUSIONS

Superselective pseudocontinuous arterial spin-labeling is a robust technique for regional brain perfusion imaging, suitable for the noninvasive diagnostics of individual perfusion patterns in patients with complex cerebrovascular disease.

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MR Imaging of Individual Perfusion Reorganization Using Superselective Pseudocontinuous Arterial Spin-Labeling in Patients with Complex Extracranial Steno-Occlusive Disease
jross
Jeffrey Ross • Mayo Clinic, Phoenix

Dr. Jeffrey S. Ross is a Professor of Radiology at the Mayo Clinic College of Medicine, and practices neuroradiology at the Mayo Clinic in Phoenix, Arizona. His publications include over 100 peer-reviewed articles, nearly 60 non-refereed articles, 33 book chapters, and 10 books. He was an AJNR Senior Editor from 2006-2015, is a member of the editorial board for 3 other journals, and a manuscript reviewer for 10 journals. He became Editor-in-Chief of the AJNR in July 2015. He received the Gold Medal Award from the ASSR in 2013.