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Updated: Aug 19, 2026
Construction and Application of Cerebral Functional Region-Based Cerebral Blood Flow Atlas Using Magnetic Resonance Imaging-Arterial Spin Labeling
Published on: May 31, 2024
Pattern of cerebral hypoperfusion in Alzheimer disease and mild cognitive impairment measured with arterial
Nathan A Johnson1, Geon-Ho Jahng, Michael W Weiner
1MR Research Unit, VA Medical Center, 4150 Clement St 114M San Francisco, CA 94107, USA.
Purpose:
To prospectively determine if pulsed arterial spin-labeling perfusion magnetic resonance (MR) imaging depicts regional cerebral hypoperfusion in subjects with Alzheimer disease (AD) and mild cognitive impairment (MCI), compared with perfusion in cognitively normal (CN) subjects, that is consistent with results of fluorodeoxyglucose (FDG) positron emission tomography (PET) and hexamethylpropyleneamine oxime (HMPAO) single photon emission computed tomography (SPECT) studies of similar populations.
Materials And Methods:
Institutional review board approval and informed consent were obtained. Twenty subjects with AD (13 men, seven women; mean age, 72.9 years), 18 with MCI (nine men, nine women; mean age, 73.3 years), and 23 CN subjects (10 men, 13 women; mean age, 72.9 years) underwent arterial spin-labeling and volumetric T1-weighted structural MR imaging. Perfusion images were coregistered to structural images, corrected for partial volume effects (PVEs) with information from the structural image to determine tissue content of perfusion voxels, and normalized to a study-specific template. Analyses of perfusion differences between groups, with and without corrections for PVEs, were performed on a voxel-by-voxel basis with a one-tailed fixed-effects analysis of covariance model adjusted for age. In addition, tests were performed with and without accounting for global perfusion.
Results:
The AD group showed significant regional hypoperfusion, compared with the CN group, in the right inferior parietal cortex extending into the bilateral posterior cingulate gyri (P <.001), bilateral superior and middle frontal gyri (P <.001), and left inferior parietal lobe (P=.007). When PVEs from underlying cortical gray matter atrophy were accounted for, the AD group still showed hypoperfusion in the right inferior parietal lobe extending into the bilateral posterior cingulate gyri (P <.001) and left (P=.003) and right (P=.012) middle frontal gyri. With a more liberal voxel-level threshold of P <.01, the MCI group showed significant regional hypoperfusion relative to the CN group in the inferior right parietal lobe (P=.046), similar to the region of greatest significance in the AD group.
Conclusion:
Arterial spin-labeling MR imaging showed regional hypoperfusion with AD, in brain regions similar to those seen in FDG PET and HMPAO SPECT studies of similar populations; this hypoperfusion persists after accounting for underlying cortical gray matter atrophy.
Insights
Pulsed arterial spin-labeling MR imaging detects reduced brain blood flow in Alzheimer disease (AD) and mild cognitive impairment (MCI) patients. This hypoperfusion is found in brain regions consistent with other imaging studies and persists despite brain atrophy.
Area of Science:
- Neuroimaging
- Neurology
- Radiology
Background:
- Alzheimer disease (AD) and mild cognitive impairment (MCI) are associated with changes in brain metabolism and perfusion.
- Previous studies utilized fluorodeoxyglucose (FDG) positron emission tomography (PET) and hexamethylpropyleneamine oxime (HMPAO) single photon emission computed tomography (SPECT) to assess these changes.
Purpose of the Study:
- To prospectively evaluate if pulsed arterial spin-labeling (ASL) perfusion MR imaging can identify regional cerebral hypoperfusion in subjects with AD and MCI.
- To compare ASL findings with established results from FDG-PET and HMPAO-SPECT studies in similar populations.
Main Methods:
- Prospective study involving 20 AD, 18 MCI, and 23 cognitively normal (CN) subjects.
- All subjects underwent ASL and volumetric T1-weighted structural MR imaging.
- Perfusion images were coregistered, corrected for partial volume effects (PVEs), and analyzed voxel-by-voxel using ANCOVA, with and without global perfusion adjustments.
Main Results:
- The AD group exhibited significant regional hypoperfusion compared to the CN group in the inferior parietal cortex, posterior cingulate gyri, and frontal gyri.
- Hypoperfusion in AD persisted in the inferior parietal lobe and middle frontal gyri even after correcting for PVEs due to cortical gray matter atrophy.
- The MCI group showed significant hypoperfusion in the right inferior parietal lobe compared to the CN group, a region overlapping with the most significant findings in AD.
Conclusions:
- Pulsed ASL MR imaging effectively demonstrates regional cerebral hypoperfusion in AD.
- The observed hypoperfusion patterns in AD align with findings from FDG-PET and HMPAO-SPECT studies.
- The study confirms that ASL-detected hypoperfusion in AD is robust and remains evident even when accounting for cortical gray matter atrophy.
