Arterial spin-labeling in routine clinical practice, part 1: technique and artifacts

Area of Science:

• Radiology
• Neuroimaging

Background:

• Arterial spin-labeling (ASL) is increasingly used in clinical settings to visualize diverse brain pathologies.
• Challenges exist in acquiring, postprocessing, and analyzing cerebral blood flow (CBF) maps in clinical populations.

Purpose of the Study:

• To review experiences with ASL perfusion cases in a heterogeneous clinical population.
• To emphasize methodology and common artifacts encountered during ASL imaging.

Main Methods:

• Analysis of over 3000 pulsed ASL cases performed over one year as part of routine clinical brain MRI at 1.5T and 3T.
• Evaluation of image quality and perfusion patterns on grayscale DICOM images and color JPEG CBF maps.
• Categorization of common artifacts and their impact on image quality.

Main Results:

• High-quality ASL CBF maps can be consistently generated with dedicated postprocessing and quality control.
• Familiarity with common artifacts is crucial for accurate interpretation of CBF maps.
• Diverse brain pathologic features can be depicted using ASL.

Conclusions:

• Routine clinical use of ASL is feasible and beneficial for depicting brain pathology.
• Attention to quality control and a dedicated postprocessing pipeline are essential for reliable ASL CBF mapping.
• Understanding and identifying common artifacts are critical for avoiding misinterpretations in clinical ASL studies.