Related Experiment Video
Updated: May 24, 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
Whole-brain arterial spin labeling perfusion MRI in patients with acute stroke
Reinoud P H Bokkers1, Daymara A Hernandez, José G Merino
1Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands. r.p.h.bokkers@umcutrecht.nl
Background And Purpose:
Perfusion MRI can be used to identify patients with acute ischemic stroke who may benefit from reperfusion therapies. The risk of nephrogenic systemic fibrosis, however, limits the use of contrast agents. Our objective was to evaluate the ability of arterial spin labeling (ASL), an alternative noninvasive perfusion technique, to detect perfusion deficits compared with dynamic susceptibility contrast (DSC) perfusion imaging.
Methods:
Consecutive patients referred for emergency assessment of suspected acute stroke within a 7-month period were imaged with both ASL and DSC perfusion MRI. Images were interpreted in a random order by 2 experts blinded to clinical information for image quality, presence of perfusion deficits, and diffusion-perfusion mismatches.
Results:
One hundred fifty-six patients were scanned with a median time of 5.6 hours (range, 3.0-17.7 hours) from last seen normal. Stroke diagnosis was clinically confirmed in 78 patients. ASL and DSC imaging were available in 64 of these patients. A perfusion deficit was detected with DSC in 39 of these patients; ASL detected 32 of these index perfusion deficits, missing 7 lesions. The median volume of the perfusion deficits as determined with DSC was smaller in patients who were evaluated as normal with ASL than in those with a deficit (median [interquartile range], 56 [10-116] versus 114 [41-225] mL; P=0.01).
Conclusions:
ASL can depict large perfusion deficits and perfusion-diffusion mismatches in correspondence with DSC. Our findings show that a fast 2½-minute ASL perfusion scan may be adequate for screening patients with acute stroke with contraindications to gadolinium-based contrast agents.
Insights
Arterial spin labeling (ASL) MRI can detect large perfusion deficits in acute stroke patients, offering a noninvasive alternative to contrast-enhanced dynamic susceptibility contrast (DSC) MRI. This technique may be suitable for screening patients with contraindications to gadolinium-based contrast agents.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Perfusion MRI is crucial for identifying acute ischemic stroke patients eligible for reperfusion therapies.
- Nephrogenic systemic fibrosis risk associated with contrast agents limits their use.
- Arterial spin labeling (ASL) presents a noninvasive alternative for perfusion imaging.
Purpose of the Study:
- To evaluate the efficacy of ASL in detecting perfusion deficits compared to DSC perfusion imaging.
- To assess ASL's ability to identify perfusion deficits in acute stroke patients.
Main Methods:
- Consecutive patients with suspected acute stroke underwent both ASL and DSC perfusion MRI.
- Two blinded experts evaluated image quality, perfusion deficits, and diffusion-perfusion mismatches.
- Image interpretation was performed in a random order.
Main Results:
- Of 64 patients with available ASL and DSC data, DSC detected perfusion deficits in 39 patients.
- ASL identified 32 of these 39 deficits, missing 7.
- Perfusion deficit volumes were significantly smaller in patients ASL evaluated as normal compared to those with detected deficits (P=0.01).
Conclusions:
- ASL effectively depicts large perfusion deficits and diffusion-perfusion mismatches comparable to DSC.
- A rapid 2.5-minute ASL scan may be sufficient for screening acute stroke patients.
- ASL is a viable noninvasive option for patients with contraindications to gadolinium-based contrast agents.
