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Comparison of CBF Measured with Combined Velocity-Selective Arterial Spin-Labeling and Pulsed Arterial Spin-Labeling
D S Bolar1,2, B Gagoski3,4, D B Orbach4,5
1From the Department of Radiology (D.S.B.) dbolar@ucsd.edu.
Insights
Velocity-selective arterial spin-labeling (VSASL) accurately images pediatric moyamoya perfusion, unlike traditional ASL which is affected by transit delays. This new method, combined with pulsed ASL, provides crucial information comparable to conventional angiography.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Pediatric moyamoya management relies on cerebral blood flow (CBF) imaging.
- Traditional arterial spin-labeling (ASL) MR imaging is inaccurate for moyamoya perfusion due to arterial transit delays.
- Velocity-selective ASL (VSASL) is insensitive to transit delays, making it suitable for moyamoya perfusion imaging.
Purpose of the Study:
- To assess the accuracy of a combined VSASL and traditional pulsed ASL (P-ASL) CBF approach in pediatric moyamoya.
- To compare this combined MR imaging approach with conventional digital subtraction angiography (DSA).
Main Methods:
- Twenty-two pediatric moyamoya patients and 5 asymptomatic siblings underwent VSASL, P-ASL, and DSA.
- Qualitative and quantitative comparisons were made between imaging techniques.
- ASPECTS-based scoring was used for systematic comparison.
Main Results:
- VSASL perfusion maps correlated well with DSA parenchymal phase, irrespective of timing.
- P-ASL maps reflected DSA appearance closer to the ASL postlabeling delay.
- ASPECTS comparison showed excellent agreement (88%, κ = 0.77) between ASL and DSA.
- VSASL showed similar perfusion variability in moyamoya patients versus controls (CV=0.30 vs 0.26).
- P-ASL showed significantly higher perfusion variability in moyamoya patients (CV=0.64 vs 0.34).
Conclusions:
- VSASL is a powerful tool for imaging pediatric moyamoya perfusion due to its insensitivity to transit delays.
- Combining VSASL with P-ASL provides volumetric MR imaging that captures key DSA information.
- This combined approach offers a valuable non-invasive method for assessing moyamoya.
Background And Purpose:
Imaging CBF is important for managing pediatric moyamoya. Traditional arterial spin-labeling MR imaging detects delayed transit thorough diseased arteries but is inaccurate for measuring perfusion because of these delays. Velocity-selective arterial spin-labeling is insensitive to transit delay and well-suited for imaging Moyamoya perfusion. This study assesses the accuracy of a combined velocity-selective arterial spin-labeling and traditional pulsed arterial spin-labeling CBF approach in pediatric moyamoya, with comparison to blood flow patterns on conventional angiography.
Materials And Methods:
Twenty-two neurologically stable pediatric patients with moyamoya and 5 asymptomatic siblings without frank moyamoya were imaged with velocity-selective arterial spin-labeling, pulsed arterial spin-labeling, and DSA (patients). Qualitative comparison was performed, followed by a systematic comparison using ASPECTS-based scoring. Quantitative pulsed arterial spin-labeling CBF and velocity-selective arterial spin-labeling CBF for the middle cerebral artery, anterior cerebral artery, and posterior cerebral artery territories were also compared.
Results:
Qualitatively, velocity-selective arterial spin-labeling perfusion maps reflect the DSA parenchymal phase, regardless of postinjection timing. Conversely, pulsed arterial spin-labeling maps reflect the DSA appearance at postinjection times closer to the arterial spin-labeling postlabeling delay, regardless of vascular phase. ASPECTS comparison showed excellent agreement (88%, κ = 0.77, P < .001) between arterial spin-labeling and DSA, suggesting velocity-selective arterial spin-labeling and pulsed arterial spin-labeling capture key perfusion and transit delay information, respectively. CBF coefficient of variation, a marker of perfusion variability, was similar for velocity-selective arterial spin-labeling in patient regions of delayed-but-preserved perfusion compared to healthy asymptomatic sibling regions (coefficient of variation = 0.30 versus 0.26, respectively, Δcoefficient of variation = 0.04), but it was significantly different for pulsed arterial spin-labeling (coefficient of variation = 0.64 versus 0.34, Δcoefficient of variation = 0.30, P < .001).
Conclusions:
Velocity-selective arterial spin-labeling offers a powerful approach to image perfusion in pediatric moyamoya due to transit delay insensitivity. Coupled with pulsed arterial spin-labeling for transit delay information, a volumetric MR imaging approach capturing key DSA information is introduced.
