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Updated: Aug 22, 2025

Magnetic Resonance Imaging Quantification of Pulmonary Perfusion using Calibrated Arterial Spin Labeling
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Arterial Spin Labeling: Techniques, Clinical Applications, and Interpretation.

Tatiana Iutaka1, Marina Bellintani de Freitas1, Samir Sari Omar1

  • 1From the Neuroradiology Section, Department of Radiology, Irmandade da Santa Casa de Misericórdia de São Paulo, Rua Dr. Cesário Mota Júnior 112, São Paulo, SP, Brazil 01221-020 (T.I., M.B.d.F., R.H.N., F.T.P., A.C.M.M.J., L.L.F.d.A., A.J.d.R.); Neuroradiology Section, Department of Radiology, Diagnósticos da América SA, Barueri, Brazil (T.I., M.B.d.F., S.S.O., F.A.S., R.H.N., F.T.P., A.J.d.R.); Neuroradiology Section, Department of Radiology, Beneficência Portuguesa de São Paulo, São Paulo, Brazil (S.S.O., L.L.F.d.A.); Department of Radiology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif (K.N.); and Neuroradiology Section, Department of Radiology, Fleury Group, São Paulo, Brazil (A.C.M.M.J.).

Radiographics : a Review Publication of the Radiological Society of North America, Inc
|November 11, 2022
PubMed
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Arterial spin labeling (ASL) is a noninvasive MRI technique using endogenous tracers for cerebral perfusion assessment. Despite its advantages, including quantitative analysis, ASL is underused due to technical challenges and a need for clearer guidelines.

Area of Science:

  • Medical Imaging
  • Neuroscience
  • Radiology

Background:

  • Arterial spin labeling (ASL) is an emerging noninvasive MRI technique for assessing cerebral perfusion.
  • It utilizes magnetically labeled arterial blood water protons as an endogenous tracer, avoiding exogenous contrast agents.
  • This makes ASL particularly suitable for pediatric patients, those with contraindications to gadolinium, renal failure, or requiring frequent follow-up.

Purpose of the Study:

  • To review the technical and physiologic basis of ASL perfusion imaging.
  • To discuss current clinical applications, artifacts, and pitfalls of ASL.
  • To suggest a practical approach for interpreting ASL findings in clinical practice.

Main Methods:

  • Review of existing literature on ASL principles and applications.

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  • Discussion of ASL's advantages over other perfusion techniques, such as quantitative cerebral blood flow measurement.
  • Analysis of factors limiting widespread clinical adoption of ASL.

    • Main Results:

    • ASL offers quantitative cerebral blood flow (CBF) measurement, enabling longitudinal study comparisons.
    • Despite successful clinical translation, ASL remains underutilized in routine practice.
    • Disadvantages include lower signal-to-noise ratio and longer acquisition times compared to dynamic susceptibility contrast-enhanced MRI.

    Conclusions:

    • ASL is a valuable noninvasive tool for cerebral perfusion assessment with unique advantages.
    • Overcoming limitations such as technical complexity, standardization, and interpretation guidelines is crucial for broader clinical implementation.
    • Further education and standardization are needed to fully leverage ASL's potential in clinical settings.