title: Arterial spin-label imaging in patients with normal bolus perfusion-weighted MR imaging findings: pilot identification of the borderzone sign.
abstract: OBJECTIVE
  To determine whether perfusion abnormalities are depicted on arterial spin-labeling (ASL) images obtained in patients with normal bolus perfusion-weighted (PW) magnetic resonance (MR) imaging findings.
  
  
  METHODS
  Institutional review board approval and written informed patient consent were obtained. This study was HIPAA compliant. Consecutive patients suspected or known to have cerebrovascular disease underwent 1.5-T brain MR imaging, including MR angiography, gradient-echo PW imaging, and pseudocontinuous ASL imaging, between October 2007 and January 2008. Patients with normal bolus PW imaging findings were retrospectively identified, and two neuroradiologists subsequently evaluated the ASL images for focal abnormalities. The severity of the borderzone sign-that is, bilateral ASL signal dropout with surrounding cortical areas of hyperintensity in the middle cerebral artery borderzone regions-was classified by using a four-point scale. For each group, the ASL-measured mean mixed cortical cerebral blood flow (CBF) at the level of the centrum semiovale was evaluated by using the Jonckheere-Terpstra test.
  
  
  RESULTS
  One hundred thirty-nine patients met the study inclusion criteria, and 41 (30%) of them had normal bolus PW imaging findings. Twenty-three (56%) of these 41 patients also had normal ASL imaging findings. The remaining 18 (44%) patients had the ASL borderzone sign; these patients were older (mean age, 71 years +/- 11 [standard deviation] vs 57 years +/- 16; P < .005) and had lower mean CBF (30 mL/100 g/min +/- 12 vs 46 mL/100 g/min +/- 12, P < .003) compared with the patients who had normal ASL imaging findings. Five patients had additional focal ASL findings that were related to either slow blood flow in a vascular structure or postsurgical perfusion defects and were not visible on the PW images.
  
  
  CONCLUSIONS
  Approximately half of the patients with normal bolus PW imaging findings had abnormal ASL findings-most commonly the borderzone sign. Results of this pilot study suggest that ASL imaging in patients who have this sign and are suspected of having cerebrovascular disease yields additional and complementary hemodynamic information.
authors.affiliation: Department of Radiology, Stanford University Medical Center, 1201 Welch Rd, PS-04, MC 5488, Stanford, CA 94305-5488, USA. gregz@stanford.edu
authors.forename: Greg
authors.initials: G
authors.lastname: Zaharchuk
authors.forename: Roland
authors.initials: R
authors.lastname: Bammer
authors.forename: Matus
authors.initials: M
authors.lastname: Straka
authors.forename: Ajit
authors.initials: A
authors.lastname: Shankaranarayan
authors.forename: David C
authors.initials: DC
authors.lastname: Alsop
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Fischbein
authors.forename: Scott W
authors.initials: SW
authors.lastname: Atlas
authors.forename: Michael E
authors.initials: ME
authors.lastname: Moseley
mesh_terms: D000368:Aged; D002560:Cerebrovascular Circulation; D002561:Cerebrovascular Disorders / Q000473:pathology*; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012189:Retrospective Studies; D013113:Spin Labels
chemical_list: D003287:Contrast Media; D013113:Spin Labels; D019786:Gadolinium DTPA
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