title: Periprocedural arterial spin labeling and dynamic susceptibility contrast perfusion in detection of cerebral blood flow in patients with acute ischemic syndrome.
abstract: OBJECTIVE
  To compare the diagnostic performance of arterial spin-labeling (ASL) and dynamic susceptibility contrast (DSC) perfusion in detecting cerebral blood flow (CBF) changes before and after endovascular recanalization in acute ischemic syndrome.
  
  
  METHODS
  The inclusion criteria for this retrospective study were patients with acute ischemic syndrome who underwent endovascular recanalization and acquisition of both ASL and DSC before and after revascularization. ASL-CBF and multiparametric DSC maps were evaluated for image quality, location, and type of perfusion abnormality. Relative CBF (rCBF) was calculated in the infarction core and hypoperfused areas using coregistered ASL and DSC. Core and hypoperfused rCBF were used for paired pretreatment and posttreatment comparisons. Interobserver and intermodality agreement were evaluated by κ test, and t test was calculated for ASL and DSC rCBF values.
  
  
  RESULTS
  Twenty-five patients met our inclusion criteria. Five studies were rated nondiagnostic, resulting in 45 pairs of DSC-ASL available for comparison. ASL and DSC agreed on type and location of the perfusion abnormality in 71% and 80% of cases, respectively. The image quality of ASL was lower than DSC, resulting in interobserver variability for the type (κ=0.45) and location (κ=0.56) of perfusion abnormality. ASL was unable to show any type of perfusion abnormality in 11% of patients. In successfully recanalized patients, hyperperfusion (rCBF >1) was detected in 100% on DSC and 47% on ASL.
  
  
  CONCLUSIONS
  ASL is less sensitive than DSC for detecting rCBF changes in patients with acute ischemic syndrome, particularly with respect to hyperperfusion after successful recanalization.
authors: Department of Medical Imaging, University of Arizona Medical Center, Tucson, AZ 85724-5067, USA. kambiznael@gmail.com
authors: Kambiz
authors: K
authors: Nael
authors: Arash
authors: A
authors: Meshksar
authors: David S
authors: DS
authors: Liebeskind
authors: Danny J J
authors: DJ
authors: Wang
authors: Benjamin M
authors: BM
authors: Ellingson
authors: Noriko
authors: N
authors: Salamon
authors: Juan Pablo
authors: JP
authors: Villablanca
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology; D002560:Cerebrovascular Circulation / Q000502:physiology*; D003287:Contrast Media; D004578:Electron Spin Resonance Spectroscopy / Q000379:methods*; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D055420:Perfusion Imaging / Q000379:methods*; D011859:Radiography; D012039:Regional Blood Flow / Q000502:physiology*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013113:Spin Labels; D020521:Stroke / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*
chemical_list: D003287:Contrast Media; D013113:Spin Labels
references: J Neuroimaging. 2003 Jan;13(1):17-27
references: 12593127
references: Magn Reson Med. 1992 Jan;23(1):37-45
references: 1734182
references: Magn Reson Med. 2006 Feb;55(2):219-32
references: 16416430
references: AJNR Am J Neuroradiol. 2004 Jun-Jul;25(6):951-7
references: 15205129
references: Magn Reson Med. 2000 Apr;43(4):559-64
references: 10748431
references: Neurology. 1997 Mar;48(3):673-9
references: 9065546
references: Magn Reson Med. 2008 Dec;60(6):1488-97
references: 19025913
references: Stroke. 2012 Apr;43(4):1018-24
references: 22328551
references: JAMA. 1999 Dec 1;282(21):2003-11
references: 10591382
references: Radiology. 1996 May;199(2):391-401
references: 8668784
references: Neurology. 2009 Mar 31;72(13):1140-5
references: 19332690
references: AJR Am J Roentgenol. 2007 Jun;188(6):1447-74
references: 17515363
references: Magn Reson Med. 2008 Jun;59(6):1467-71
references: 18506806
references: Stroke. 2009 Aug;40(8):2761-8
references: 19590057
references: NMR Biomed. 2007 Jun;20(4):429-38
references: 17044140
references: Magn Reson Med. 2007 Nov;58(5):1020-7
references: 17969096
references: Magn Reson Med. 1998 Sep;40(3):383-96
references: 9727941
references: Magn Reson Med. 2000 Sep;44(3):440-9
references: 10975897
references: Stroke. 2003 Aug;34(8):e109-37
references: 12869717
references: Ann Neurol. 2006 Nov;60(5):508-17
references: 17066483
references: Stroke. 2000 Mar;31(3):680-7
references: 10700504
references: Stroke. 2007 Jul;38(7):2127-35
references: 17525387
references: Stroke. 2012 May;43(5):1290-4
references: 22426319
references: Magn Reson Med. 2006 Jun;55(6):1334-41
references: 16700025
references: Stroke. 2005 Jan;36(1):66-73
references: 15569863
references: Radiology. 2005 Apr;235(1):218-28
references: 15716390
references: Lancet Neurol. 2008 Apr;7(4):299-309
references: 18296121
references: Magn Reson Med. 2001 Dec;46(6):1113-22
references: 11746577
references: Magn Reson Med. 1993 Sep;30(3):318-25
references: 8412602
references: Magn Reson Med. 2003 Jul;50(1):164-74
references: 12815691