Comparison of Quantitative Cerebral Blood Flow Measurements Performed by Bookend Dynamic Susceptibility Contrast and Arterial Spin-Labeling MRI in Relapsing-Remitting Multiple Sclerosis.
Quantitative CBF usage as a biomarker for cognitive impairment and disease progression in MS is potentially a powerful tool for longitudinal patient monitoring. Dynamic susceptibility contrast perfusion with bookend T1-calibration (bookend technique) and pseudocontinuous arterial spin-labeling have recently been used for CBF quantification in relapsing-remitting MS. The noninvasive nature of pseudocontinuous arterial spin-labeling is advantageous over gadolinium-based techniques, but correlation between the techniques is not well-established in the context of MS.



We compared pseudocontinuous arterial spin-labeling CBF with the bookend technique in a prospective cohort of 19 healthy controls, 19 subjects with relapsing-remitting MS without cognitive impairment, and 20 subjects with relapsing-remitting MS with cognitive impairment on a voxelwise and Brodmann region basis. The linear Pearson correlation, SNR, and coefficient of variation were quantified.



Voxelwise paired t tests revealed no significant CBF differences between techniques after normalization of global mean intensities. The highest Pearson correlations were observed in deep GM structures (average r = 0.71 for the basal ganglia and r = 0.65 for the thalamus) but remained robust for cortical GM, WM, and white matter lesions (average r = 0.51, 0.53, 0.54, respectively). Lower Pearson correlations were observed for cortical lesions (average r = 0.23). Brodmann region correlations were significant for all groups. All correlations were maintained in healthy controls and in patients with relapsing-remitting multiple sclerosis. The highest SNR was present in bookend perfusion, while the highest coefficient of variation was present in white matter lesions.



Agreement between pseudocontinuous arterial spin-labeling and bookend technique CBF measurements is demonstrated in healthy controls and patients with relapsing-remitting MS.
University of Toronto (R.M.D., P.O.C., L.L., A.F., R.I.A.), Toronto, Ontario, Canada.
R M
0000-0001-9228-9523
RM
D'Ortenzio
Medical Imaging (S.P.H., R.V., R.I.A.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada r.dortenzio@mail.utoronto.ca.
S P
0000-0003-0188-1578
SP
Hojjat
Medical Imaging (S.P.H., R.V., R.I.A.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
R
0000-0001-6416-6278
R
Vitorino
Departments of Biomedical Engineering (C.G.C., T.J.C.).
C G
0000-0003-0559-8681
CG
Cantrell
Neurology (L.L.).|University of Toronto (R.M.D., P.O.C., L.L., A.F., R.I.A.), Toronto, Ontario, Canada.
L
0000-0001-7322-9672
L
Lee
From the Departments of Psychiatry (A.F.).|University of Toronto (R.M.D., P.O.C., L.L., A.F., R.I.A.), Toronto, Ontario, Canada.
A
0000-0002-0132-0909
A
Feinstein
University of Toronto (R.M.D., P.O.C., L.L., A.F., R.I.A.), Toronto, Ontario, Canada.
P
0000-0002-5632-8385
P
O'Connor
Departments of Biomedical Engineering (C.G.C., T.J.C.).|Radiology (T.J.C.), Northwestern University, Chicago, Illinois.
T J
0000-0002-5149-8377
TJ
Carroll
Medical Imaging (S.P.H., R.V., R.I.A.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.|University of Toronto (R.M.D., P.O.C., L.L., A.F., R.I.A.), Toronto, Ontario, Canada.
R I
0000-0003-0259-970X
RI
Aviv
D000328:Adult; D001921:Brain / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000502:physiology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D011446:Prospective Studies; D013113:Spin Labels
D013113:Spin Labels
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