title: Multi-delay ASL can identify leptomeningeal collateral perfusion in endovascular therapy of ischemic stroke.
abstract: OBJECTIVE
  Multi-delay arterial spin-labeling (ASL) perfusion imaging has been used as a promising modality to evaluate cerebral perfusion. Our aim was to assess the association of leptomeningeal collateral perfusion scores based on ASL parameters with outcome of endovascular treatment in patients with acute ischemic stroke (AIS) in the middle cerebral artery (MCA) territory.
  
  
  METHODS
  ASL data at 4 post-labeling delay (PLD) times (PLD = 1.5, 2, 2.5, 3 s) were acquired during routine clinical magnetic resonance examination on AIS patients prior to endovascular treatment. A 3-point scale of leptomeningeal collateral perfusion grade on 10 anatomic regions was determined based on arterial transit times (ATT), cerebral blood flow (CBF), and arterial cerebral blood volume (CBV), estimated by the multi-delay ASL protocol. Based on a 90-day modified Rankin Scale (mRS), the patients were dichotomized to moderate/good (mRS 0-3) and poor outcome (mRS 4-6) and the regional collateral flow scores were compared.
  
  
  RESULTS
  Fifty-five AIS patients with unilateral MCA stroke (mean 73.95±14.82 years) including 23 males were enrolled. Compared with poor outcome patients, patients with moderate to good outcomes had a significantly higher leptomeningeal collateral perfusion scores on CBV (3.01±2.11 vs. 1.82±1.51, p=0.024) but no differences on scores on CBF (2.31±1.61 vs. 1.66±1.32, p=0.231) and ATT (2.67±2.33 vs. 3.42±3.37, p=0.593).
  
  
  CONCLUSIONS
  Higher leptomeningeal collateral perfusion scores on CBV images by ASL may be a specific marker of clinical outcome after endovascular treatment in patients with acute MCA ischemic stroke. Further study with larger sample size is warranted.
authors.affiliation: Department of Radiology, Chinese PLA General Hospital, Beijing, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Lou
authors.affiliation: Department of Neurology, UCLA Stroke Center, Los Angeles, California, USA.
authors.forename: Songlin
authors.initials: S
authors.lastname: Yu
authors.affiliation: Department of Neurology, UCLA Stroke Center, Los Angeles, California, USA.
authors.forename: Fabien
authors.initials: F
authors.lastname: Scalzo
authors.affiliation: Department of Neurology, UCLA Stroke Center, Los Angeles, California, USA.
authors.forename: Sidney
authors.initials: S
authors.lastname: Starkman
authors.affiliation: Department of Neurology, UCLA Stroke Center, Los Angeles, California, USA.
authors.forename: Latisha K
authors.initials: LK
authors.lastname: Ali
authors.affiliation: Department of Neurology, UCLA Stroke Center, Los Angeles, California, USA.
authors.forename: Doojin
authors.initials: D
authors.lastname: Kim
authors.affiliation: Department of Neurology, UCLA Stroke Center, Los Angeles, California, USA.
authors.forename: Neal M
authors.initials: NM
authors.lastname: Rao
authors.affiliation: Department of Neurology, UCLA Stroke Center, Los Angeles, California, USA.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Hinman
authors.affiliation: Department of Neurology, UCLA Stroke Center, Los Angeles, California, USA.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Vespa
authors.affiliation: Department of Radiology, UCLA Stroke Center, Los Angeles, California, USA.
authors.forename: Reza
authors.initials: R
authors.lastname: Jahan
authors.affiliation: Department of Medical Center, UCLA Stroke Center, Los Angeles, California, USA.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Tateshima
authors.affiliation: Department of Neurosurgery/Interventional Neuroradiology, UCLA Stroke Center, Los Angeles, California, USA.
authors.forename: Nestor R
authors.initials: NR
authors.lastname: Gonzalez
authors.affiliation: Department of Radiology and Neurosurgery, UCLA Stroke Center, Los Angeles, California, USA.
authors.forename: Gary R
authors.initials: GR
authors.lastname: Duckwiler
authors.affiliation: Department of Neurology, UCLA Stroke Center, Los Angeles, California, USA.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Saver
authors.affiliation: Department of Radiology, UCLA Stroke Center, Los Angeles, California, USA.
authors.forename: Bryan
authors.initials: B
authors.lastname: Yoo
authors.affiliation: Department of Radiology, UCLA Stroke Center, Los Angeles, California, USA.
authors.forename: Noriko
authors.initials: N
authors.lastname: Salamon
authors.affiliation: Department of Radiology, Chinese PLA General Hospital, Beijing, China.
authors.forename: Jinhao
authors.initials: J
authors.lastname: Lyu
authors.affiliation: Department of Radiology, Chinese PLA General Hospital, Beijing, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Ma
authors.affiliation: Department of Neurology, UCLA Stroke Center, Los Angeles, California, USA.
authors.forename: Danny Jj
authors.initials: DJ
authors.lastname: Wang
authors.affiliation: Department of Neurology, UCLA Stroke Center, Los Angeles, California, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Liebeskind
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging*; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008578:Meninges / Q000000981:diagnostic imaging*; D008875:Middle Aged; D055420:Perfusion Imaging; D013113:Spin Labels
chemical_list: D013113:Spin Labels
keywords: arterial spin-labeling; cerebral blood flow; collateral circulation; perfusion imaging; stroke