MR Imaging of Individual Perfusion Reorganization Using Superselective Pseudocontinuous Arterial Spin-Labeling in Patients with Complex Extracranial Steno-Occlusive Disease.
Patients with multiple stenoses or occlusions of the extracranial arteries require an individualized diagnostic approach. We evaluated the feasibility and clinical utility of a novel MR imaging technique for regional perfusion imaging in this patient group.



Superselective pseudocontinuous arterial spin-labeling with a circular labeling spot enabling selective vessel labeling was added to routine imaging in a prospective pilot study in 50 patients (10 women, 70.05 ± 10.55 years of age) with extracranial steno-occlusive disease. Thirty-three had infarct lesions. DSC-MR imaging was performed in 16/50 (32%), and cerebral DSA, in 12/50 patients (24%). Vascular anatomy and the distribution of vessel stenoses and occlusions were defined on sonography and TOF-MRA. Stenoses were classified according to the NASCET criteria. Infarct lesions and perfusion deficits were defined on FLAIR and DSC-MR imaging, respectively. Individual perfusion patterns were defined on the superselective pseudocontinuous arterial spin-labeling maps and were correlated with vascular anatomy and infarct lesion localization.



The superselective pseudocontinuous arterial spin-labeling imaging sequence could be readily applied by trained technicians, and the additional scan time of 12.7 minutes was well-tolerated by patients. The detected vessel occlusions/stenoses and perfusion patterns corresponded between cerebral DSA and superselective pseudocontinuous arterial spin-labeling maps in all cases. Perfusion deficits on DSC-CBF maps significantly correlated with those on superselective pseudocontinuous arterial spin-labeling maps (Pearsonr= 0.9593,P< .01). Individual collateral recruitment patterns were not predictable from the vascular anatomy in 71% of our patients.



Superselective pseudocontinuous arterial spin-labeling is a robust technique for regional brain perfusion imaging, suitable for the noninvasive diagnostics of individual perfusion patterns in patients with complex cerebrovascular disease.
From the Department of Radiology (V.R.), Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany vivien.richter@med.uni-tuebingen.de.
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0000-0002-4723-1055
V
Richter
Department of Radiology and Neuroradiology (M.H., T.L.), University Medical Center Schleswig-Holstein, Kiel, Germany.|Philips GmbH Innovative Technologies (M.H.), Research Laboratories, Hamburg, Germany.
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0000-0001-7666-2316
M
Helle
The C. J. Gorter Center for High Field MRI (M.J.P.v.O.), Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
M J P
0000-0001-7034-8959
MJ
van Osch
Department of Radiology and Neuroradiology (M.H., T.L.), University Medical Center Schleswig-Holstein, Kiel, Germany.
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0000-0002-4408-2429
T
Lindner
Departments of Diagnostic and Interventional Neuroradiology (A.S.G., C.P., C.Z.).
A S
0000-0003-1687-5541
AS
Gersing
Vascular and Endovascular Surgery (P.T., H.-H.E.), Klinikum Rechts der Isar, Technical University Munich, Munich, Germany.
P
0000-0002-7097-6776
P
Tsantilas
Vascular and Endovascular Surgery (P.T., H.-H.E.), Klinikum Rechts der Isar, Technical University Munich, Munich, Germany.
H-H
0000-0002-5628-6859
HH
Eckstein
Departments of Diagnostic and Interventional Neuroradiology (A.S.G., C.P., C.Z.).
C
0000-0003-4067-1928
C
Preibisch
Departments of Diagnostic and Interventional Neuroradiology (A.S.G., C.P., C.Z.).
C
0000-0002-4805-9103
C
Zimmer
D000328:Adult; D000368:Aged; D001158:Arteries / Q000000981:diagnostic imaging; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging*; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D055420:Perfusion Imaging / Q000379:methods*; D010865:Pilot Projects; D011446:Prospective Studies; D013113:Spin Labels
D013113:Spin Labels