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Arterial spin labelled imaging

Arterial spin labeling (ASL) will soon be available as a routine clinical perfusion imaging sequence for a significant number of MRI scanners. The ASL perfusion technique offers similar information as conventional Dynamic susceptibility weighted contrast enhanced perfusion imaging; however, it does not require intravenous contrast and can be quantified. The appearance of pathology is significantly impacted by the ASL techniques used.

Arterial spin labeling perfusion-weighted imaging (ASL-PWI) enables quantification of tissue perfusion.

Arterial spin labelled imaging for glioblastoma

Arterial spin labelled imaging for cerebral blood flow

Arterial spin labelled imaging in Moyamoya disease

Post-label delay times of ≥4 seconds are needed and may be combined with multidelay strategies for robust ASL assessment of CBF in Moyamoya disease 1).

ASL-PWI may provide a reliable and noninvasive means of predicting angiographic vascularity of meningiomas. It may thus assist in selecting potential candidates for preoperative digital subtraction angiography and embolization in clinical practice. 2).

High-grade pediatric brain tumors display higher CBF than do low-grade tumors, and they may be accurately graded by using these values. CBF is correlated with tumor microvascular density 3).

A study clearly demonstrates that the initial use of ASL and DWI could help to diagnose partial nonconvulsive status epilepticus (NCSE) and also combined use of the MRI and EEG allows documentation of the pathophysiological mechanism in each patient 4).

Case series


ASL data obtained in 129 children between 2011 and 2015 were retrospectively analyzed. CBF and relative CBF in the most perfused area of each neoplasm and contrast enhancement were quantified with a semiquantitative ratio. The correlation between CBF and microvascular density was analyzed in specimens stained with anti-CD34. Results were controlled in two validation cohorts with 1.5- and 3.0-T magnetic resonance (MR) imaging.

Mean CBF was significantly higher for high-grade than for low-grade hemispheric (116 mL/min/100 g [interquartile range {IQR}, 73-131 mL/min/100 g] vs 29 mL/min/100 g [IQR, 23-35 29 mL/min/100 g], P < .001), thalamic (87 mL/min/100 g [IQR, 73-100 mL/min/100 g] vs 36 mL/min/100 g [IQR, 30-40 mL/min/100 g], P = .016), and posterior fossa (59 mL/min/100 g [IQR, 45-91 mL/min/100 g] vs 33 mL/min/100 g [IQR, 25-40 mL/min/100 g], P < .001) tumors. With a cutoff of 50 mL/min/100 g, sensitivity and specificity were 90% (95% confidence interval [CI]: 68, 100) and 93% (95% CI: 66, 100), respectively, for hemispheric tumors; 100% (95% CI: 48, 100) and 80% (95% CI: 28, 100), respectively, for thalamic tumors; and 65% (95% CI: 51, 78) and 94% (95% CI: 80, 99), respectively, for posterior fossa tumors. In posterior fossa tumors, additional use of the CBF-to-contrast enhancement ratio yielded sensitivity and specificity of 96% (95% CI: 87, 100) and 97% (95% CI: 84, 100), respectively. Use of a simple algorithm based on these values yielded an accuracy of 93% (95% CI: 87, 97). Validation sets yielded similar results, with grading accuracy of 88% (95% CI: 62, 98) with 1.5-T MR imaging and 77% (95% CI: 46, 95) with 3.0-T MR imaging. CBF was strongly correlated with microvascular density (R = 0.66, P < .001).

High-grade pediatric brain tumors display higher CBF than do low-grade tumors, and they may be accurately graded by using these values. CBF is correlated with tumor microvascular density 5).


Arterial spin-labeling perfusion of 54 children (mean age, 7.5 years; 33 boys and 21 girls) with treatment-naive brain tumors was retrospectively evaluated. The 3D pseudocontinuous spin-echo arterial spin-labeling technique was acquired at 3T MR imaging. Maximal relative tumor blood flow was obtained by use of the ROI method and was compared with tumor histologic features and grade.

Tumors consisted of astrocytic (20), embryonal (11), ependymal (3), mixed neuronal-glial (8), choroid plexus (5), craniopharyngioma (4), and other pathologic types (3). The maximal relative tumor blood flow of high-grade tumors (grades III and IV) was significantly higher than that of low-grade tumors (grades I and II) (P < .001). There was a wider relative tumor blood flow range among high-grade tumors (2.14 ± 1.78) compared with low-grade tumors (0.60 ± 0.29) (P < .001). Across the cohort, relative tumor blood flow did not distinguish individual histology; however, among posterior fossa tumors, relative tumor blood flow was significantly higher for medulloblastoma compared with pilocytic astrocytoma (P = .014).

Characteristic arterial spin-labeling perfusion patterns were seen among diverse pathologic types of brain tumors in children. Arterial spin-labeling perfusion can be used to distinguish high-grade and low-grade tumors 6).

Fan AP, Guo J, Khalighi MM, Gulaka PK, Shen B, Park JH, Gandhi H, Holley D, Rutledge O, Singh P, Haywood T, Steinberg GK, Chin FT, Zaharchuk G. Long-Delay Arterial Spin Labeling Provides More Accurate Cerebral Blood Flow Measurements in Moyamoya Patients: A Simultaneous Positron Emission Tomography/MRI Study. Stroke. 2017 Aug 1. pii: STROKEAHA.117.017773. doi: 10.1161/STROKEAHA.117.017773. [Epub ahead of print] PubMed PMID: 28765286.
Yoo RE, Yun TJ, Cho YD, Rhim JH, Kang KM, Choi SH, Kim JH, Kim JE, Kang HS, Sohn CH, Park SW, Han MH. Utility of arterial spin labeling perfusion magnetic resonance imaging in prediction of angiographic vascularity of meningiomas. J Neurosurg. 2016 Sep;125(3):536-43. doi: 10.3171/2015.8.JNS151211. Epub 2016 Jan 29. PubMed PMID: 26824378.
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Dangouloff-Ros V, Deroulers C, Foissac F, Badoual M, Shotar E, Grévent D, Calmon R, Pagès M, Grill J, Dufour C, Blauwblomme T, Puget S, Zerah M, Sainte-Rose C, Brunelle F, Varlet P, Boddaert N. Arterial Spin Labeling to Predict Brain Tumor Grading in Children: Correlations between Histopathologic Vascular Density and Perfusion MR Imaging. Radiology. 2016 Nov;281(2):553-566. PubMed PMID: 27257950.
Shimogawa T, Morioka T, Sayama T, Haga S, Kanazawa Y, Murao K, Arakawa S, Sakata A, Iihara K. The initial use of arterial spin labeling perfusion and diffusion-weighted magnetic resonance images in the diagnosis of nonconvulsive partial status epileptics. Epilepsy Res. 2016 Dec 21;129:162-173. doi: 10.1016/j.eplepsyres.2016.12.008. [Epub ahead of print] PubMed PMID: 28092848.
Yeom KW, Mitchell LA, Lober RM, Barnes PD, Vogel H, Fisher PG, Edwards MS. Arterial spin-labeled perfusion of pediatric brain tumors. AJNR Am J Neuroradiol. 2014 Feb;35(2):395-401. doi: 10.3174/ajnr.A3670. Epub 2013 Aug 1. PubMed PMID: 23907239.
arterial_spin_labelled_imaging.txt · Last modified: 2018/12/19 19:18 by administrador