Reduced transit-time sensitivity in noninvasive magnetic resonance imaging of human cerebral blood flow

Murine orthostatic response during prolonged vertical studies: Effect on cerebral blood flow measured by arterial spin-labeled MRI

High-field MRI scanners are, in principle, well suited for mouse studies; however, many high-field magnets employ a vertical design that may influence the physiological state of the rodent. The purpose of this study was to investigate the orthostatic response of cerebral blood flow (CBF) in mice during a prolonged MR experiment in the vertical position. Arterial spin-labeled (ASL) MRI was performed at 4.7-Tesla with a 15-cm gradient insert that allowed horizontal and vertical CBF measurements to be obtained with the same scanner. For mice in the head-up (HU) vertical position, CBF decreased by approximately 40% compared to the horizontal position, although blood pressure did not differ. Furthermore, CBF values for vertically positioned mice treated with phenylephrine remained constant while blood pressure increased. These results support the conclusion that cerebral autoregulation was intact, albeit at a lower level. Since CBF recovers to near horizontal values by volume loading with saline, it appears that a decrease in central venous pressure (CVP) leading to an increase in sympathetic tone may be a contributing mechanism for lowered CBF. This suggests that using an HU vertical position for MRI in mice may have broader implications, especially for studies that rely on CBF (such as BOLD and fMRI).

Dynamic imaging of perfusion and oxygenation by functional magnetic resonance imaging

Cerebral blood flow can be measured with magnetic resonance imaging (MRI) by arterial spin labeling techniques, where magnetic labeling of flowing spins in arterial blood water functions as the endogenous tracer upon mixing with the unlabeled stationary spins of tissue water. The consequence is that the apparent longitudinal relaxation time (T1) of tissue water is attenuated. A modified functional MRI scheme for dynamic CBF measurement is proposed that depends on extraction of T1 weighting from the blood oxygenation level-dependent (BOLD) image contrast, because the functional MRI signal also has an intrinsic T1 weighting that can be altered by variations of the excitation flip angle. In the alpha-chloralose-anesthetized rat model at 7T, the authors show that the stimulation-induced BOLD signal change measured with two different flip angles can be combined to obtain a T1-weighted MRI signal, reflecting the magnitude of the CBF change, which can be deconvolved to obtain dynamic changes in CBF. The deconvolution of the T1-weighted MRI signal, which is a necessary step for accurate reflection of the dynamic changes in CBF, was made possible by a transfer function obtained from parallel laser-Doppler flowmetry experiments. For all stimulus durations (ranging from 4 to 32 seconds), the peak CBF response measured by MRI after the deconvolution was reached at 4.5 +/- 1.0 seconds, which is in good agreement with (present and prior) laser-Doppler measurements. Because the low flip angle data can also provide dynamic changes of the conventional BOLD image contrast, this method can be used for simultaneous imaging of CBF and BOLD dynamics.

Abnormalities of cerebral perfusion in multiple sclerosis

BACKGROUND

Measuring perfusion provides a potential indication of metabolic activity in brain tissue. Studies in multiple sclerosis (MS) have identified areas of decreased perfusion in grey matter (GM) and white matter (WM), but the pattern in clinical subgroups is unclear.

OBJECTIVES

This study investigated perfusion changes in differing MS clinical subgroups on or off beta-interferon therapy using a non-invasive MRI technique (continuous arterial spin labelling) to investigate whether different clinical MS subtypes displayed perfusion changes and whether this could give a further insight into the pathological mechanisms involved.

METHODS

Sixty patients (21 relapsing remitting, 14 secondary progressive, 12 primary progressive, 13 benign) and 34 healthy controls were compared. Statistical parametric mapping (SPM '99) was used to investigate regional variations in perfusion in both GM and WM. Global WM perfusion was derived by segmenting WM from images using T(1) relaxation times.

RESULTS

Regions of lower perfusion in predominantly GM were observed in the primary and secondary progressive cohorts, particularly in the thalamus. Increased WM perfusion was seen in relapsing remitting and secondary progressive cohorts.

CONCLUSIONS

Low GM perfusion could reflect decreased metabolism secondary to neuronal and axonal loss or dysfunction with a predilection for progressive forms of MS. Increased WM perfusion may indicate increased metabolic activity possibly due to increased cellularity and inflammation. Improved methodology and longitudinal studies may enable further investigation of regional and temporal changes, and their relationship with physical and cognitive impairment.

Perfusion imaging using arterial spin labeling

Arterial spin labeling is a magnetic resonance method for the measurement of cerebral blood flow. In its simplest form, the perfusion contrast in the images gathered by this technique comes from the subtraction of two successively acquired images: one with, and one without, proximal labeling of arterial water spins after a small delay time. Over the last decade, the method has moved from the experimental laboratory to the clinical environment. Furthermore, numerous improvements, ranging from new pulse sequence implementations to extensive theoretical studies, have broadened its reach and extended its potential applications. In this review, the multiple facets of this powerful yet difficult technique are discussed. Different implementations are compared, the theoretical background is summarized, and potential applications of various implementations in research as well as in the daily clinical routine are proposed. Finally, a summary of the new developments and emerging techniques in this field is provided.

Precision of the CASL-perfusion MRI technique for the measurement of cerebral blood flow in whole brain and vascular territories

PURPOSE

To analyze the precision of cerebral blood flow (CBF) measurements made with continuous arterial spin labeling(CASL) perfusion magnetic resonance imaging (MRI) over experimentally relevant intervals.

MATERIALS AND METHODS

CASL perfusion MRI measurements of CBF on a 1.5-T GE Signa magnet were repeated in young healthy male and female subjects at one hour and one week. Precision of the measurement was evaluated at both time intervals.

RESULTS

CASL perfusion MRI measurements of CBF yielded within-subject coefficients of variation (wsCV) of 5.8% for global and 13% for individual vascular regions when measurements were repeated within one hour. Differences in these values represent the error in post-processing. Global and regional CBF measurements over one week yielded wsCVs of 13% and 14%, respectively. At one week, error secondary to physiologic variability affected global and regional measurements to the same degree and masked the software post-processing error seen at one hour. The magnitude of the difference in repeated measures correlated with the magnitude of the measurement.

CONCLUSION

CASL perfusion MRI CBF measurements are accurate and precise. Variability over longer periods of time appears attributable to physiologic factors. Repeatability of the CASL measurement is sensitive to the magnitude of the measurement. This should be taken into account when studies requiring repeated measures involve subjects with significant variability in CBF.

Application of new MR techniques in pediatric patients

Pediatric neuroradiology is a fascinating and challenging field because there are normal changes associated with normal development and unique and unusual pathologies that occur in this population. The numerous new MR techniques first applied in the adult population are appropriate for use in the pediatric population, often with minimal modification of parameters. These new techniques will undoubtedly contribute significantly to use of pediatric neuroimaging, but the adult experience is not always directly transferable. The pediatric brain, particularly the immature brain is different in structure, has predilection for different types of disease processes, and may react differently to insults than the adult brain. As a result, the role of these techniques needs to be evaluated in the context of the pediatric brain and common pediatric disease processes.

Fast, pseudo-continuous arterial spin labeling for functional imaging using a two-coil system

A fast, two-coil, pseudo-continuous labeling scheme is presented. This new scheme permits the collection of a multislice subtraction pair in <3 s, depending on the subject's arterial transit times. The method consists of acquiring both control and tag images immediately after a labeling period that matches the arterial transit time. The theoretical basis of the technique, and simulations of the signal during changes in both transit time and perfusion are presented. Experimental data from functional imaging experiments were collected to demonstrate the technique and its characteristics.

Pediatric perfusion imaging using pulsed arterial spin labeling

PURPOSE

To test the feasibility of pediatric perfusion imaging using a pulsed arterial spin labeling (ASL) technique at 1.5 T.

MATERIALS AND METHODS

ASL perfusion imaging was carried out on seven neurologically normal children and five healthy adults. The signal-to-noise ratio (SNR) of the perfusion images along with T1, M(0), arterial transit time, and the temporal fluctuation of the ASL image series were measured and compared between the two age groups. In addition, ASL perfusion magnetic resonance (MR) was performed on three children with neurologic disorder.

RESULTS

In the cohort of neurologically normal children, a 70% increase in the SNR of the ASL perfusion images and a 30% increase in the absolute cerebral blood flow compared to the adult data were observed. The measures of ASL SNR, T1, and M(0) were found to decrease linearly with age. Transit time and temporal fluctuation of the ASL perfusion image series were not significantly different between the two age groups. The feasibility of ASL in the diagnosis of pediatric neurologic disease was also illustrated.

CONCLUSION

ASL is a promising tool for pediatric perfusion imaging given the unique and reciprocal benefits in terms of safety and image quality.

Brain perfusion territory imaging applying oblique-plane arterial spin labeling with a standard send/receive head coil

A new method for the selective spin labeling of left- or right-sided supplying arteries of the brain without the need for additional RF coils is demonstrated. A clinical 1.5 T scanner was used. The spatial selectivity of the labeling process is based on the limited coverage of the excitation field of a standard send/receive head coil together with an oblique positioning of the labeling plane. A computer simulation was used to optimize key labeling parameters under the condition of laminar flow. The validity of the computer model results was confirmed by MRI measurements with a flow model. For human studies, a double-inversion continuous arterial spin labeling (CASL) sequence was modified to allow for arbitrary positioning of the labeling plane. The obtained perfusion-weighted images showed a clear delineation of the perfusion territories of the selected arteries in the anterior circulation of the brain and good gray/white matter contrast.

Reduced susceptibility effects in perfusion fMRI with single-shot spin-echo EPI acquisitions at 1.5 tesla

Arterial spin labeling (ASL) perfusion contrast is not based on susceptibility effects and can therefore be used to study brain function in regions of high static inhomogeneity. As a proof of concept, single-shot spin-echo echo-planar imaging (EPI) acquisition was carried out with a multislice continuous ASL (CASL) method at 1.5T. A bilateral finger tapping paradigm was used in the presence of an exogenously induced susceptibility artifact over left motor cortex. The spin-echo CASL technique was compared with a regular gradient-echo EPI sequence with the same slice thickness, as well as other imaging methods using thin slices and spin-echo acquisitions. The results demonstrate improved functional sensitivity and efficiency of the spin-echo CASL approach as compared with gradient-echo EPI techniques, and a trend of improved sensitivity as compared with spin-echo EPI approach in the brain regions affected by the susceptibility artifact. ASL images, either with or without subtraction of the control, provide a robust alternative to blood oxygenation level dependant (BOLD) methods for activation imaging in regions of high static field inhomogeneity.

Whole-brain 3D perfusion MRI at 3.0 T using CASL with a separate labeling coil

A variety of continuous and pulsed arterial spin labeling (ASL) perfusion MRI techniques have been demonstrated in recent years. One of the reasons these methods are still not routinely used is the limited extent of the imaging region. Of the ASL methods proposed to date, continuous ASL (CASL) with a separate labeling coil is particularly attractive for whole-brain studies at high fields. This approach can provide an increased signal-to-noise ratio (SNR) in perfusion images because there are no magnetization transfer (MT) effects, and lessen concerns regarding RF power deposition at high field because it uses a local labeling coil. In this work, we demonstrate CASL whole-brain quantitative perfusion imaging at 3.0 T using a combination of strategies: 3D volume acquisition, background tissue signal suppression, and a separate labeling coil. The results show that this approach can be used to acquire perfusion images in all brain regions with good sensitivity. Further, it is shown that the method can be performed safely on humans without exceeding the current RF power deposition limits. The current method can be extended to higher fields, and further improved by the use of multiple receiver coils and parallel imaging techniques to reduce scan time or provide increased resolution.

MR image-guided investigation of regional signal transducers and activators of transcription-1 activation in a rat model of focal cerebral ischemia

BACKGROUND AND PURPOSE

STAT-1 is a member of a family of proteins called signal transducers and activators of transcription (STATs), and recent studies have shown its involvement in the induction of apoptosis. There is limited information on the role of STAT-1 following stroke. In this study we use MRI measurements of cerebral perfusion and bioenergetic status to target measurements of regional STAT-1 activity.

METHODS

Rats were subjected to 60 or 90 min of middle cerebral artery occlusion with and without reperfusion. MRI maps of the apparent diffusion coefficient of water and cerebral blood flow were acquired throughout the study. After the ischemia or reperfusion period, the brain was excised and samples were analyzed by Western blots using anti-phospho-STAT1 and anti-Fas antibodies. Regions were selected for analysis according to their MRI characteristics.

RESULTS

Transcriptional factor STAT-1 was enhanced in the lesion core and, to a lesser extent, in the lesion periphery, following ischemia and reperfusion. This level of activity was greater than for ischemia alone. Western blots demonstrated STAT-1 phosphorylation on tyrosine 701 and not serine 727 after ischemia and 3 h of reperfusion. Enhanced expression of the apoptotic death receptor Fas was confirmed after ischemia followed by reperfusion.

CONCLUSIONS

This study demonstrates that focal ischemia of the rat brain can induce STAT-1 activation, particularly following a period of reperfusion. The activation occurs not only in the lesion core, but also in the lesion periphery, as identified using MRI. STAT-1 may play an important role in the induction of cell death following stroke.

Comparison of FAIR perfusion kinetics with DSC-MRI and functional histology in a model of transient ischemia

Flow-sensitive alternating inversion recovery (FAIR) is a noninvasive method for perfusion imaging. It has been shown that the FAIR signal may depend on hemodynamic parameters other than perfusion, the most important one being transit delays of labeled spins to the observed tissue. These parameters are expected to change with ischemia. The goal of this study was to assess the effect of these changes on the interpretation of FAIR results in the case of altered perfusion. This was investigated in a rat model of transient cerebral ischemia. It was shown that the ratio of FAIR signal in the infarct compared to the contralateral side was lower at short inflow times, which suggests that transit times affected the effective FAIR signal. The FAIR results were compared with those from functional histology and dynamic susceptibility contrast MRI, and the findings indicated that the altered kinetics of the FAIR signal were related to reduced and delayed inflow in the infarct region--not to a decrease in the number of functional vessels.

Independent cerebral vasoconstrictive effects of hyperoxia and accompanying arterial hypocapnia at 1 ATA

Breathing 100% O2 at 1 atmosphere absolute (ATA) is known to be associated with a decrease in cerebral blood flow (CBF). It is also accompanied by a fall in arterial Pco2 leading to uncertainty as to whether the cerebral vasoconstriction is totally or only in part caused by arterial hypocapnia. We tested the hypothesis that the increase in arterial Po2 while O2 was breathed at 1.0 ATA decreases CBF independently of a concurrent fall in arterial Pco2. CBF was measured in seven healthy men aged 21-62 yr by using noninvasive continuous arterial spin-labeled-perfusion MRI. The tracer in this technique, magnetically labeled protons in blood, has a half-life of seconds, allowing repetitive measurements over short time frames without contamination. CBF and arterial blood gases were measured while breathing air, 100% O2, and 4 and 6% CO2 in air and O2 backgrounds. Arterial Po2 increased from 91.7 +/- 6.8 Torr in air to 576.7 +/- 18.9 Torr in O2. Arterial Pco2 fell from 43.3 +/- 1.8 Torr in air to 40.2 +/- 3.3 Torr in O2. CBF-arterial Pco2 response curves for the air and hyperoxic runs were nearly parallel and separated by a distance representing a 28.7-32.6% decrement in CBF. Regression analysis confirmed the independent cerebral vasoconstrictive effect of increased arterial Po2. The present results also demonstrate that the magnitude of this effect at 1.0 ATA is greater than previously measured.

Comparison of Arterial Spin-Labeling Techniques and Dynamic Susceptibility-Weighted Contrast-Enhanced MRI in Perfusion Imaging of Normal Brain Tissue

OBJECTIVES

To evaluate relative cerebral blood flow (rCBF) in normal brain tissue using arterial spin-labeling (ASL) methods and first-pass dynamic susceptibility-weighted contrast-enhanced (DSC) magnetic resonance imaging (MRI).

METHODS

Sixty-two patients with brain metastases were examined on a 1.5 T-system up to 6 times during routine follow-up after stereotactic radiosurgery. Perfusion values in normal gray and white matter were measured using the ASL techniques ITS-FAIR in 38 patients, Q2TIPS in 62 patients, and the first-pass DSC echo-planar (EPI) MRI after bolus administration of gadopentetate dimeglumine in 42 patients. Precision of the ASL sequences was tested in follow-up examinations in 10 healthy volunteers.

RESULTS

Perfusion values in normal brain tissue obtained by all sequences correlated well by calculating Pearson's correlation coefficients (P < 0.0001) and remained unchanged after stereotactic radiosurgery as shown by analysis of variance (P > 0.05).

CONCLUSION

Both ASL and DSC EPI MRI yield highly comparable perfusion values in normal brain tissue.

Effect of vascular crushing on FAIR perfusion kinetics, using a BIR-4 pulse in a magnetization prepared FLASH sequence

Flow-sensitive alternating inversion recovery (FAIR) perfusion imaging suffers from high vascular signal, resulting in artifacts and overestimation of perfusion. With TurboFLASH acquisition, crushing of vascular signal by bipolar gradients after each excitation is difficult due to the requirement of an ultrashort repetition time. Therefore, insertion of a preparation phase in the FAIR sequence, after labeling and prior to TurboFLASH acquisition, is proposed. A segmented adiabatic BIR-4 pulse, interleaved with crusher gradients, was used for flow crushing. The effect of the crusher preparation is shown as a function of crusher strength for a flow phantom and in rat brain. Influence of crusher strength on the time-dependent FAIR signal from rat brain was also measured. Signal from flowing spins in a flow phantom and from arterial spins in rat brain was significantly suppressed. Image quality was improved and the overestimation of perfusion at short inflow times was eliminated.

Arterial transit time imaging with flow encoding arterial spin tagging (FEAST)

Arterial spin labeling (ASL) perfusion imaging provides direct and absolute measurement of cerebral blood flow (CBF). Arterial transit time is a related physiological parameter reflecting the duration for the labeled spins to reach the brain region of interest. Most of the existing ASL approaches to assess arterial transit time rely on multiple measurements at various postlabeling delay times, and thus are vulnerable to motion artifact as well as computational error. We describe the use of flow encoding arterial spin tagging (FEAST) technique to measure tissue transit time, which can be derived from the ratio between the ASL signals measured with and without appropriate bipolar gradients. In the present study, we provided a theoretical framework and carried out an experimental validation during steady-state imaging. The global mean tissue transit time was approximately 1100 and 1400 ms for two conditions of bipolar gradients with specific encoding velocity (Venc) of 29 and 8 mm/sec, respectively. The mean tissue transit time measured within cerebral vascular territories was shortest in the deep middle cerebral artery (MCA) territory. Application of the FEAST technique in two patients with cerebrovascular disease demonstrated prolonged tissue transit times in the affected vascular territories which were consistent with results from other MR imaging modalities.

Measurements of cerebral perfusion and arterial hemodynamics during visual stimulation using TURBO-TILT

Estimation of cerebral blood flow (CBF) in functional perfusion imaging could benefit from a method capable of separating effects of arterial arrival time and trailing edge. To accomplish this, the transfer insensitive labeling technique (TILT) was combined with a train of 13 consecutive acquisitions, called TURBO-TILT. Visual activation maps obtained at 13 postlabeling delay times (TI) showed a spatial shift from regions surrounding the arterial vasculature at short TI to brain parenchyma at longer delay times. High baseline CBF and short arrival times were found for the voxels with maximum activation at short TI (<1200 ms), while CBF values (43 ml / 100 g tissue/min) and its increase upon activation (55%) at longer TI were in agreement with literature data on regional cerebral perfusion.

Empirical analyses of null-hypothesis perfusion FMRI data at 1.5 and 4 T

Functional magnetic resonance imaging (fMRI) based on arterial spin labeling (ASL) perfusion contrast is an emergent methodology for visualizing brain function both at rest and during task performance. Because of the typical pairwise subtraction approach in generating perfusion images, ASL contrast manifests different noise properties and offers potential advantages for some experimental designs as compared with blood oxygenation-level-dependent (BOLD) contrast. We studied the noise properties and statistical power of ASL contrast, with a focus on temporal autocorrelation and spatial coherence, at both 1.5- and 4.0-T field strengths. Perfusion fMRI time series were found to be roughly independent in time, and voxelwise statistical analysis assuming independence of observations yielded false-positive rates compatible with theoretical values using appropriate analysis methods. Unlike BOLD fMRI data, perfusion data were not found to have spatial coherence that varied across temporal frequency. This finding has implications for the application of spatial smoothing to perfusion data. It was also found that the spatial coherence of the ASL data is greater at high magnetic field than low field, and including the global signal as a covariate in the general linear model improves the central tendency of test statistic as well as reduces the noise level in perfusion fMRI, especially at high magnetic field.

Evaluation of systematic quantification errors in velocity-selective arterial spin labeling of the brain

Velocity-selective (VS) sequences potentially permit arterial spin labeling (ASL) perfusion imaging with labeling applied very close to the tissue. In this study the effects of cerebrospinal fluid (CSF) motion, radiofrequency (RF) field imperfections, and sequence timing parameters on the appearance and quantitative perfusion values obtained with VS-ASL were evaluated. Large artifacts related to CSF motion were observed with moderate velocity weighting, which were removed by inversion recovery preparation at the cost of increased imaging time. Imperfect refocusing and excitation pulses resulting from nonuniform RF fields produced systematic errors in the ASL subtraction images. A phase cycling scheme was introduced to eliminate these errors. Quantitative perfusion images were obtained with CSF suppression and phase cycling. Gray matter blood flow of 27.7 ml 100 g(-1) min(-1), approximately half the value reported in studies using spatially-selective ASL, was measured. Potential sources for this underestimation are discussed.

Sickle cell disease: continuous arterial spin-labeling perfusion MR imaging in children

Cerebral blood flow (CBF) was measured with continuous arterial spin-labeling perfusion magnetic resonance (MR) imaging in 14 children with sickle cell disease and seven control subjects. Mean CBF values were higher in patients (P <.005) than in control subjects in all cerebral artery territories. Three patients had decreased CBF in right anterior and middle cerebral artery territories compared with CBF on the left, and one patient had a profound decrease in CBF in all three territories in the right hemisphere. Baseline CBF was significantly decreased in territories seen as unaffected on conventional MR images and MR angiograms in four children with sickle cell disease.

Functional perfusion imaging using continuous arterial spin labeling with separate labeling and imaging coils at 3 T

Functional perfusion imaging with a separate labeling coil located above the common carotid artery was demonstrated in human volunteers at 3 T. A helmet resonator and a spin-echo echo-planar imaging (EPI) sequence were used for imaging, and a circular surface coil of 6 cm i.d. was employed for labeling. The subjects performed a finger-tapping task. Signal differences between the condition of finger tapping and the resting state were between -0.5% and -1.1 % among the subjects. The imaging protocol included a long post-label delay (PLD) to reduce transit time effects. Labeling was applied for all repetitions of the functional run to reduce the sampling interval.

Direct comparison of local cerebral blood flow rates measured by MRI arterial spin-tagging and quantitative autoradiography in a rat model of experimental cerebral ischemia

The present study determined cerebral blood flow (CBF) in the rat using two different magnetic resonance imaging (MRI) arterial spin-tagging (AST) methods and 14C-iodoantipyrine (IAP)-quantitative autoradiography (QAR), a standard but terminal technique used for imaging and quantitating CBF, and compared the resulting data sets to assess the precision and accuracy of the different techniques. Two hours after cerebral ischemia was produced in eight rats via permanent occlusion of one middle cerebral artery (MCA) with an intraluminal suture, MRI-CBF was measured over a 2.0-mm coronal slice using single-coil AST, and tissue magnetization was assessed by either a spin-echo (SE) or a variable tip-angle gradient-echo (VTA-GE) readout. Subsequently ( approximately 2.5 hours after MCA occlusion), CBF was assayed by QAR with the blood flow indicator 14C-IAP, which produced coronal images of local flow rates every 0.4 mm along the rostral-caudal axis. The IAP-QAR images that spanned the 2-mm MRI slice were selected, and regional flow rates (i.e., local CBF [lCBF]) were measured and averaged across this set of images by both the traditional approach, which involved reader interaction and avoidance of sectioning artifacts, and a whole film-scanning technique, which approximated total radioactivity in the entire MRI slice with minimal user bias. After alignment and coregistration, the concordance of the CBF rates generated by the two QAR approaches and the two AST methods was examined for nine regions of interest in each hemisphere. The QAR-lCBF rates were higher with the traditional method of assaying tissue radioactivity than with the MRI-analog approach; although the two sets of rates were highly correlated, the scatter was broad. The flow rates obtained with the whole film-scanning technique were chosen for subsequent comparisons to MRI-CBF results because of the similarity in tissue "sampling" among these three methods. As predicted by previous modeling, "true" flow rates, assumed to be given by QAR-lCBF, tended to be slightly lower than those measured by SE and were appreciably lower than those assessed by VTA-GE. When both the ischemic and contralateral hemispheres were considered together, SE-CBF and VTA-GE-CBF were both highly correlated with QAR-lCBF ( P< 0.001). If evaluated by flow range, however, SE-CBF estimates were more accurate in high-flow (contralateral) areas (CBF > 80 mL. 100 g(-1). min(-1) ), whereas VTA-GE-CBF values were more accurate in low-flow (ipsilateral) areas (CBF < or= 60 mL. 100 g(-1). min(-1) ). Accordingly, the concurrent usage of both AST-MRI methods or the VTA-GE technique alone would be preferred for human studies of stroke.

Dynamic changes in the cerebral metabolic rate of O2 and oxygen extraction ratio in event-related functional MRI

Dynamic changes in the cerebral metabolic rate of oxygen (CMRO(2)) and oxygen extraction ratio (OER) in an event-related functional MRI (ER-fMRI) were measured in this study. Six subjects participated in this study at a magnetic field of 1.9 T. Cerebral blood flow (CBF) and blood oxygenation level-dependent (BOLD) changes were acquired during the brief visual stimulation, and the corresponding changes in CMRO(2) and OER were then determined. The results showed that the maximum relative changes in CMRO(2) and OER were about 10.36 +/- 0.85 and -6.54 +/- 0.55%, respectively, while the maximum changes in CBF and BOLD were approximately 17.35 +/- 1.37 and 1.03 +/- 0.06%, respectively. The CBF, CMRO(2), and OER changes reach their maximum approximately 1 s earlier than the BOLD signal change (4.15 +/- 0.21, 4.16 +/- 0.21, and 4.17 +/- 0.21 s vs 5.12 +/- 0.24 s after stimulation, P < 0.05).

Velocity-driven adiabatic fast passage for arterial spin labeling: results from a computer model

Velocity-driven adiabatic fast passage (AFP) is commonly employed for perfusion imaging by continuous arterial spin labeling (CASL). The degree of inversion of protons in blood determines the sensitivity of CASL to perfusion. For this study, a computer model of the modified Bloch equations was developed to establish the optimum conditions for velocity-driven AFP. Natural variations in blood velocity over the course of the cardiac cycle were found to result in significant variations in the degree of inversion. However, the mean degree of inversion was similar to that for blood moving at a constant velocity, equal to the time-averaged mean, at peak velocities and heart rates within normal ranges. A train of RF pulses instead of a continuous RF pulse for labeling was found to result in a highly nonlinear dependence of the degree of inversion on RF duty cycle. This may have serious implications for the quantification of perfusion.

Pulsed arterial spin labeling using TurboFLASH with suppression of intravascular signal

Accurate quantification of perfusion with the ADC techniques requires the suppression of the majority of the intravascular signal. This is normally achieved with the use of diffusion gradients. The TurboFLASH sequence with its ultrashort repetition times is not readily amenable to this scheme. This report demonstrates the implementation of a modified TurboFLASH sequence for FAIR imaging. Intravascular suppression is achieved with a modified preparation period that includes a driven equilibrium Fourier transform (DEFT) combination of 90 degrees-180 degrees-90 degrees hard RF pulses subsequent to the inversion delay. These pulses rotate the perfusion-prepared magnetization into the transverse plane where it can experience the suitably placed diffusion gradients before being returned to the longitudinal direction by the second 90 degrees pulse. A value of b = 20-30 s/mm(2) was thereby found to suppress the majority of the intravascular signal. For single-slice perfusion imaging, quantification is only slightly modified. The technique can be readily extended to multislice acquisition if the evolving flow signal after the DEFT preparation is considered. An advantage of the modified preparation scheme is evident in the multislice FAIR images by the preservation of the sign of the magnetization difference.

Continuous arterial spin labeling using a local magnetic field gradient coil

Continuous arterial spin labeling (ASL) using a locally induced magnetic field gradient for adiabatic inversion of spins in the common carotid artery of human volunteers is demonstrated. The experimental setup consisted of a helmet resonator for imaging, a circular RF surface coil for labeling, and gradient loops to produce a magnetic field gradient. A spin-echo (SE) echo-planar imaging (EPI) sequence was used for imaging. The approach is independent of the gradients of the MR scanner. This technology may be used if the imaging gradient system does not produce an appropriate magnetic field gradient at the location of the carotid artery-for example, in a head-only scanner-and is a prerequisite for the development of a system that allows continuous labeling during the imaging experiment.

FAIR and dynamic susceptibility contrast-enhanced perfusion imaging in healthy subjects and stroke patients

PURPOSE

To compare dynamic susceptibility contrast-enhanced magnetic resonance imaging (DSC-MRI) and the flow-sensitive alternating inversion recovery (FAIR) technique for measuring brain perfusion.

MATERIALS AND METHODS

We investigated 12 patients with acute stroke, and 10 healthy volunteers with FAIR and DSC maps of regional cerebral blood volume (rCBV), mean transit time (MTT), and regional cerebral blood flow (rCBF).

RESULTS

In volunteers good gray/white-matter contrast was observed in FAIR, rCBF, and rCBV maps. Regions with high signal intensities in FAIR matched well with high values of rCBV and rCBF. In ischemic stroke patients a high correlation (r = 0.78) of the ipsi- to contralateral signal intensity ratios in FAIR and rCBF was observed in areas with perfusion abnormalities. In contrast, FAIR and rCBV (r = 0.50), and FAIR and MTT (r = -0.22) correlated only modestly. Furthermore, FAIR and rCBF demonstrated similar sizes of perfusion abnormality.

CONCLUSION

This study demonstrates for the first time that FAIR and rCBF depict similar relations of perfusion in ischemic stroke patients and healthy subjects.

Comparison of quantitative perfusion imaging using arterial spin labeling at 1.5 and 4.0 Tesla

High-field arterial spin labeling (ASL) perfusion MRI is appealing because it provides not only increased signal-to-noise ratio (SNR), but also advantages in terms of labeling due to the increased relaxation time T(1) of labeled blood. In the present study, we provide a theoretical framework for the dependence of the ASL signal on the static field strength, followed by experimental validation in which a multislice pulsed ASL (PASL) technique was carried out at 4T and compared with PASL and continuous ASL (CASL) techniques at 1.5T, both in the resting state and during motor activation. The resting-state data showed an SNR ratio of 2.3:1.4:1 in the gray matter and a contrast-to-noise ratio (CNR) of 2.7:1.1:1 between the gray and white matter for the difference perfusion images acquired using 4T PASL, 1.5T CASL, and 1.5T PASL, respectively. However, the functional data acquired using 4T PASL did not show significantly improved sensitivity to motor cortex activation compared with the 1.5T functional data, with reduced fractional perfusion signal change and increased intersubject variability. Possible reasons for these experimental results, including susceptibility effects and physiological noise, are discussed.

Simultaneous perfusion and BOLD imaging using reverse spiral scanning at 3T: characterization of functional contrast and susceptibility artifacts

Reverse spiral scanning with arterial spin-labeling was developed at 3T to simultaneously detect perfusion and BOLD signals in the brain by subtracting or adding the control and labeled images, respectively, in the same dataset. BOLD contrast was improved with the longer effective echo time achieved in the reverse spiral scan compared to conventional forward spiral scans. Susceptibility artifacts near air-tissue interfaces in the brain were substantially reduced in the reverse spiral images due to their early data acquisition time and, hence, less signal attenuation. Brain activation experiments with the reverse spiral scan were performed on normal subjects and were compared to forward spiral imaging in the same subjects. The experiments demonstrated that reverse spiral imaging was able to detect perfusion and BOLD signals simultaneously and reliably, even in the brain regions with severe susceptibility-induced local gradients, while forward spiral scans were either not optimal for detecting the two functional signals at the same time or were vulnerable to susceptibility artifacts.

Spoiled gradient-echo as an arterial spin tagging technique for quick evaluation of local perfusion

PURPOSE

To introduce a simple gradient-echo arterial spin tagging (GREAST) technique available for most commercial magnetic resonance (MR) systems, for a quick evaluation of tissue perfusion.

MATERIALS AND METHODS

The GREAST technique uses a combination of a short TR spoiled gradient-echo (SPGR) sequence with a selective presaturation radio frequency (RF) pulse that allows acquiring each tagged and control image within 10-20 seconds. The phantom and human studies were performed for evaluating the feasibility in measurement of local perfusion and the efficacy in alleviation of the asymmetric magnetization transfer (MT) and slice profile effects.

RESULTS

Results show a good linear relationship between the signal attenuation caused by the presaturation pulse and flow rates in the phantom experiment and effective alleviation of the asymmetric MT and slice profile effects for various orientations of imaging slices. Human studies showed good perfusion results in brain imaging. Perfusion imaging on the liver and kidney were also conducted. The results could be significantly improved by effectively lessening motion-related artifacts.

CONCLUSION

The GREAST technique is simple, easy to use, and applicable to examine local perfusion of the brain and other organs in the trunk.

Improved accuracy of human cerebral blood perfusion measurements using arterial spin labeling: accounting for capillary water permeability

A two-compartment exchange model for perfusion quantification using arterial spin labeling (ASL) is presented, which corrects for the assumption that the capillary wall has infinite permeability to water. The model incorporates an extravascular and a blood compartment with the permeability surface area product (PS) of the capillary wall characterizing the passage of water between the compartments. The new model predicts that labeled spins spend longer in the blood compartment before exchange. This makes an accurate blood T(1) measurement crucial for perfusion quantification; conversely, the tissue T(1) measurement is less important and may be unnecessary for pulsed ASL experiments. The model gives up to 62% reduction in perfusion estimate for human imaging at 1.5T compared to the single compartment model. For typical human perfusion rates at 1.5T it can be assumed that the venous outflow signal is negligible. This simplifies the solution, introducing only one more parameter than the single compartment model, PS/v(bw), where v(bw) is the fractional blood water volume per unit volume of tissue. The simplified model produces an improved fit to continuous ASL data collected at varying delay time. The fitting yields reasonable values for perfusion and PS/v(bw).

Effects of indomethacin on cerebral blood flow at rest and during hypercapnia: an arterial spin tagging study in humans

PURPOSE

To investigate using an arterial spin tagging (AST) approach the effect of indomethacin on the cerebral blood flow (CBF) response to hypercapnia.

MATERIALS AND METHODS

Subjects inhaled a gas mixture containing 6% CO(2) for two 5-minute periods, which were separated by a 10-minute interval, in which subjects inhaled room air. In six subjects, indomethacin (i.v., 0.2 mg/kg) was infused in the normocapnic interval between the two hypercapnic periods.

RESULTS

Indomethacin reduced normocapnic gray matter CBF by 36 +/- 5% and reduced the CBF increase during hypercapnia from 43 +/- 9% to 16 +/- 5% in gray matter (P < 0.001) and from 48 +/- 11% to 35 +/- 9% in white matter (P < 0.025).

CONCLUSION

The results demonstrate that an AST approach can measure the effects of indomethacin on global CBF increases during hypercapnia and suggest that an AST approach could be used to investigate pharmacological effects on focal CBF increases during functional activation.

Quantification of perfusion using bolus tracking magnetic resonance imaging in stroke: assumptions, limitations, and potential implications for clinical use

BACKGROUND

MR techniques have been very powerful in providing indicators of tissue perfusion, particularly in studies of cerebral ischemia. There is considerable interest in performing absolute perfusion measurements, with the aim of improving the characterization of tissue "at risk" of stroke. However, some important caveats relating to absolute measurements need to be taken into account. The purpose of this article is to discuss some of the issues involved and the potential implications for absolute cerebral blood flow measurements in clinical use.

SUMMARY OF COMMENT

In bolus tracking MRI, deconvolution of the concentration-time course can in theory provide accurate quantification. However, there are several important assumptions in the tracer kinetic model used, some of which may be invalid in cerebral ischemia. These can introduce significant errors in perfusion quantification.

CONCLUSIONS

Although we believe that bolus tracking MRI is a powerful technique for the evaluation of perfusion in cerebral ischemia, interpretation of perfusion maps requires caution; this is particularly true when absolute quantification is attempted. Work is currently under way in a number of centers to address these problems, and with appropriate modeling they may be overcome in the future. In the interim, we believe that it is necessary for users of bolus tracking perfusion data to be aware of the current technical limitations if they are to avoid misinterpretation or overinterpretation of their findings.

Relationship between absolute mean cerebral transit time and absolute mean flow velocity on transcranial Doppler ultrasound after ischemic stroke

BACKGROUND AND PURPOSE

Previous studies of transcranial Doppler (TCD) sonography in acute stroke have used the relative difference between the symptomatic and asymptomatic arteries to assess arterial occlusion. However, a simple measure of absolute mean flow velocity might provide a direct assessment of "perfusion reserve" in acute ischemic stroke.

METHODS

In a prospective study, 62 patients with ischemic stroke had TCD and a mean cerebral transit time examination within 48 hours of stroke. Absolute intracranial arterial mean flow velocities were correlated with the corresponding absolute mean transit times.

RESULTS

The authors found a significant correlation between middle cerebral artery (MCA) mean flow velocity and transit time in the symptomatic (Spearman rank correlation coefficient [rho] = -0.65, P < .01) but not in the asymptomatic (rho = -0.04, P = ns) MCA territory. Equations relating absolute mean flow velocity to absolute transit time were derived.

CONCLUSION

The findings suggest that in the normal hemisphere (with intact autoregulation on the horizontal portion of the autoregulation curve), flow velocity and transit time are not closely related to each other, but in the symptomatic hemisphere (on the downward slope of the autoregulation curve), flow velocity is directly proportional to the transit time and, therefore, to its inverse, perfusion reserve. The use of absolute mean flow velocity values on TCD should be further explored as a simple way of assessing "perfusion" in acute ischemic stroke.

Experimental design and the relative sensitivity of BOLD and perfusion fMRI

This paper compares the statistical power of BOLD and arterial spin labeling perfusion fMRI for a variety of experimental designs within and across subjects. Based on theory and simulations, we predict that perfusion data are composed of independent observations in time under the null hypothesis, in contrast to BOLD data, which possess marked autocorrelation. We also present a method (sinc subtraction) of generating perfusion data from its raw source signal that minimizes the presence of oxygen-sensitive signal changes and can be used with any experimental design. Empirically, we demonstrate the absence of autocorrelation in perfusion noise, examine the shape of the hemodynamic response function for BOLD and perfusion, and obtain a measure of signal to noise for each method. This information is then used to generate a model of relative sensitivity of the BOLD and perfusion methods for within-subject experimental designs of varying temporal frequency. It is determined that perfusion fMRI provides superior sensitivity for within-subject experimental designs that concentrate their power at or below approximately 0.009 Hz (corresponding to a "blocked" experimental design of 60-s epochs). Additionally, evidence is presented that across-subject hypothesis tests may be more sensitive when conducted using perfusion imaging, despite the better within-subject signal to noise obtained in some cases with BOLD.

Functional magnetic resonance imaging of the visual system

Functional magnetic resonance imaging (fMRI), which is a technique useful for non-invasive mapping of brain function, is well suited for studying the visual system. This review highlights current clinical applications and research studies involving patients with visual deficits. Relevant reports regarding the investigation of the brain's role in visual processing and some newer fMRI techniques are also reviewed. Functional magnetic resonance imaging has been used for presurgical mapping of visual cortex in patients with brain lesions and for studying patients with amblyopia, optic neuritis, and residual vision in homonymous hemianopia. Retinotopic borders, motion processing, and visual attention have been the topics of several fMRI studies. These reports suggest that fMRI can be useful in clinical and research studies in patients with visual deficits.

FAIR exempting separate T (1) measurement (FAIREST): a novel technique for online quantitative perfusion imaging and multi-contrast fMRI

A new pulse sequence, dubbed FAIR exempting separate T(1) measurement (FAIREST) in which a slice-selective saturation recovery acquisition is added in addition to the standard FAIR (flow-sensitive alternating inversion recovery) scheme, was developed for quantitative perfusion imaging and multi-contrast fMRI. The technique allows for clean separation between and thus simultaneous assessment of BOLD and perfusion effects, whereas quantitative cerebral blood flow (CBF) and tissue T(1) values are monitored online. Online CBF maps were obtained using the FAIREST technique and the measured CBF values were consistent with the off-line CBF maps obtained from using the FAIR technique in combination with a separate sequence for T(1) measurement. Finger tapping activation studies were carried out to demonstrate the applicability of the FAIREST technique in a typical fMRI setting for multi-contrast fMRI. The relative CBF and BOLD changes induced by finger-tapping were 75.1 +/- 18.3 and 1.8 +/- 0.4%, respectively, and the relative oxygen consumption rate change was 2.5 +/- 7.7%. The results from correlation of the T(1) maps with the activation images on a pixel-by-pixel basis show that the mean T(1) value of the CBF activation pixels is close to the T(1) of gray matter while the mean T(1) value of the BOLD activation pixels is close to the T(1) range of blood and cerebrospinal fluid.

The effects of ketamine-xylazine anesthesia on cerebral blood flow and oxygenation observed using nuclear magnetic resonance perfusion imaging and electron paramagnetic resonance oximetry

Ketamine-xylazine is a commonly used anesthetic for laboratory rats. Previous results showed that rats anesthetized with ketamine-xylazine can have a much lower cerebral partial pressure of oxygen (P(t)O(2)), compared to unanesthetized and isoflurane anesthetized rats. The underlying mechanisms for the P(t)O(2) reduction need to be elucidated. In this study, we measured regional cerebral blood flow (CBF) using nuclear magnetic resonance (NMR) perfusion imaging and cortical P(t)O(2) using electron paramagnetic resonance (EPR) oximetry in the forebrain of rats under isoflurane, ketamine, ketamine-xylazine and isoflurane-xylazine anesthesia. The results show that in ventilated rats ketamine at a dose of 50 mg/kg does not induce significant changes in CBF, compared to isoflurane. Ketamine-xylazine in combination causes 25-65% reductions in forebrain CBF in a region-dependent manner. Adding xylazine to isoflurane anesthesia results in similar regional reductions in CBF. EPR oximetry measurements show ketamine increases cortical P(t)O(2) while xylazine decreases cortical P(t)O(2). The xylazine induced reduction in CBF could explain the reduced brain oxygenation observed in ketamine-xylazine anesthetized rats.

Single-coil arterial spin-tagging for estimating cerebral blood flow as viewed from the capillary: relative contributions of intra- and extravascular signal

The single-capillary model was applied to the exchange microvessels for water in the cerebral parenchyma and used to calculate blood-to-brain flux of water; the theory of the steady-state arterial spin-tagging (AST) technique for estimating cerebral blood flow (CBF) was revised to incorporate the presence of both extravascular (tissue) and capillary signal. A crucial element of the single-coil AST experiment is that magnetization transfer (MT) shortens the effective T1 of the extravascular water, making it one-quarter that of the T1 of capillary blood. Furthermore, the mean capillary transit time is on the order of the T1 of the extravascular water. The single-coil AST experiment is distinguished from other methods which use water as an indicator for measurement of CBF in that the (flow-dependent) populations of inverted protons in the intra- and extravascular compartments can be nearly equal for normal physiological conditions. The following questions are considered: Is single-coil AST contrast linear in resting CBF? Is contrast in the single-coil AST technique likely to be linear under changes in CBF in normal tissue? Is the contrast likely to be linear in such common pathologies as stroke and cerebral tumor? We demonstrate that, if the population of inverted protons in the microvessels is included in the experiment, the voxel population of inverted protons will be approximately linear with flow across a broad range of flow values. We predict that the single-coil AST experiment will systematically overestimate resting CBF for flows in the normal range, that changes in CBF in normal tissue will produce an approximately linear response in AST measurement, and, finally, we predict the operating characteristics of the measurement in common cerebral pathologies.

Dynamic observation of pulmonary perfusion using continuous arterial spin-labeling in a pig model

The continuous arterial spin-labeling (CASL) method of perfusion MRI is used to observe pulmonary perfusion dynamically in an animal model. Specifically, a respiratory-triggered implementation of the CASL method is used with approximate spatial resolution of 0.9 x 1.8 x 5.0 mm (0.008 cc) and 2-minute temporal resolution. Perfusion MRI is performed dynamically during repeated balloon occlusion of a segmental pulmonary artery, as well as during pharmacological stimulation. A total of three Yorkshire pigs were studied. The results demonstrate the ability of the endogenous spin-labeling method to characterize the dynamic changes in pulmonary perfusion that occur during important physiological alterations.

Perfusion imaging using dynamic arterial spin labeling (DASL)

Recently, a technique based on arterial spin labeling, called dynamic arterial spin labeling (DASL (Magn Reson Med 1999;41:299-308)), has been introduced to measure simultaneously the transit time of the labeled blood from the labeling plane to the exchange site, the longitudinal relaxation time of the tissue, and the perfusion of the tissue. This technique relies on the measurement of the tissue magnetization response to a time varying labeling function. The analysis of the characteristics of the tissue magnetization response (transit time, filling time constant, and perfusion) allows for quantification of the tissue perfusion and for transit time map computations. In the present work, the DASL scheme is used in conjunction with echo planar imaging at 4.7 T to produce brain maps of perfusion and transit time in the anesthetized rat, under graded hypercapnia. The data obtained show the variation of perfusion and transit time as a function of arterial pCO2. Based on the data, CO2 reactivity maps are computed. Published 2001 Wiley-Liss, Inc.

Simultaneous noninvasive measurement of CBF and CBV using double-echo FAIR (DEFAIR)

A new method for measuring cerebral blood flow (CBF) and cerebral blood volume (CBV) noninvasively using MRI is presented. The approach is based on the technique of arterial spin labelling (ASL), in which CBF-based contrast is generated by controlled modulation of the longitudinal magnetization of the blood. The proposed method also uses differences in T(2) between tissue and blood to differentiate the two compartments and allow assessment of the relative size of each. Two successive EPI images are acquired following spin preparation using either a slice-selective or global inversion pulse, and the technique is therefore referred to as double-echo FAIR (DEFAIR). DEFAIR is demonstrated in the normal gerbil brain and during hypothermia, where reductions of both CBF and CBV are known to occur. It is also shown theoretically that this method can be extended to include a measurement of oxygen extraction fraction. The main drawbacks of the technique are the long acquisition time and relatively low sensitivity to hemodynamic changes compared to conventional qualitative T2(*)-weighted BOLD contrast, which may limit its applicability and practical use in monitoring functional cerebral activation. However, the technique can be used repetitively in longer-term time course studies due to its noninvasive and quantitative nature.

Methodology of brain perfusion imaging

Numerous techniques have been proposed in the last 15 years to measure various perfusion-related parameters in the brain. In particular, two approaches have proven extremely successful: injection of paramagnetic contrast agents for measuring cerebral blood volumes (CBV) and arterial spin labeling (ASL) for measuring cerebral blood flows (CBF). This review presents the methodology of the different magnetic resonance imaging (MRI) techniques in use for CBV and CBF measurements and briefly discusses their limitations and potentials.