Arterial spin labeling (ASL) is a non-invasive MRI technique to measure cerebral blood flow (CBF). This review provides a practical guide and overview of the clinical applications of ASL of the brain, as well its potential pitfalls. The technical and physiological background is also addressed. At present, main areas of interest are cerebrovascular disease, dementia and neuro-oncology. In cerebrovascular disease, ASL is of particular interest owing to its quantitative nature and its capability to determine cerebral arterial territories. In acute stroke, the source of the collateral blood supply in the penumbra may be visualised. In chronic cerebrovascular disease, the extent and severity of compromised cerebral perfusion can be visualised, which may be used to guide therapeutic or preventative intervention. ASL has potential for the detection and follow-up of arteriovenous malformations. In the workup of dementia patients, ASL is proposed as a diagnostic alternative to PET. It can easily be added to the routinely performed structural MRI examination. In patients with established Alzheimer’s disease and frontotemporal dementia, hypoperfusion patterns are seen that are similar to hypometabolism patterns seen with PET. Studies on ASL in brain tumour imaging indicate a high correlation between areas of increased CBF as measured with ASL and increased cerebral blood volume as measured with dynamic susceptibility contrast-enhanced perfusion imaging. Major advantages of ASL for brain tumour imaging are the fact that CBF measurements are not influenced by breakdown of the blood–brain barrier, as well as its quantitative nature, facilitating multicentre and longitudinal studies.

/pdf/a-neuroradiologist-s-guide-to-arterial-spin-labeling-mri-in-44g69j48ys.pdf

A neuroradiologist’s guide to arterial spin labeling MRI in clinical practice

Cerebral blood flow measured by arterial spin labeling MRI at resting state in normal aging and Alzheimer's disease.

Dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) is used to track the first pass of an exogenous, paramagnetic, nondiffusible contrast agent through brain tissue, and has emerged as a powerful tool in the characterization of brain tumor hemodynamics. DSC-MRI parameters can be helpful in many aspects, including tumor grading, prediction of treatment response, likelihood of malignant transformation, discrimination between tumor recurrence and radiation necrosis, and differentiation between true early progression and pseudoprogression. This review aims to provide a conceptual overview of the underlying principles of DSC-MRI of the brain for clinical neuroradiologists, scientists, or students wishing to improve their understanding of the technical aspects, pitfalls, and controversies of DSC perfusion MRI of the brain. Future consensus on image acquisition parameters and postprocessing of DSC-MRI will most likely allow this technique to be evaluated and used in high-quality multicenter studies and ultimately help guide clinical care. J. Magn. Reson. Imaging 2015;41:296–313.© 2013 Wiley Periodicals, Inc.

https://www.onlinelibrary.wiley.com/doi/pdf/10.1002/jmri.24648

Principles of T2 *-weighted dynamic susceptibility contrast MRI technique in brain tumor imaging.

Quantifying the test–retest reliability of cerebral blood flow measurements in a clinical model of on-going post-surgical pain: A study using pseudo-continuous arterial spin labelling

The aim of the present study is to use 3D pseudo-continuous arterial spin labeling (pCASL) to measure changes in normal cerebral blood flow (CBF) values with sex and age. Eighty subjects underwent magnetic resonance imaging study on a 3.0-T scanner. 3D pCASL was used to measure CBF. Estradiol and testosterone levels were also assessed. Based on sex and age, the subjects were divided into four groups for statistical analysis. CBF was higher in young premenopausal women than in young men (P < 0.01), while there was no difference in CBF between older postmenopausal women and older men. CBF was also significantly decreased in older postmenopausal women compared with young women (P < 0.01), whereas no such age-related effect was present in men. These observations indicate that sex and age differences are important considerations when studying nervous system diseases and that the age range and female-to-male ratio should be considered in the selection of subjects for brain studies in order to eliminate bias. Further, the normal CBF values assessed by pCASL provide a basis for further clinical use of pCASL.

Use of 3D pseudo-continuous arterial spin labeling to characterize sex and age differences in cerebral blood flow.

http://hub.hku.hk/bitstream/10722/123994/2/Content.pdf

Reliability and reproducibility of perfusion MRI in cognitively normal subjects.

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Reliability and reproducibility of perfusion MRI in cognitively normal subjects.