Multi-delay multi-parametric arterial spin-labeled perfusion MRI in acute ischemic stroke — Comparison with dynamic susceptibility contrast enhanced perfusion imaging

•A multi-delay multi-parametric pCASL GRASE protocol was developed.•The pCASL protocol showed consistent results with DSC perfusion MRI in acute stroke patients.•The capability for multi-parametric perfusion imaging using ASL offers numerous potentials.

The purpose of the present study was to present a multi-delay multi-parametric pseudo-continuous arterial spin labeling (pCASL) protocol with background suppressed 3D GRASE (gradient and spin echo) readout for perfusion imaging in acute ischemic stroke. PCASL data at 4 post-labeling delay times (PLD = 1.5, 2, 2.5, 3 s) were acquired within 4.5 min in 24 patients (mean age 79.7 ± 11.4 years; 11 men) with acute middle cerebral artery (MCA) stroke who also underwent dynamic susceptibility contrast (DSC) enhanced perfusion imaging. Arterial transit times (ATT) were estimated through the calculation of weighted delays across the 4 PLDs, which were included in the calculation of cerebral blood flow (CBF) and arterial cerebral blood volume (CBV). Mean perfusion parameters derived using pCASL and DSC were measured within MCA territories and infarct regions identified on diffusion weighted MRI. The results showed highly significant correlations between pCASL and DSC CBF measurements (r > = 0.70, p < = 0.0001) and moderately significant correlations between pCASL and DSC CBV measurements (r > = 0.45, p < = 0.027) in both MCA territories and infarct regions. ASL ATT showed correlations with DSC time to the maximum of tissue residual function (Tmax)(r = 0.66, p = 0.0005) and mean transit time (MTT)(r = 0.59, p = 0.0023) in leptomeningeal MCA territories. The present study demonstrated the feasibility for noninvasive multi-parametric perfusion imaging using ASL for acute stroke imaging.

Graphical abstractComparison of multi-parametric ASL and DSC perfusion images along with FLAIR and DWI in a representative stroke case (89 year-old female). ASL shows decreased CBF, decreased CBV and prolonged ATT in the left MCA region. DSC Tmax and MTT are prolonged in the left frontal region with mildly decreased CBF and CBV.Figure optionsDownload full-size imageDownload as PowerPoint slide