Whole-brain arterial spin labeling perfusion MRI in patients with acute stroke

Reinoud P H Bokkers, Daymara A. Hernandez, José G. Merino, Raymond V. Mirasol, Matthias J. Van Osch, Jeroen Hendrikse, Steven Warach, Lawrence L. Latour

Research output: Contribution to journalArticle

67 Citations (Scopus)

Abstract

Background and Purpose-Perfusion MRI can be used to identify patients with acute ischemic stroke who may benefit from reperfusion therapies. The risk of nephrogenic systemic fibrosis, however, limits the use of contrast agents. Our objective was to evaluate the ability of arterial spin labeling (ASL), an alternative noninvasive perfusion technique, to detect perfusion deficits compared with dynamic susceptibility contrast (DSC) perfusion imaging. Methods-Consecutive patients referred for emergency assessment of suspected acute stroke within a 7-month period were imaged with both ASL and DSC perfusion MRI. Images were interpreted in a random order by 2 experts blinded to clinical information for image quality, presence of perfusion deficits, and diffusion-perfusion mismatches. Results-One hundred fifty-six patients were scanned with a median time of 5.6 hours (range, 3.0-17.7 hours) from last seen normal. Stroke diagnosis was clinically confirmed in 78 patients. ASL and DSC imaging were available in 64 of these patients. A perfusion deficit was detected with DSC in 39 of these patients; ASL detected 32 of these index perfusion deficits, missing 7 lesions. The median volume of the perfusion deficits as determined with DSC was smaller in patients who were evaluated as normal with ASL than in those with a deficit (median [interquartile range], 56 [10-116] versus 114 [41-225] mL; P=0.01). Conclusions-ASL can depict large perfusion deficits and perfusion-diffusion mismatches in correspondence with DSC. Our findings show that a fast 21/2-minute ASL perfusion scan may be adequate for screening patients with acute stroke with contraindications to gadolinium-based contrast agents.

Original languageEnglish (US)
Pages (from-to)1290-1294
Number of pages5
JournalStroke
Volume43
Issue number5
DOIs
StatePublished - May 2012

Fingerprint

Perfusion
Stroke
Brain
Contrast Media
Nephrogenic Fibrosing Dermopathy
Perfusion Imaging
Gadolinium
Reperfusion
Emergencies

Keywords

  • Acute stroke
  • Cerebral hemodynamics
  • Imaging
  • MRI
  • Stroke management

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing

Cite this

Bokkers, R. P. H., Hernandez, D. A., Merino, J. G., Mirasol, R. V., Van Osch, M. J., Hendrikse, J., ... Latour, L. L. (2012). Whole-brain arterial spin labeling perfusion MRI in patients with acute stroke. Stroke, 43(5), 1290-1294. https://doi.org/10.1161/STROKEAHA.110.589234

Whole-brain arterial spin labeling perfusion MRI in patients with acute stroke. / Bokkers, Reinoud P H; Hernandez, Daymara A.; Merino, José G.; Mirasol, Raymond V.; Van Osch, Matthias J.; Hendrikse, Jeroen; Warach, Steven; Latour, Lawrence L.

In: Stroke, Vol. 43, No. 5, 05.2012, p. 1290-1294.

Research output: Contribution to journalArticle

Bokkers, RPH, Hernandez, DA, Merino, JG, Mirasol, RV, Van Osch, MJ, Hendrikse, J, Warach, S & Latour, LL 2012, 'Whole-brain arterial spin labeling perfusion MRI in patients with acute stroke', Stroke, vol. 43, no. 5, pp. 1290-1294. https://doi.org/10.1161/STROKEAHA.110.589234
Bokkers RPH, Hernandez DA, Merino JG, Mirasol RV, Van Osch MJ, Hendrikse J et al. Whole-brain arterial spin labeling perfusion MRI in patients with acute stroke. Stroke. 2012 May;43(5):1290-1294. https://doi.org/10.1161/STROKEAHA.110.589234
Bokkers, Reinoud P H ; Hernandez, Daymara A. ; Merino, José G. ; Mirasol, Raymond V. ; Van Osch, Matthias J. ; Hendrikse, Jeroen ; Warach, Steven ; Latour, Lawrence L. / Whole-brain arterial spin labeling perfusion MRI in patients with acute stroke. In: Stroke. 2012 ; Vol. 43, No. 5. pp. 1290-1294.
@article{0ae3b5a3d35d42f687d44e9f6e0e9ac5,
title = "Whole-brain arterial spin labeling perfusion MRI in patients with acute stroke",
abstract = "Background and Purpose-Perfusion MRI can be used to identify patients with acute ischemic stroke who may benefit from reperfusion therapies. The risk of nephrogenic systemic fibrosis, however, limits the use of contrast agents. Our objective was to evaluate the ability of arterial spin labeling (ASL), an alternative noninvasive perfusion technique, to detect perfusion deficits compared with dynamic susceptibility contrast (DSC) perfusion imaging. Methods-Consecutive patients referred for emergency assessment of suspected acute stroke within a 7-month period were imaged with both ASL and DSC perfusion MRI. Images were interpreted in a random order by 2 experts blinded to clinical information for image quality, presence of perfusion deficits, and diffusion-perfusion mismatches. Results-One hundred fifty-six patients were scanned with a median time of 5.6 hours (range, 3.0-17.7 hours) from last seen normal. Stroke diagnosis was clinically confirmed in 78 patients. ASL and DSC imaging were available in 64 of these patients. A perfusion deficit was detected with DSC in 39 of these patients; ASL detected 32 of these index perfusion deficits, missing 7 lesions. The median volume of the perfusion deficits as determined with DSC was smaller in patients who were evaluated as normal with ASL than in those with a deficit (median [interquartile range], 56 [10-116] versus 114 [41-225] mL; P=0.01). Conclusions-ASL can depict large perfusion deficits and perfusion-diffusion mismatches in correspondence with DSC. Our findings show that a fast 21/2-minute ASL perfusion scan may be adequate for screening patients with acute stroke with contraindications to gadolinium-based contrast agents.",
keywords = "Acute stroke, Cerebral hemodynamics, Imaging, MRI, Stroke management",
author = "Bokkers, {Reinoud P H} and Hernandez, {Daymara A.} and Merino, {Jos{\'e} G.} and Mirasol, {Raymond V.} and {Van Osch}, {Matthias J.} and Jeroen Hendrikse and Steven Warach and Latour, {Lawrence L.}",
year = "2012",
month = "5",
doi = "10.1161/STROKEAHA.110.589234",
language = "English (US)",
volume = "43",
pages = "1290--1294",
journal = "Stroke",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Whole-brain arterial spin labeling perfusion MRI in patients with acute stroke

AU - Bokkers, Reinoud P H

AU - Hernandez, Daymara A.

AU - Merino, José G.

AU - Mirasol, Raymond V.

AU - Van Osch, Matthias J.

AU - Hendrikse, Jeroen

AU - Warach, Steven

AU - Latour, Lawrence L.

PY - 2012/5

Y1 - 2012/5

N2 - Background and Purpose-Perfusion MRI can be used to identify patients with acute ischemic stroke who may benefit from reperfusion therapies. The risk of nephrogenic systemic fibrosis, however, limits the use of contrast agents. Our objective was to evaluate the ability of arterial spin labeling (ASL), an alternative noninvasive perfusion technique, to detect perfusion deficits compared with dynamic susceptibility contrast (DSC) perfusion imaging. Methods-Consecutive patients referred for emergency assessment of suspected acute stroke within a 7-month period were imaged with both ASL and DSC perfusion MRI. Images were interpreted in a random order by 2 experts blinded to clinical information for image quality, presence of perfusion deficits, and diffusion-perfusion mismatches. Results-One hundred fifty-six patients were scanned with a median time of 5.6 hours (range, 3.0-17.7 hours) from last seen normal. Stroke diagnosis was clinically confirmed in 78 patients. ASL and DSC imaging were available in 64 of these patients. A perfusion deficit was detected with DSC in 39 of these patients; ASL detected 32 of these index perfusion deficits, missing 7 lesions. The median volume of the perfusion deficits as determined with DSC was smaller in patients who were evaluated as normal with ASL than in those with a deficit (median [interquartile range], 56 [10-116] versus 114 [41-225] mL; P=0.01). Conclusions-ASL can depict large perfusion deficits and perfusion-diffusion mismatches in correspondence with DSC. Our findings show that a fast 21/2-minute ASL perfusion scan may be adequate for screening patients with acute stroke with contraindications to gadolinium-based contrast agents.

AB - Background and Purpose-Perfusion MRI can be used to identify patients with acute ischemic stroke who may benefit from reperfusion therapies. The risk of nephrogenic systemic fibrosis, however, limits the use of contrast agents. Our objective was to evaluate the ability of arterial spin labeling (ASL), an alternative noninvasive perfusion technique, to detect perfusion deficits compared with dynamic susceptibility contrast (DSC) perfusion imaging. Methods-Consecutive patients referred for emergency assessment of suspected acute stroke within a 7-month period were imaged with both ASL and DSC perfusion MRI. Images were interpreted in a random order by 2 experts blinded to clinical information for image quality, presence of perfusion deficits, and diffusion-perfusion mismatches. Results-One hundred fifty-six patients were scanned with a median time of 5.6 hours (range, 3.0-17.7 hours) from last seen normal. Stroke diagnosis was clinically confirmed in 78 patients. ASL and DSC imaging were available in 64 of these patients. A perfusion deficit was detected with DSC in 39 of these patients; ASL detected 32 of these index perfusion deficits, missing 7 lesions. The median volume of the perfusion deficits as determined with DSC was smaller in patients who were evaluated as normal with ASL than in those with a deficit (median [interquartile range], 56 [10-116] versus 114 [41-225] mL; P=0.01). Conclusions-ASL can depict large perfusion deficits and perfusion-diffusion mismatches in correspondence with DSC. Our findings show that a fast 21/2-minute ASL perfusion scan may be adequate for screening patients with acute stroke with contraindications to gadolinium-based contrast agents.

KW - Acute stroke

KW - Cerebral hemodynamics

KW - Imaging

KW - MRI

KW - Stroke management

UR - http://www.scopus.com/inward/record.url?scp=84860225375&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84860225375&partnerID=8YFLogxK

U2 - 10.1161/STROKEAHA.110.589234

DO - 10.1161/STROKEAHA.110.589234

M3 - Article

C2 - 22426319

AN - SCOPUS:84860225375

VL - 43

SP - 1290

EP - 1294

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 5

ER -