Arterial Spin Labeling-Based MRI Estimation of Penumbral Tissue in Acute Ischemic Stroke

Background Arterial spin labeling (ASL) has shown potential for the assessment of penumbral tissue in patients with acute ischemic stroke (AIS). The postlabeling delay (PLD) parameter is sensitive to arterial transit delays and influences cerebral blood flow measurements. Purpose To assess the impact of ASL acquisition at different PLDs for penumbral tissue quantification and to compare their performance regarding assisting patient selection for endovascular treatment with dynamic susceptibility contrast MRI (DSC-MRI) as the reference method. Study Type Retrospective. Population A total of 53 patients (59.98 +/- 12.60 years, 32% women) with AIS caused by internal carotid or middle cerebral artery occlusion. Field Strength/Sequence A 3-T, three-dimensional pseudo-continuous ASL with fast-spin echo readout. Assessment Hypoperfusion volume was measured using DSC-MRI and ASL with PLDs of 1.500 msec and 2.500 msec, respectively. Eligibility for endovascular treatment was retrospectively determined according to the imaging criteria of the Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke trial (DEFUSE 3). Statistical Tests Kruskal-Wallis tests, Bland-Altman plots, Cohen's kappa, and receiver operating characteristic analyses were used. The threshold for statistical significance was set at P < 0.05. Results Hypoperfusion volume for ASL with a PLD of 1.500 msec was significantly larger than that for DSC-MRI, while the hypoperfusion volume for a PLD of 2.500 msec was not significantly different from that of DSC-MRI (P = 0.435). Bland-Altman plots showed that the mean volumetric error between the hypoperfusion volume measured by DSC-MRI and ASL with PLDs of 1.500/2.500 msec was -107.0 mL vs. 4.49 mL. Cohen's kappa was 0.679 vs. 0.773 for DSC-MRI and ASL, respectively, with a PLD of 1.500/2.500 msec. The sensitivity and specificity for ASL with a PLD of 1.500/2.500 msec in identifying patients eligible for treatment were 89.74% vs. 97.44% and 92.86% vs. 64.29%, respectively. Data Conclusion In AIS, PLDs for ASL acquisition may have a considerable impact on the quantification of the hypoperfusion volume. Evidence Level 3 Technical Efficacy Stage 2