Recommendations for quantitative cerebral perfusion MRI using multi-timepoint arterial spin labeling: Acquisition, quantification, and clinical applications

Joseph G. Woods*, Eric Achten, Iris Asllani, Divya S. Bolar, Weiying Dai, John A. Detre, Audrey P. Fan, María A. Fernández-Seara, Xavier Golay, Matthias Günther, Jia Guo, Luis Hernandez-Garcia, Mai Lan Ho, Meher R. Juttukonda, Hanzhang Lu, Bradley J. MacIntosh, Ananth J. Madhuranthakam, Henk Jan Mutsaerts, Thomas W. Okell, Laura M. ParkesNandor Pinter, Joana Pinto, Qin Qin, Marion Smits, Yuriko Suzuki, David L. Thomas, Matthias J.P. Van Osch, Danny J.J. Wang, Esther A.H. Warnert, Greg Zaharchuk, Fernando Zelaya, Moss Zhao, Michael A. Chappell

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Accurate assessment of cerebral perfusion is vital for understanding the hemodynamic processes involved in various neurological disorders and guiding clinical decision-making. This guidelines article provides a comprehensive overview of quantitative perfusion imaging of the brain using multi-timepoint arterial spin labeling (ASL), along with recommendations for its acquisition and quantification. A major benefit of acquiring ASL data with multiple label durations and/or post-labeling delays (PLDs) is being able to account for the effect of variable arterial transit time (ATT) on quantitative perfusion values and additionally visualize the spatial pattern of ATT itself, providing valuable clinical insights. Although multi-timepoint data can be acquired in the same scan time as single-PLD data with comparable perfusion measurement precision, its acquisition and postprocessing presents challenges beyond single-PLD ASL, impeding widespread adoption. Building upon the 2015 ASL consensus article, this work highlights the protocol distinctions specific to multi-timepoint ASL and provides robust recommendations for acquiring high-quality data. Additionally, we propose an extended quantification model based on the 2015 consensus model and discuss relevant postprocessing options to enhance the analysis of multi-timepoint ASL data. Furthermore, we review the potential clinical applications where multi-timepoint ASL is expected to offer significant benefits. This article is part of a series published by the International Society for Magnetic Resonance in Medicine (ISMRM) Perfusion Study Group, aiming to guide and inspire the advancement and utilization of ASL beyond the scope of the 2015 consensus article.

Original languageEnglish
Pages (from-to)469-495
Number of pages27
JournalMagnetic Resonance in Medicine
Volume92
Issue number2
DOIs
Publication statusPublished - Aug 2024

Bibliographical note

Publisher Copyright:
© 2024 The Authors. Magnetic Resonance in Medicine published by Wiley Periodicals LLC on behalf of International Society for Magnetic Resonance in Medicine.

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