Learning objectives
To illustrate the role of Arterial Spin Labelling (ASL) in various neurological presentations using clinical vignettes and highlight its usefulness in addressing various problem statements
To understand the clinical caveats and pitfallsin interpretation of ASL in various conditions.
Background
ASL is a non-invasive MRI technique of perfusion using labelled RBCs as tracers. It can be applied in both 1.5 and 3T scanners alike using different labelling techniques (pulsed ASL and Pseudo-continuous ASL).
We explore the role of ASL in routine neuroimaging protocols (in both elective and emergency indications) and highlight its usefulness while raising red flags about its pitfalls, technical limitations as well as clinical caveats.
Findings and procedure details
Between March 2018 - January 2020, we have employed 3D-ASL in our scanners (1.5 T and 3T) using both pseudo-continuous and pulsed techniques.
Following are brief descriptions of commonly encountered clinical scenarios wherein ASL can help provideuseful informationand also discuss its caveats.
Clinical vignette 1: Acute Ischemic Stroke
Problem statement
Estimating penumbra (Fig 2)
Current guidelines recommend CT/CTA for patient selection within 6 hours for endovascular treatment. Delayed presentations however warrant additional information regarding penumbra using contrast perfusion techniques either with CT or MRI.
Role...
Conclusion
ASL should routinely be incorporated into various clinical neuroimaging protocols and can help in diagnosis, prognostication, guiding therapy and in follow up of various conditions.
Personal information and conflict of interest
M. Nedunchelian; Chennai, TAMIL NADU/IN - nothing to disclose S. Varadharajan; Chennai, TAMIL NADU/IN - nothing to disclose
References
1.Deibler, A. R. et al. Arterial Spin-Labeling in Routine Clinical Practice, Part 1: Technique and Artifacts. American Journal of Neuroradiology 29, 1228–1234 (2008).
2.Deibler, A. R. et al. Arterial Spin-Labeling in Routine Clinical Practice, Part 2: Hypoperfusion Patterns. American Journal of Neuroradiology 29, 1235–1241 (2008).
3.Deibler, A. R. et al. Arterial Spin-Labeling in Routine Clinical Practice, Part 3: Hyperperfusion Patterns. American Journal of Neuroradiology 29, 1428–1435 (2008).
4.Haller, S. et al. Arterial Spin Labeling Perfusion of the Brain: Emerging Clinical Applications. Radiology 281, 337–356 (2016)....
