Cerebral perfusion MRI

Matthias JP van Osch, Wouter M Teeuwisse, Eidrees Ghariq, Sophie Schmid, Xingxing Zhang, Behnam Sabayan, Naj Mahani, Marianne A.A. van Walderveen, Serge A.R.B. Rombouts, Egbert JW Bleeker

Background

Brain diseases frequently manifest them first as changes in the hemodynamic status of brain tissue, before structural damage can be proven by anatomical imaging. Additionally, perfusion changes upon neuronal activation provide a precise method to map cognitive processes. Magnetic resonance imaging (MRI) provides two methods to measure cerebral perfusion. The first method, dynamic susceptibility contrast MRI (DSC-MRI) monitors the first passage of a bolus of contrast agent through brain tissue. The second method, arterial spin labeling (ASL), is based on magnetically inverting the magnetization of the arterial blood flow and is therefore completely non-invasive.

Goals

  1. Improve image quality of perfusion MRI
  2. Accurate quantification of cerebral perfusion MRI
  3. Application of perfusion MRI in clinical research
  4. Development of reactivity measurements
  5. Characterization of physiological processes in the healthy and diseased brain 

Approach

Quantification of DSC-MRI is mainly improved by optimization of the arterial input function measurement. Based on classical physics theory, simulations, phantom experiments and in vivo evaluation the measurement of concentration contrast agent in large brain feeding vessels, like the MCA, is made more quantitative. Furthermore, it is anticipated that moving the arterial input function measurements higher into the vascular tree will decrease artifacts in DSC-MRI due to smaller delay and dispersion effects of the bolus-passage curve.

The newest ASL sequences, like pseudo-continuous ASL with background suppression were implemented on 3 and 7 Tesla Philips MRI scanners. It was shown that these sequences provide optimal image quality, enabling for example the depiction of ASL signal in the white matter. Furthermore, flow territory mapping techniques were developed that enabled both superselective ASL as well as planning-free flow territory mapping. Current research focuses on using ASL as a pre-pulse to quantitative MRI techniques to provide more information on the status of the microvasculature (like oxygenation, arteriolar vessel wall condition, etc) as well as reactivity measurements by ASL under lower-body-negative-pressure, hypercapnia and hypoxemia challenges.

Both techniques are currently applied in clinical studies, like in patients with AVMs, migraine, and in pharmacological MRI.

Status

This project started in November 2004.

Gallery

Arterial spin labeling and dynamic susceptibility contrast MRI
Figure 1: Arterial spin labeling and dynamic susceptibility contrast MRI in a male subject with a partially treated cerebral arterio-venous malformation (region of embolisation shows as signal loss, see green arrows). ASL shows white matter hypo-intensity (left pane, upper 2 rows, see white arrows). DSC-MRI shows no CBF changes in the corresponding brain areas (left pane, middle 2 rows), but shows delayed arrival of contrast agent (right pane, lower 2 rows). During the second visit, 7 months after the first visit and after a second – almost total - embolisation, the hemodynamical deficit is absent both on ASL as well as on the CBF and delay map of DSC-MRI (right pane).


Planning-free flow territory mapping by arterial spin labeling

Figure 2: Planning-free flow territory mapping by arterial spin labeling in a healthy volunteer showing the main flow territories (Red: posterior circulation, Green: left internal carotid artery, Blue: right internal carotid artery).


Optimal locations for arterial input function measurements near the MCA
Figure 3: Optimal locations for arterial input function measurements near the MCA for three different sized vessels and four different acquisition techniques (from left to right: single shot EPI, short echo time segmented EPI, long echo time segmented EPI, and PRESTO).

Funding

This research is made possible by a VENI grant of the Dutch Technology Foundation (STW-7291)

and a STW-project (STW-11047). Eidrees Ghariq is funded by the excellent student program of the LUMC.

Publication list

  1. Taei-Tehrani MR, Van Osch MJ, Brown TR. Pseudo-random arterial modulation (PRAM): A novel arterial spin labeling approach to measure flow and blood transit times. J Magn Reson Imaging. 2012 Jan;35(1):223-8.
  2. Gevers S, Heijtel D, Ferns SP, van Ooij P, van Rooij WJ, van Osch MJ, van den Berg R, Nederveen AJ, Majoie CB. Cerebral Perfusion Long Term after Therapeutic Occlusion of the Internal Carotid Artery in Patients Who Tolerated Angiographic Balloon Test Occlusion. AJNR Am J Neuroradiol. 2011 Nov 11. [Epub ahead of print]
  3. Gevers S, Nederveen AJ, Fijnvandraat K, van den Berg SM, van Ooij P, Heijtel DF, Heijboer H, Nederkoorn PJ, Engelen M, van Osch MJ, Majoie CB. Arterial spin labeling measurement of cerebral perfusion in children with sickle cell disease. J Magn Reson Imaging. 2011 Nov 16. [Epub ahead of print]
  4. Ghariq E, Teeuwisse WM, Webb AG, van Osch MJ. Feasibility of pseudocontinuous arterial spin labeling at 7 T with whole-brain coverage. MAGMA. 2011
  5. Bleeker EJ, Webb AG, van Walderveen MA, van Buchem MA, van Osch MJ. Evaluation of signal formation in local arterial input function measurements of dynamic susceptibility contrast MRI. Magn Reson Med. 2011 [Epub ahead of print]
  6. Peng Q,Zhang Y, San Emeterio Nateras O, van Osch MJ, Duong TQ. MRI of Blood Flow of the Human Retina. Magn Reson Med.2011 Jun;65(6):1768-75
  7. van Hell HH, Bossong MG, Jager G, Kristo G, van Osch MJ, Zelaya F, Kahn RS, Ramsey NF. Evidence for involvement of the insula in the psychotropic effects of THC in humans: a double-blind, randomized pharmacological MRI study. Int J Neuropsychopharmacol. 2011 Nov;14(10):1377-88
  8. Gevers S, van Osch, MJ; Bokkers R; Kies D, Teeuwisse W, Majoie C, Hendrikse J, Nederveen AJ. Intra- and multicenter reproducibility of pulsed, continuous and pseudo-continuous Arterial Spin Labeling methods for measuring cerebral perfusion. J Cereb Blood Flow Metab. 2011 Aug;31(8):1706-15
  9. Gevers S, Bokkers R, Hendrikse J, Majoie CB, Kies DA, Teeuwisse WM, Nederveen AJ, van Osch MJ. Robustness and Reproducibility of Flow Territories defined by Planning-Free Vessel-encoded Pseudo-continuous Arterial Spin Labeling. AJNR Mar 10. [Epub ahead of print]
  10. Khalili-Mahani N, van Osch MJ, Baerends E, Soeter RP, de Kam M, Zoethout RW, Dahan A, van Buchem MA, van Gerven JM, Rombouts SA. Pseudocontinuous arterial spin labeling reveals dissociable effects of morphine and alcohol on regional cerebral blood flow. J Cereb Blood Flow Metab. 2011 May;31(5):1321-33
  11. Bleeker EJ, van Osch MJ, Connelly A, van Buchem MA, Webb AG, Calamante F. New criterion to aid manual and automatic selection of the arterial input function in dynamic susceptibility contrast MRI. Magn Reson Med. 2011 Feb;65(2):448-56
  12. Hartkamp NS, Bokkers RP, van der Worp HB, van Osch MJ, Kappelle LJ, Hendrikse J. Distribution of cerebral blood flow in the caudate nucleus, lentiform nucleus and thalamus in patients with carotid artery stenosis. Eur Radiol. 2011 Apr;21(4):875-81.
  13. Emmer BJ, van Osch MJ, Wu O, Steup-Beekman GM, Steens SC, Huizinga TW, van Buchem MA, van der Grond J. Perfusion MRI in neuro-psychiatric systemic lupus erthemathosus. J Magn Reson Imaging. 2010 Aug;32(2):283-8
  14. Bleeker EJ, Webb AG, Van Buchem MA, Van Osch MJ. Phase-based arterial input function measurements for dynamic susceptibility contrast MRI. Magn Reson Med 2010. In press.
  15. Teeuwisse WM, Webb AG, Van Osch MJ. Arterial spin labeling at ultra-high field: All that glitters is not gold. Invited contribution. International Journal of Imaging Systems and Technology 2010. March; 20 (1), 62–70
  16. Bleeker EJ and Van Osch MJ. Measurement of cerebral perfusion using MRI. Invited review for Imaging in Medicine. 2010. Feb; 2 (1), 41-61.
  17. Van Osch MJ and Lu H. Arterial spin labeling perfusion MRI in Alzheimer’s Disease. Invited review for Current Medical Imaging Review. 2010. In press.
  18. Bokkers R, Van Osch MJ, De Borst GJ, Van der Worp HB, Hendrikse J. Cerebral autoregulation impairment measured at the brain tissue level in patients with a symptomatic carotid artery stenosis with arterial spin labeling MRI. Radiology. In Press.
  19. Aslan S, Xu F, Wang P, Uh J, Yezhuvath U, Van Osch MJ, Lu H.. Estimation of labeling efficiency in pseudo-continuous arterial spin labeling. Magn Reson Med 2010 Mar;63(3):765-71.
  20. van Osch MJ, Teeuwisse WM, Van Walderveen MA, Hendrikse J, Kies DA, Van Buchem MA. Can arterial spin labeling detect white matter perfusion signal? Magn Reson Med 2009 Apr;62(1):165-173.
  21. Bleeker EJ, Van Buchem MA, Van Osch MJ. Optimal location for arterial input function measurements near the middle cerebral artery in first pass perfusion MRI. J Cereb Blood Flow Metab 2009 Apr;29(4):840-52.
  22. Waaijer A, van Leeuwen MS, van Osch MJ, van der Worp BH, Moll FL, Lo RT, Mali WP, Prokop M. Changes in cerebral perfusion after revascularization of symptomatic carotid artery stenosis: CT measurement. Radiology. 2007 Nov;245(2):541-8.
  23. Calamante F, Vonken EJ, van Osch MJ. Contrast agent concentration measurements affecting quantification of bolus-tracking perfusion MRI. Magn Reson Med. 2007 Sep;58(3):544-53.
  24. Waaijer A, van der Schaaf IC, Velthuis BK, Quist M, van Osch MJ, Vonken EP, van Leeuwen MS, Prokop M. Reproducibility of quantitative CT brain perfusion measurements in patients with symptomatic unilateral carotid artery stenosis. AJNR Am J Neuroradiol. 2007 May;28(5):927-32.
  25. van Osch MJ, Hendrikse J, van der Grond J. Sensitivity comparison of multiple vs. single inversion time pulsed arterial spin labeling fMRI. J Magn Reson Imaging. 2007 Jan;25(1):215-21.
  26. van der Schaaf I, Vonken EJ, Waaijer A, Velthuis B, Quist M, van Osch T. Influence of partial volume on venous output and arterial input function. AJNR Am J Neuroradiol. 2006 Jan;27(1):46-50.
  27. van Osch MJ, van der Grond J, Bakker CJ. Partial volume effects on arterial input functions: shape and amplitude distortions and their correction. J Magn Reson Imaging. 2005 Dec;22(6):704-9.

Contact

Matthias van Osch Ph.D.
Department of Radiology - C3Q
Leiden University Medical Center
Albinusdreef 2
2333 ZA Leiden
The Netherlands
E-mail: M.J.P.van_Osch<at>lumc.nl
Fax: +31-71-524-8256
Phone: +31-71-526-3678

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