Periprocedural arterial spin labeling and dynamic susceptibility contrast perfusion in detection of cerebral blood flow in patients with acute ischemic syndrome

Background and Purpose-To compare the diagnostic performance of arterial spin-labeling (ASL) and dynamic susceptibility contrast (DSC) perfusion in detecting cerebral blood flow (CBF) changes before and after endovascular recanalization in acute ischemic syndrome. Methods-The inclusion criteria for this retrospective study were patients with acute ischemic syndrome who underwent endovascular recanalization and acquisition of both ASL and DSC before and after revascularization. ASL-CBF and multiparametric DSC maps were evaluated for image quality, location, and type of perfusion abnormality. Relative CBF (rCBF) was calculated in the infarction core and hypoperfused areas using coregistered ASL and DSC. Core and hypoperfused rCBF were used for paired pretreatment and posttreatment comparisons. Interobserver and intermodality agreement were evaluated by κ test, and t test was calculated for ASL and DSC rCBF values. Results-Twenty-five patients met our inclusion criteria. Five studies were rated nondiagnostic, resulting in 45 pairs of DSC-ASL available for comparison. ASL and DSC agreed on type and location of the perfusion abnormality in 71% and 80% of cases, respectively. The image quality of ASL was lower than DSC, resulting in interobserver variability for the type (κ=0.45) and location (κ=0.56) of perfusion abnormality. ASL was unable to show any type of perfusion abnormality in 11% of patients. In successfully recanalized patients, hyperperfusion (rCBF >1) was detected in 100% on DSC and 47% on ASL. Conclusions-ASL is less sensitive than DSC for detecting rCBF changes in patients with acute ischemic syndrome, particularly with respect to hyperperfusion after successful recanalization.