Efficacy of arterial spin labeling for detection of the ruptured micro-arteriovenous malformation: illustrative cases

BACKGROUND Diagnosis of a microarteriovenous malformation (micro-AVM) is difficult, especially in the acute stage of rupture because of the small size of the nidus and the existence of hematoma. We report two cases of ruptured micro-AVMs detected by arterial spin labeling (ASL). OBSERVATIONS In one case, a 45-year-old male was transported with a complaint of right hemiparesis. Computed tomography (CT) revealed a right parietal lobar hemorrhage. Standard magnetic resonance imaging (MRI) showed no abnormal findings as the cause of the hemorrhage. ASL 23 days after the onset demonstrated high signals on the medial wall of the hematoma. Digital subtraction angiography (DSA) showed a micro-AVM in accordance with the site of high signals on ASL. In another case, a 38-year-old female was transported with a complaint of left hemianopsia. CT on admission revealed a right parietal lobar hemorrhage. Standard MRI showed no abnormal findings as the cause of the hemorrhage. ASL 15 days after the onset demonstrated high signals on the internal wall of the hematoma. DSA showed micro-AVM in accordance with the site of high signaling on ASL. Both cases were successfully treated with open surgery. LESSONS ASL can manifest micro-AVMs as high signals within the hematoma. ASL is a useful less-invasive screening tool for the detection of ruptured micro-AVMs.

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Arterial Spin Labeling for the Etiological Workup of Intracerebral Hemorrhage in Children

Stroke ◽

10.1161/strokeaha.120.032690 ◽

2021 ◽

Author(s):

Jean François Hak ◽

Grégoire Boulouis ◽

Basile Kerleroux ◽

Sandro Benichi ◽

Sarah Stricker ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Computed Tomography ◽

Magnetic Resonance ◽

Intracerebral Hemorrhage ◽

Computed Tomography Angiography ◽

Arterial Spin Labeling ◽

Diagnostic Performance ◽

Spin Labeling ◽

Digital Subtraction ◽

Resonance Imaging

Background and Purpose: Pediatric nontraumatic intracerebral hemorrhage accounts for half of stroke in children. Early diagnostic of the causative underlying lesion is the first step toward prevention of hemorrhagic recurrence. We aimed to investigate the performance of arterial spin labeling sequence (ASL) in the acute phase etiological workup for the detection of an arteriovenous shunt (AVS: including malformation and fistula), the most frequent cause of pediatric nontraumatic intracerebral hemorrhage. Methods: Children with a pediatric nontraumatic intracerebral hemorrhage between 2011 and 2019 enrolled in a prospective registry were retrospectively included if they had undergone ASL-magnetic resonance imaging before any etiological treatment. ASL sequences were reviewed using cerebral blood flow maps by 2 raters for the presence of an AVS. The diagnostic performance of ASL was compared with admission computed tomography angiography, other magnetic resonance imaging sequences including contrast-enhanced sequences and subsequent digital subtraction angiography. Results: A total of 121 patients with pediatric nontraumatic intracerebral hemorrhage were included (median age, 9.9 [interquartile range, 5.8–13]; male sex 48.8%) of whom 76 (63%) had a final diagnosis of AVS. Using digital subtraction angiography as an intermediate reference, visual ASL inspection had a sensitivity and a specificity of, respectively, 95.9% (95% CI, 88.5%–99.1%) and 79.0% (95% CI, 54.4%–94.0%). ASL had a sensitivity, specificity, and accuracy of 90.2%, 97.2%, and 92.5%, respectively for the detection of the presence of an AVS, with near perfect inter-rater agreement (κ=0.963 [95% CI, 0.912–1.0]). The performance of ASL alone was higher than that of other magnetic resonance imaging sequences, individually or combined, and higher than that of computed tomography angiography. Conclusions: ASL has strong diagnostic performance for the detection of AVS in the initial workup of intracerebral hemorrhage in children. If our findings are confirmed in other settings, ASL may be a helpful diagnostic imaging modality for patients with pediatric nontraumatic intracerebral hemorrhage. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifiers: 3618210420, 2217698.

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Accuracy of arterial spin labeling magnetic resonance imaging (MRI) perfusion in detecting the epileptogenic zone in patients with drug-resistant neocortical epilepsy: comparison with electrophysiological data, structural MRI, SISCOM and FDG-PET

European Journal of Neurology ◽

10.1111/ene.12826 ◽

2015 ◽

Vol 23 (1) ◽

pp. 160-167 ◽

Cited By ~ 22

Author(s):

A. Sierra-Marcos ◽

M. Carreño ◽

X. Setoain ◽

A. López-Rueda ◽

J. Aparicio ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Arterial Spin Labeling ◽

Structural Mri ◽

Spin Labeling ◽

Epileptogenic Zone ◽

Drug Resistant ◽

Resonance Imaging ◽

Neocortical Epilepsy ◽

Magnetic Resonance Imaging Mri

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A case of recurrent cavernous sinus dural arteriovenous fistula arising after superselective shunt occlusion and detected by venous arterial spin labeling

Surgical Neurology International ◽

10.25259/sni_825_2021 ◽

2021 ◽

Vol 12 ◽

pp. 594

Author(s):

Hiromu Sunada ◽

Ryosuke Maeoka ◽

Ichiro Nakagawa ◽

Hiroyuki Nakase ◽

Hideyuki Ohnishi

Keyword(s):

Arteriovenous Fistula ◽

Cavernous Sinus ◽

Arterial Spin Labeling ◽

Dural Arteriovenous Fistula ◽

Spin Labeling ◽

Digital Subtraction ◽

Resonance Imaging ◽

Shunt Occlusion ◽

Paradoxical Worsening ◽

The Right

Background: Superselective shunt occlusion (SSSO) for cavernous sinus dural arteriovenous fistula (CSDAVF) avoids the risk of cranial nerve palsy, unlike entire sinus packing, but requires paying attention to recurrence. Distinguishing between true and paradoxical worsening of postoperative ophthalmic symptoms using a less-invasive modality is often difficult. Here, we report a case of true worsening of neuro-ophthalmic symptom by recurrent CSDAVF detected by venous-arterial spin labeling (ASL) on magnetic resonance imaging. Case Description: A 55-year-old woman with neither contributory medical history nor previous head trauma presented with neuro-ophthalmic symptoms and pulsatile tinnitus. Digital subtraction angiography (DSA) revealed CSDAVF with multiple shunted pouches. She underwent successful transvenous SSSO, but neuroophthalmic symptom worsened after SSSO and venous-ASL revealed increased signal intensity in the right superior orbital vein (SOV). DSA confirmed recurrent CSDAVF and additional transvenous embolization was performed. Neuro-ophthalmic symptoms and venous-ASL hyperintensity on SOV improved postoperatively. Conclusion: Venous-ASL is noninvasive and seems useful for detecting true worsening of neuro-ophthalmic symptoms of recurrent CSDAVF.

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Arterial Spin Labeling Magnetic Resonance Imaging Can Identify the Occlusion Site and Collateral Perfusion in Patients with Acute Ischemic Stroke: Comparison with Digital Subtraction Angiography

Cerebrovascular Diseases ◽

10.1159/000503090 ◽

2019 ◽

Vol 48 (1-2) ◽

pp. 70-76 ◽

Cited By ~ 1

Author(s):

Yoichi Morofuji ◽

Nobutaka Horie ◽

Yohei Tateishi ◽

Minoru Morikawa ◽

Susumu Yamaguchi ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Ischemic Stroke ◽

Magnetic Resonance ◽

Acute Ischemic Stroke ◽

Digital Subtraction Angiography ◽

Arterial Spin Labeling ◽

Spin Labeling ◽

Collateral Flow ◽

Digital Subtraction ◽

Resonance Imaging

Background and Objectives: Determining the occlusion site and collateral blood flow is important in acute ischemic stroke. The purpose of the current study was to test whether arterial spin labeling (ASL) magnetic resonance imaging (MRI) could be used to identify the occlusion site and collateral perfusion, using digital subtraction angiography (DSA) as a gold standard. Method: Data from 521 consecutive patients who presented with acute ischemic stroke at our institution from January 2012 to September 2014 were retrospectively reviewed. Image data were included in this study if: (1) the patient presented symptoms of acute ischemic stroke; (2) MRI was performed within 24 h of symptom onset; and (3) DSA following MRI was performed (n = 32 patients). We defined proximal intra-arterial sign (IAS) on ASL as enlarged circular or linear bright hyperintense signal within the occluded artery and distal IAS as enlarged circular or linear bright hyperintense signals within arteries inside or surrounding the affected region. The presence or absence of the proximal IAS and distal IAS were assessed, along with their inter-rater agreement and consistency with the presence of occlusion site and collateral flow on DSA images. Results: The sensitivity and specificity for identifying occlusion site with ASL were 82.8 and 100%, respectively. Those for identifying collateral flow with ASL were 96.7 and 50%, respectively. The inter-rater reliability was excellent for proximal IAS (κ = 0.92; 95% CI 0.76–1.00) and substantial for distal IAS detection (κ = 0.78; 95% CI 0.38–1.00). Conclusions: Proximal IAS and distal IAS on ASL imaging can provide important diagnostic clues for the detection of arterial occlusion sites and collateral perfusion in patients with acute ischemic stroke.

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Impact of Arginase II on CBF in Experimental Cortical Impact Injury in Mice Using MRI

Journal of Cerebral Blood Flow & Metabolism ◽

10.1038/jcbfm.2010.47 ◽

2010 ◽

Vol 30 (6) ◽

pp. 1105-1109 ◽

Cited By ~ 11

Author(s):

Brittany R Bitner ◽

Danielle C Brink ◽

Leela C Mathew ◽

Robia G Pautler ◽

Claudia S Robertson

Keyword(s):

Arterial Spin Labeling ◽

Spin Labeling ◽

Brain Regions ◽

No Production ◽

Resonance Imaging ◽

Low Levels ◽

Arginase Ii ◽

Magnetic Resonance Imaging Mri ◽

Hemodynamic Processes ◽

Impact Injury

Traumatic brain injury (TBI) results in reduced cerebral blood flow (CBF) and low levels of the vasodilator nitric oxide (NO) may be involved. Arginase II negatively regulates NO production through competition for the substrate L-arginine. We determined whether arginase II-deficient (ArgII−/−) mice would show improved CBF after TBI through arterial spin-labeling magnetic resonance imaging (MRI). The ArgII−/− mice exhibit a significantly improved CBF recovery after trauma in the perilesional brain ( P=0.0015) and in various other brain regions. In conclusion, arginase II deficiency leads to a better CBF recovery after TBI and implicates arginase II in hemodynamic processes.

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THE POSSIBILITIES OF COMPLEX VISUAL DIAGNOSTICS OF LIVER PATHOLOGY IN PATIENTS WITH DIFFUSE LIVER DISEASES ASSOCIATED WITH COVID-19.

East European Scientific Journal ◽

10.31618/essa.2782-1994.2021.4.75.173 ◽

2021 ◽

Vol 4 (11(75)) ◽

pp. 41-45

Author(s):

A. Telesh ◽

T. Morozova

Keyword(s):

Liver Diseases ◽

Arterial Spin Labeling ◽

Spin Labeling ◽

Diagnostic Methods ◽

Hospital Treatment ◽

Liver Pathology ◽

Resonance Imaging ◽

Specific Diagnosis ◽

Magnetic Resonance Imaging Mri ◽

Diffuse Liver Diseases

The research shows the possibilities of visual diagnostics of liver pathology in patients with various diffuse liver diseases and COVID-19. The analysis is based on the results of examination of patients, who got hospital treatment in Clinical Hospital №1 of Smolensk from September to November 2021. The research shows the efficiency of ultrasound diagnosis as the first step of examination. Using Magnetic Resonance Imaging (MRI) allowed to study the symptoms of liver pathology more deeply. In order to improve the exact specific diagnosis of liver pathology in patients with diffuse liver diseases and COVID-19, arterial spin labeling technique is recommended to use. The research shows the efficiency of complex using of diagnostic methods in patients with diffuse liver diseases and SARS-CoV-2 infection

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Cortical microinfarcts in memory clinic patients are associated with reduced cerebral perfusion

Journal of Cerebral Blood Flow & Metabolism ◽

10.1177/0271678x19877403 ◽

2019 ◽

Vol 40 (9) ◽

pp. 1869-1878 ◽

Cited By ~ 5

Author(s):

Doeschka A Ferro ◽

Henri JJM Mutsaerts ◽

Saima Hilal ◽

Hugo J Kuijf ◽

Esben T Petersen ◽

...

Keyword(s):

Arterial Spin Labeling ◽

Cerebral Perfusion ◽

Region Of Interest ◽

Resonance Imaging ◽

Memory Clinic ◽

Anterior Circulation ◽

Cortical Gray Matter ◽

Arterial Transit Time ◽

Magnetic Resonance Imaging Mri ◽

Continuous Arterial Spin Labeling

Cerebral cortical microinfarcts (CMIs) are small ischemic lesions associated with cognitive impairment and dementia. CMIs are frequently observed in cortical watershed areas suggesting that hypoperfusion contributes to their development. We investigated if presence of CMIs was related to a decrease in cerebral perfusion, globally or specifically in cortex surrounding CMIs. In 181 memory clinic patients (mean age 72 ± 9 years, 51% male), CMI presence was rated on 3-T magnetic resonance imaging (MRI). Cerebral perfusion was assessed from cortical gray matter of the anterior circulation using pseudo-continuous arterial spin labeling parameters cerebral blood flow (CBF) (perfusion in mL blood/100 g tissue/min) and spatial coefficient of variation (CoV) (reflecting arterial transit time (ATT)). Patients with CMIs had a 12% lower CBF (beta = −.20) and 22% higher spatial CoV (beta = .20) (both p < .05) without a specific regional pattern on voxel-based CBF analysis. CBF in a 2 cm region-of-interest around the CMIs did not differ from CBF in a reference zone in the contralateral hemisphere. These findings show that CMIs in memory clinic patients are primarily related to global reductions in cerebral perfusion, thus shedding new light on the etiology of vascular brain injury in dementia.

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