Ultra-high-field arterial spin labelling MRI for non-contrast assessment of cortical lesion perfusion in multiple sclerosis

Dury, Richard J.; Falah, Yasser; Gowland, Penny A.; Evangelou, Nikos; Bright, Molly G.; Francis, Susan T.

Abstract

© 2018, The Author(s). Objectives: To assess the feasibility of using an optimised ultra-high-field high-spatial-resolution low-distortion arterial spin labelling (ASL) MRI acquisition to measure focal haemodynamic pathology in cortical lesions (CLs) in multiple sclerosis (MS). Methods: Twelve MS patients (eight female, mean age 50 years; range 35–64 years) gave informed consent and were scanned on a 7 Tesla Philips Achieva scanner. Perfusion data were collected at multiple post-labelling delay times using a single-slice flow-sensitive alternating inversion recovery ASL protocol with a balanced steady-state free precession readout scheme. CLs were identified using a high-resolution Phase-Sensitive Inversion Recovery (PSIR) scan. Significant differences in perfusion within CLs compared to immediately surrounding normal appearing grey matter (NAGMlocal) and total cortical normal appearing grey matter (NAGMcortical) were assessed using paired t-tests. Results: Forty CLs were identified in PSIR scans that overlapped with the ASL acquisition coverage. After excluding lesions due tosmall size or intravascular contamination, 27 lesions were eligible for analysis. Mean perfusion was 40 ± 25 ml/100 g/min in CLs, 53 ± 12 ml/100 g/min in NAGMlocal, and 53 ± 8 ml/100 g/min in NAGMcortical. CL perfusion was significantly reduced by 23 ± 9% (mean ± SE, p = 0.013) and 26 ± 9% (p = 0.006) relative to NAGMlocal and NAGMcortical perfusion, respectively. Conclusion: This is the first ASL MRI study quantifying CL perfusion in MS at 7Tesla, demonstrating that an optimised ASL acquisition is sensitive to focal haemodynamic pathology previously observed using dynamic susceptibility contrast MRI. ASL requires no exogenous contrast agent, making it a more appropriate tool to monitor longitudinal perfusion changes in MS, providing a new window to study lesion development. Key Points: • Perfusion can be quantified within cortical lesions in multiple sclerosis using an optimised high spatial resolution arterial spin Labelling MRI acquisition at ultra-high-field. • The majority of cortical lesions assessed using arterial spin labelling are hypo-perfused compared to normal appearing grey matter, in agreement with dynamic susceptibility contrast MRI literature. • Arterial spin labelling MRI, which does not involve the injection of a contrast agent, is a safe and appropriate technique for repeat scanning of an individual patient.

Citation

Dury, R. J., Falah, Y., Gowland, P. A., Evangelou, N., Bright, M. G., & Francis, S. T. (2019). Ultra-high-field arterial spin labelling MRI for non-contrast assessment of cortical lesion perfusion in multiple sclerosis. European Radiology, 29(4), 2027-2033. https://doi.org/10.1007/s00330-018-5707-5

• Journal Article Type: Article
• Acceptance Date: Aug 10, 2018
• Online Publication Date: Oct 2, 2018
• Publication Date: 2019-04
• Deposit Date: Oct 27, 2019
• Publicly Available Date: Oct 31, 2019
• Journal: European Radiology
• Print ISSN: 0938-7994
• Electronic ISSN: 1432-1084
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 29
• Issue: 4
• Pages: 2027-2033
• DOI: https://doi.org/10.1007/s00330-018-5707-5
• Keywords: Radiology Nuclear Medicine and imaging; General Medicine
• Public URL: https://nottingham-repository.worktribe.com/output/1869349
• Publisher URL: https://link.springer.com/article/10.1007%2Fs00330-018-5707-5