Multiple Sclerosis Clinical Trial
Official title:
Measuring Cerebral Blood Flow Using Pseudo-continuous Arterial Spin Labeling Perfusion Magnetic Resonance Imaging
This study will test a new MRI sequence that measures cerebral blood flow (CBF). Because this technique for measuring CBF is new, there is little information on what the normal values for different regions of the brain should be. Information from the study will be used to establish normative CBF values for the brain, improving the reliable use of this technique for the diagnosis of brain injury or disease.
Cerebral blood flow (CBF) represents an important physiological parameter for the diagnosis
and management of multiple brain disorders. The clinical need for CBF measurements is further
complicated by the desire to have a non-invasive method with high temporal resolution that
can measure CBF over a wide range of blood flows and in a wide range of patients. Numerous
techniques are available to measure CBF. Nuclear medicine approaches, such as single positron
emission computed tomography (SPECT) and positron emission tomography (PET) rely on
radioisotopes which can be problematic in the pediatric population. In contrast, MRI-based
methods are non-invasive and the CBF information can be obtained in conjunction with other
MRI techniques (i.e. diffusion weighted imaging or spectroscopy) which allows for a combined
longitudinal assessment of CBF, morphology, and metabolism, to provide a more complete
understanding of the developing pathophysiological mechanisms.
Arterial spin labeling (ASL) perfusion imaging uses arterial blood water as an endogenous
diffusible tracer where radiofrequency (RF) pulses magnetically label the moving spins in
flowing blood without the use of a contrast agent. After a time delay allowing for the
magnetically labeled blow to flow into the brain, "labeled" images are acquired. Separate
control images are also acquired, without labeling and the difference between the two sets of
imaged provides a measure of perfusion. Since gadolinium-based contrast agents are not
required, the ASL perfusion technique is completely non-invasive. In addition, ASL techniques
are insensitive to blood-brain barrier permeability changes, which can occur after strokes or
with tumors.
Because gadolinium-based contrast is not used, the ASL technique has an inherently lower
sensitivity than DSC-PWI. To date, there are a number of commercially available ASL
techniques that differ in their labeling schemes, which has contributed to the difficulty in
obtaining consistent results across different patient populations (pediatric, elderly,
stroke, tumors). A number of recent reports using pseudo-continuous ASL (pCASL) have been
published and show increased reliability across different patient populations. Moreover, a
recent consensus statement published by the International Society of Magnetic Resonance in
Medicine Perfusion Study Group recommends the use of pCASL labeling strategies for clinical
applications.
The objectives of this study is to determine the accuracy and reliability of a newly
developed pCASL sequence and post-processing software across multiple patient populations
(neonate to elderly) and pathological processes.
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