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ASL study of carotid stenosis

Case Study
Kawauchi, Nobuo, M.D. Tokyo Metropolitan Police Hospital
Sato, Hiroaki, M.D. Tokyo Metropolitan Police Hospital

Patient history

The patient (75-year-old male) with right carotid stenosis without symptoms underwent an MRI examination before and after carotid artery stenting (CAS). The purpose of the initial MR exam was to determine the presence of any cerebral infarction, and qualitative evaluation of perfusion using Arterial Spin Labeling (ASL) perfusion. Scans were also assessed to visualize the extent of carotid stenosis, the low return flow, and lateralization of blood flow.

MR examination

The MR examinations were performed on an Achieva 3.0T X-series using the 16-channel SENSE NeuroVascular coil.

Images

T2W TSE FLAIR TSE
T2W TSE
FLAIR TSE
T1W SE DWI EPI
T1W SE
DWI EPI
On T1w, T2w, FLAIR and DWI images a small lacunar infarction is seen on the right side, no other abnormalities noted.
Brain Inflow-MRA Right Neck Inflow-MRA Left Neck Inflow-MRA
Brain Inflow-MRA
Right Neck Inflow-MRA
Left Neck Inflow-MRA
Pre-intervention inflow MRA shows decreased flow in the right middle cerebral artery due to stenosis of the right internal carotid artery. Collateral flow is seen from the left anterior communicating artery.
Right Neck Inflow-MRA T1W VISTA
Right Neck Inflow-MRA
T1W VISTA
3D VISTA images reformatted in an oblique sagittal plane help to visualize the extent and character of the plaque and the structure of the vessel wall.

Pre-intervention multi-phase, multislice ASL

Pre-intervention multi-phase, multi-slice ASL shows differences between right and left sides of brain.
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Post-CAS multi-phase, multislice ASL

Post-CAS ASL shows comparable perfusion on both sides of the brain.
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Brain Inflow-MRA
Brain Inflow-MRA
Post-intervention inflow MRA in the brain shows that the blood flow is normal after the CAS intervention.

Clinical value of ASL

Arterial Spin Labeling (ASL) is a technique to measure brain perfusion. The scan is non-invasive and does not require contrast agents, because ASL uses magnetically labeled water protons in the arterial blood flow into the brain as the contrast agent, to evaluate perfusion. Multislice scanning (e.g. 5 slices) is preferable to evaluate the central cerebral blood flow. Multi-phase ASL is especially important to visualize the temporal characteristics of the blood passage.


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Jan 14, 2010

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Case Study
Achieva 3.0T X-series
Release 2
Brain, Carotid, Neuro, Vascular
 

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