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Pseudo-Continuous Arterial Spin Labelling MRI for Non-Invasive, Whole-Brain, Serial Quantification of Cerebral Blood Flow Following Aneurysmal Subarachnoid Haemorrhage

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Abstract

Delayed cerebral ischaemia (DCI) is the major cause of mortality and morbidity following aneurysmal subarachnoid haemorrhage (SAH). Recent experimental evidence from animal models has highlighted the need for non-invasive and robust measurements of brain tissue perfusion in patients in order to help understand the pathophysiology underlying DCI. Quantitative, serial, whole-brain cerebral perfusion measurements were obtained with pseudo-continuous arterial spin labelling (PCASL) magnetic resonance imaging (MRI) in six SAH patients acutely following endovascular coiling. This technique requires no injected contrast or radioactive isotopes. MRI scanning was well tolerated. Artefact from endovascular coils was minimal. PCASL MRI was able to detect time-dependent and patient-specific changes in voxel-wise and regional cerebral blood flow. These changes reflected changes in clinical condition. Data obtained in healthy controls using the same experimental protocol confirm the reliability and reproducibility of these results. This is the first study to use whole-brain, quantitative PCASL to identify time-dependent changes in cerebral blood flow at the tissue level in the acute period following SAH. This technique has the potential to better understand changes in cerebral pathophysiology as a consequence of aneurysm rupture.

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Acknowledgments

The research was supported by the National Institute for Health Research Oxford Biomedical Research Centre based at Oxford University Hospitals NHS Trust and University of Oxford, the Oxfordshire Health Services Research Committee, the UK Medical Research Council and the National Institute of Academic Anaesthesia.

Compliance with Ethics Requirements

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5). Informed consent was obtained from all patients for being included in the study. Ethical approval for the study was obtained from the Oxfordshire NHS Research Ethics Committee B (09/H0605/128).

Conflict of Interest

Michael Kelly, Matthew Rowland, Thomas Okell, Michael Chappell, Rufus Corkill, Jon Westbrook, Peter Jezzard and Kyle Pattinson declare that they have no conflict of interest. Travel expenses of Richard Kerr were paid by Target Therapeutics to attend the 2003 Association of American Neurosurgeons Annual Scientific Meeting to deliver a lecture regarding the International Subarachnoid Aneurysm Trial.

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Authors and Affiliations

  1. Nuffield Department of Clinical Neurosciences and Oxford Acute Vascular Imaging Centre, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK

    Michael E. Kelly, Matthew J. Rowland, Thomas W. Okell, Jon Westbrook, Peter Jezzard & Kyle T. S. Pattinson

  2. Neurointensive Care, Oxford University Hospitals, NHS Trust, Oxford, OX3 9DU, UK

    Matthew J. Rowland, Rufus Corkill, Richard S. Kerr, Jon Westbrook & Kyle T. S. Pattinson

  3. Institute of Biomedical Engineering, University of Oxford, Oxford, OX3 7DQ, UK

    Michael A. Chappell

Authors
  1. Michael E. Kelly
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  2. Matthew J. Rowland
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  3. Thomas W. Okell
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  4. Michael A. Chappell
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  5. Rufus Corkill
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  6. Richard S. Kerr
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  7. Jon Westbrook
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  8. Peter Jezzard
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  9. Kyle T. S. Pattinson
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Corresponding author

Correspondence to Kyle T. S. Pattinson.

Additional information

Michael E. Kelly and Matthew J. Rowland are joint first authors.

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Kelly, M.E., Rowland, M.J., Okell, T.W. et al. Pseudo-Continuous Arterial Spin Labelling MRI for Non-Invasive, Whole-Brain, Serial Quantification of Cerebral Blood Flow Following Aneurysmal Subarachnoid Haemorrhage. Transl. Stroke Res. 4, 710–718 (2013). https://doi.org/10.1007/s12975-013-0269-y

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  • DOI: https://doi.org/10.1007/s12975-013-0269-y

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