Arterial spin labeling (ASL) perfusion has lots of utility in pediatric neuroimaging, but is also prone to interpretive pitfalls that require good understanding of the technical MRI principles of the technique. The clinical utility, advantages, technical limitations, and pitfalls of ASL in the pediatric population will be presented in the context of select neurological disorders of children.
Purpose
Arterial spin labeling (ASL) perfusion is
now becoming more widely used in clinical pediatric neuroimaging. In this educational
exhibit we will demonstrate the clinical utility of performing ASL in children
as an adjunct to routine brain imaging in the pediatric population by
presentation and discussion of representative clinical cases. The advantages,
clinical challenges, and limitations of using ASL perfusion in routine pediatric
neuroimaging will also be discussed. Artifacts and pitfalls in the performance
and application of ASL that may lead to diagnostic errors will also be enumerated
and exemplified in the context of the basic MR technical considerations in
applying ASL.
Outline of Content
First, a very brief overview of basic technical aspects of arterial spin labeling perfusion MRI will be given in order to set the stage for discussion of applications and potential pitfalls. The potential advantages of using ASL perfusion imaging and its various variants in pediatric neuroimaging will be presented. Example of ASL imaging protocols for use in children that have been utilized for imaging tens of thousands of children in our institution will be provided. The clinical utility of ASL techniques will be demonstrated and discussed for a number of disease categories in the pediatric population. These include pediatric arterial stroke, hypoxic-ischemic injury, migraine, moyamoya disease, arterial and venous malformations, epilepsy, and congenital heart disease Utility and limitations of ASL perfusion MRI in the imaging evaluation and follow-up of pediatric brain tumors and masses will also be presented. The limitations and technical challenges including various artifacts and interpretive pitfalls based on the physics of ASL in the imaging evaluation of these disorders will also be discussedSummary
Arterial spin labeling perfusion has great potential in pediatric neuroimaging, but is also prone to artifacts and interpretive pitfalls that require good understanding of the technical aspects of the technique. The clinical utility, advantages, and limitations of these techniques in the pediatric population should be recognized for optimal use and image interpretation in various neurological disorders of children.1. Haller S, Zaharchuk G, Thomas DL, Lovblad KO, Barkhof F, Golay X. Arterial Spin Labeling Perfusion of the Brain: Emerging Clinical Applications. Radiology. 2016 Nov;281(2):337-356. Amukotuwa SA, Yu C,
2. Zaharchuk G. 3D Pseudocontinuous arterial spin labeling in routine clinical practice: A review of clinically significant artifacts. J Magn Reson Imaging. 2016 Jan;43(1):11-27.