P. Ellen Grant MD, Presenter: Nothing to Disclose

Divya S Bolar BS, Abstract Co-Author: Nothing to Disclose

Andrew Kiruluta PHD, Abstract Co-Author: Nothing to Disclose

David C Alsop PHD, Abstract Co-Author: Nothing to Disclose

Arterial Spin Labeling (ASL) Blood Flow MRI is well suited to the pediatric brain because of the higher normal blood flow and shorter arterial transit times. The purpose of this study was to determine if ASL could be performed in a clinical pediatric population at 1.5T and to begin to assess its diagnostic potential.

32 pediatric patients undergoing clinical evaluation at 1.5T had ASL in addition to routine images. Whole brain ASL was performed with continuous labeling for 1.2 s followed by a 1 sec wait for labeled blood to reach the microvasculature. An interleaved stack of variable density spiral acquisition and background suppression were employed to provide volumetric coverage with reduced artifacts and robustness to motion at 3.75 mm cubic spatial resolution. With 3 time averages, total acquisition time was 5 min.

Patients ranged from 0-18 yrs with a clinical spectrum including 9 newborns presenting with neurological symptoms. 6 tuberous sclerosis complex, 2 traumatic brain injury, 1 CO poisoning, 1 near drowning, 1 Degos disease, 2 Autism and 1 Rett Syndrome. In patients with DWI abnormalities, ASL showed different blood flow (ranging from hypo- to hyperperfusion) in regions with similar DWI appearance. In patients with TSC, blood flow differences were noted in similar appearing tubers with some difficult to detect on ASL and some with decreased subcortical perfusion but preserved cortical flow and some with diffuse hypoperfusion. In one TSC case there was global hemispheric hypoperfusion involving regions without tubers. This patient had corresponding hemispheric EEG abnormalities. In 3 studies artifacts or technical difficulties resulted in uninterruptible scans.

Pediatric whole brain ASL can be performed in routine clinical settings. In this pilot study ASL provided additional information not present on routine images in at least 1/3 of these cases. Coregistration to anatomical scans and quantitative analysis are likely to improve yield. Larger prospective trials are required for full assessment of utility but this pilot study suggests that such studies are warranted.

Grant, P, Bolar, D, Kiruluta, A, Alsop, D, Clinical Applications of Endogenous Whole Brain Blood Flow (Arterial Spin Labeling) MRI in the Pediatric Brain.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4415968.html