However, MRI vendor-provided software usually is a rigid “black box” to deliver single-subject data, and therefore is not adequate for the needs of a group-based study ( 7, 8). Advanced ASL techniques, such as multi-post-labeling delay (multi-PLD) ASL, have been developed to correct for physiological differences between patients in blood arrival time ( 6).Įxpertise in ASL acquisition is slowly increasing within the clinical setting. Significant progress has been made to improve ASL acquisition techniques, and to improve data quality and robustness ( 1, 4, 5). These more invasive techniques follow acquisition techniques fundamentally different from ASL, which in return demand a different, and not easily comparable image processing strategy. ASL is therefore immediately repeatable, avoids pharmacological side effects ( 3), and has economic advantages compared to DSC, dynamic contrast-enhanced MRI perfusion (DCE) or even positron-transmitting tomography (PET). ASL has undeniable advantages: it does not require an exogenous tracer such as gadolinium, and the labeled water molecules are not confined to the intravascular space. While gadolinium-contrast-based dynamic-susceptibility contrast (DSC) MRI remains the most frequently clinically used method to measure brain perfusion ( 2). We anticipate that this educational review will help accelerate the application of ASL MRI for clinical brain research.Īrterial spin labeling (ASL) has established itself as a magnetic resonance imaging (MRI) technique for measuring cerebral perfusion ( 1). Some of the educational content can be extrapolated to the processing of other MRI data. Example video and image illustrations of ASL studies of different cases, as well as model calculations, help the reader develop an understanding of which processing steps to check for their own analyses. Starting with an introduction of the physiology and MRI technique behind ASL, and how they interact with the image processing, we present an overview of processing pipelines and explain the specific ASL processing steps. The readers are assumed to have a basic understanding of cerebral perfusion (patho) physiology a basic level of programming or image analysis is not required. We provide summaries of all typical ASL processing steps on both single-subject and group levels. This educational review is aimed at those with an interest in ASL image processing and analysis. Specifically, the post-acquisition processing of ASL images and their preparation for region-of-interest or voxel-wise statistical analyses is a topic that has not yet received much educational attention. The 2019 Ann Arbor ISMRM ASL working group established that education is one of the main areas that can accelerate the use of ASL in research and clinical practice. While it has developed into a robust technique for scientific and clinical use, its image processing can still be daunting. 12Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, NetherlandsĪrterial spin labeling (ASL) is a non-invasive and cost-effective MRI technique for brain perfusion measurements.11Queen Square Institute of Neurology and Center for Medical Image Computing, University College London, London, United Kingdom.10fMRI Laboratory, Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States.9Department of Neurosurgery, University at Buffalo, Buffalo, NY, United States.8Dent Neurologic Institute, Buffalo, Amherst, NY, United States.7School of Psychological Science, University of Bristol, England, United Kingdom.6Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States.5Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, OT, Canada.4Amsterdam Neuroscience, Brain Imaging, Amsterdam, Netherlands.3Department of Radiology and Nuclear Medicine, Amsterdam UMC, location VUmc, Amsterdam, Netherlands.2Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.1Ghent Institute for Functional and Metabolic Imaging (GIfMI), Ghent University, Ghent, Belgium.Kuijer 3, Frederik Barkhof 3,4,11, Henk J. Dijsselhof 3,4, Beatriz Padrela 3,4, Maurice Pasternak 5, Sudipto Dolui 6, Lina Jarutyte 7, Nandor Pinter 3,8,9, Luis Hernandez-Garcia 10, Andrew Jahn 10, Joost P. Patricia Clement 1†‡, Jan Petr 2,3 ‡, Mathijs B.
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