Test‐retest reproducibility of quantitative CBF measurements using FAIR perfusion MRI and acetazolamide challenge

The reproducibility of quantitative cerebral blood flow (CBF) measurements using MRI with arterial spin labeling and acetazolamide challenge was assessed in 12 normal subjects, each undergoing the identical experimental procedure on two separate days. CBF was measured on a 1.5T scanner using a flow‐sensitive alternating inversion recovery (FAIR) pulse sequence, performed both at baseline and 12 min after intravenous administration of acetazolamide. T1 was measured in conjunction with the FAIR scan in order to calculate quantitative CBF. The CBF maps were segmented to separate gray matter (GM) from white matter (WM) for region‐of‐interest (ROI) analyses. Post‐ acetazolamide CBF values (ml/100 g/min, mean ± SD) of 87.5 ± 12.5 (GM) and 46.1 ± 10.8 (WM) represented percent increases of 37.7% ± 24.4% (GM) and 40.1% ± 24.4% (WM). Day‐to‐day differences in baseline CBF were −1.7 ± 6.9 (GM) and –1.4 ± 4.7 (WM) or, relative to the mean CBF over both days for each subject, −2.5% ± 11.7% (GM) and −3.8% ± 13.6% (WM) Day‐ to‐day differences in absolute post‐ACZ CBF increase were −2.5 ± 6.8 (GM) and 2.7 ± 9.4 (WM) or, relative to the mean CBF increase over both days for each subject, –4.7% ± 13.3% (GM) and 9.1% ± 26.2% (WM). Thus, FAIR‐ based CBF measurements show satisfactory reproducibility from day to day, but with sufficient variation to warrant caution in interpreting longitudinal data. The hemispheric asymmetry of baseline CBF and post‐acetazolamide CBF increases varied within a narrower range and should be sensitive to small changes related to disease or treatment. Magn Reson Med 47:921–928, 2002. © 2002 Wiley‐Liss, Inc.

[1]  P. Adeleine,et al.  Can cerebrovascular reactivity be assessed by dynamic susceptibility contrast-enhanced MRI? , 1998, Neuroradiology.

[2]  G Brix,et al.  Cerebrovascular reserve capacity in patients with occlusive cerebrovascular disease: assessment with dynamic susceptibility contrast-enhanced MR imaging and the acetazolamide stimulation test. , 1996, Radiology.

[3]  J. H. Duyn,et al.  Multislice Imaging of Quantitative Cerebral Perfusion with Pulsed Arterial Spin-Labeling , 1998, NeuroImage.

[4]  U Sabatini,et al.  Quantitative assessment of cerebral blood volume by single-photon emission computed tomography. , 1991, Stroke.

[5]  T. Schroeder Cerebrovascular reactivity to acetazolamide in carotid artery disease. Enhancement of side-to-side CBF asymmetry indicates critically reduced perfusion pressure. , 1986, Neurological research.

[6]  YojiroOkudaira,et al.  Evaluation of the Acetazolamide Test , 1995 .

[7]  S Warach,et al.  A general kinetic model for quantitative perfusion imaging with arterial spin labeling , 1998, Magnetic resonance in medicine.

[8]  P. Adeleine,et al.  Assessment of cerebrovascular reactivity by dynamic susceptibility contrast-enhanced MR imaging , 1997, Journal of the Neurological Sciences.

[9]  P T Fox,et al.  Regional Asymmetries of Cerebral Blood Flow, Blood Volume, and Oxygen Utilization and Extraction in Normal Subjects , 1987, Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism.

[10]  Y Ishida,et al.  Vasoreactive effect of acetazolamide as a function of time with sequential PET 15O-water measurement. , 1996, Nuclear medicine communications.

[11]  W. Obrist,et al.  Regional cerebral blood flow estimated by 133-xenon inhalation. , 1975, Stroke.

[12]  M E Raichle,et al.  Positron emission tomography and its application to the study of cerebrovascular disease in man. , 1985, Stroke.

[13]  A. Buck,et al.  Simplified quantitative determination of cerebral perfusion reserve with H215O PET and acetazolamide , 2000, European Journal of Nuclear Medicine.

[14]  K. Katada,et al.  Cerebral hemodynamics in patients with chronic obstructive carotid disease by rCBF, rCBV, and rCBV/rCBF ratio using SPECT. , 1990, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[15]  F. Chollet,et al.  SPECT study of cerebral blood flow reactivity after acetazolamide in patients with transient ischemic attacks. , 1989, Stroke.

[16]  P. Renshaw,et al.  Sequential dynamic susceptibility contrast MR experiments in human brain: Residual contrast agent effect, steady state, and hemodynamic perturbation , 1995, Magnetic resonance in medicine.

[17]  Jeff Duyn,et al.  H215O PET validation of steady‐state arterial spin tagging cerebral blood flow measurements in humans , 2000, Magnetic resonance in medicine.

[18]  E M Wilson,et al.  133Xenon Inhalation Method Analysis of Reproducibility: Some of Its Physiological Implications , 1977, Stroke.

[19]  M D Devous,et al.  The effect of acetazolamide on regional cerebral blood flow in normal human subjects as measured by single-photon emission computed tomography. , 1988, Investigative radiology.

[20]  R B Buxton,et al.  A theoretical and experimental comparison of continuous and pulsed arterial spin labeling techniques for quantitative perfusion imaging , 1998, Magnetic resonance in medicine.

[21]  E M Stokely,et al.  Normal Distribution of Regional Cerebral Blood Flow Measured by Dynamic Single-Photon Emission Tomography , 1986, Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism.

[22]  J. Detre,et al.  Cerebral perfusion and arterial transit time changes during task activation determined with continuous arterial spin labeling , 2000, Magnetic resonance in medicine.

[23]  M. Raichle,et al.  What is the Correct Value for the Brain-Blood Partition Coefficient for Water? , 1985, Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism.

[24]  G. Leinsinger,et al.  A simple test to assess cerebrovascular reserve capacity using transcranial Doppler sonography and acetazolamide. , 1990, Stroke.

[25]  J. Bulte,et al.  T1 and T2 of ferritin solutions: Effect of loading factor , 1996, Magnetic resonance in medicine.

[26]  J. Detre,et al.  Noninvasive magnetic resonance imaging evaluation of cerebral blood flow with acetazolamide challenge in patients with cerebrovascular stenosis , 1999, Journal of magnetic resonance imaging : JMRI.

[27]  D. Le Bihan,et al.  Cerebral hemodynamics in CADASIL before and after acetazolamide challenge assessed with MRI bolus tracking. , 2000, Stroke.

[28]  J A Frank,et al.  Assessment of whole-brain vasodilatory capacity with acetazolamide challenge at 1.5 T using dynamic contrast imaging with frequency-shifted burst. , 1997, AJNR. American journal of neuroradiology.

[29]  J. Allison,et al.  The rCBF response to Diamox in normal subjects and cerebrovascular disease patients. , 1987, Journal of neurosurgery.

[30]  Yihong Yang,et al.  Transit time, trailing time, and cerebral blood flow during brain activation: Measurement using multislice, pulsed spin‐labeling perfusion imaging , 2000, Magnetic resonance in medicine.

[31]  H. Ito,et al.  Cerebrovascular Reserve Capacity in Ischemia due to Occlusion of a Major Arterial Trunk: Studies by Xe‐CT and the Acetazolamide Test , 1992, Journal of computer assisted tomography.

[32]  Seong-Gi Kim Quantification of relative cerebral blood flow change by flow‐sensitive alternating inversion recovery (FAIR) technique: Application to functional mapping , 1995, Magnetic resonance in medicine.

[33]  H. C. Engell,et al.  Measurement of cerebral blood flow by intravenous xenon-133 technique and a mobile system. Reproducibility using the Obrist model compared to total curve analysis. , 1986, Neurological research.

[34]  H. Arai,et al.  Evaluation of the acetazolamide test. Vasoreactivity and cerebral blood volume. , 1995, Stroke.