Multidelay Arterial Spin Labeling Versus Computed Tomography Perfusion in Penumbra Volume of Acute Ischemic Stroke

Background: Multidelay arterial spin labeling (ASL) is a novel perfusion method of ASL, with arterial transit time (ATT) calculated by multiple postlabeling delays to correct cerebral blood flow (CBF). We verify the accuracy of multidelay ASL in evaluating the ischemic penumbra and perfusion levels in patients with acute ischemic stroke, compared with computed tomography perfusion (CTP). Methods: Patients with acute ischemic stroke with anterior circulation large vessel occlusion received baseline CTP, multidelay ASL, and diffusion-weighted imaging (DWI) in succession. Multidelay ASL image was processed to reconstruct ATT, CBF without ATT correction, and CBF corrected by ATT. The consistency of hypoperfusion and ischemic penumbra volume calculated by CTP and multidelay ASL were quantified by intraclass correlation coefficient (ICC) in 2-way mixed effects, absolute agreement, and single measure. Wilcoxon signed-rank test was used to compare the difference in penumbra volume between CTP, corrected ASL, and uncorrected ASL. Results: Thirty patients were included. Hypoperfusion volume based on multidelay ASL with different thresholds were 117.95 (87.77–151.49) mL for corrected relative CBF<40%, 130.29 (85.99–249.37) mL for CBF corrected by ATT<20 mL·100g -1 ·min -1 , no statistical difference ( P >0.05) compared with the volume of CTP, and consistency was almost excellent (ICC, 0.91) and substantial consistent (ICC, 0.727). The volumes of ischemic penumbra were 91.00 (42.68–125.27) mL for corrected relative CBF<40%-DWI, 108.94 (62.03–150.86) mL for CBF corrected by ATT<20 mL·100 g -1 ·min -1 -DWI, which showed no statistical difference compared with the penumbra volume of CTP ( P >0.05). The consistency was excellent (ICC, 0.822) and moderate (ICC, 0.501), respectively. The volume of uncorrected relative CBF <40%-DWI was 209.57 (123.21–292.45) mL, statistically larger than corrected relative CBF <40%-DWI ( P <0.001) and CTP ( P <0.001). The volume of uncorrected CBF<20 mL·100g -1 ·min -1 -DWI was 186.23 (86.56–298.22) mL, statistically larger than CBF corrected by ATT<20 mL·100g -1 ·min -1 -DWI ( P <0.001) and CTP( P <0.001). Conclusions: The volume of ischemic penumbra determined by CBF/DWI mismatch based on multidelay ASL is consistent with CTP. The penumbra volume calculated by CBF adjusted by ATT is more accurate.