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AJNR - American Journal of Neuroradiology

Publication Preview: Published May 1, 2008

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American Journal of Neuroradiology
DOI 10.3174/ajnr.A1091

BRAIN

Cerebral Blood Flow by Using Pulsed Arterial Spin-Labeling in Elderly Subjects with White Matter Hyperintensities

A.J. Bastos-Leite, J.P.A. Kuijer, S.A.R.B. Rombouts, E. Sanz-Arigita, E.C. van Straaten, A.A. Gouw, W.M. van der Flier, P. Scheltens and F. Barkhof

From the Image Analysis Center (A.J.B.-L., F.B.), VU University Medical Center, Amsterdam, the Netherlands; Alzheimer Center (A.J.B.-L., E.C.v.S., A.A.G., W.M.v.d.F., P.S., F.B.), VU University Medical Center, Amsterdam, the Netherlands; Department of Medical Imaging (A.J.B.-L.), Faculty of Medicine, University of Oporto, Oporto, Portugal; Department of Physics and Medical Technology (J.P.A.K., S.A.R.B.R., E.S.-A.), VU University Medical Center, Amsterdam, the Netherlands; Department of Radiology (S.A.R.B.R.), Leiden Institute for Brain and Cognition, Leiden University Institute for Psychological Research, Leiden University Medical Center; Leiden, the Netherlands; Department of Neurology (E.C.v.S., A.A.G., W.M.v.d.F., P.S.), VU University Medical Center, Amsterdam, the Netherlands; and Department of Radiology (F.B.), VU University Medical Center, Amsterdam, the Netherlands.

Please address correspondence to António José de Bastos-Leite, MD, University of Oporto, Faculty of Medicine, Department of Medical Imaging, Alameda do Professor Hernâni Monteiro, 4200-319 Oporto, Portugal; e-mail: abastosleite{at}med.up.pt

BACKGROUND AND PURPOSE: On MR imaging, white matter hyperintensities (WMH) on T2-weighted images are generally considered as a surrogate marker of ischemic small vessel disease in elderly subjects. Pulsed arterial spin-labeling (PASL) is a noninvasive MR perfusion-weighted technique. We hypothesized that elderly subjects with diffuse confluent WMH should have lower cerebral blood flow (CBF) measurements than subjects with punctiform or beginning confluent WMH.

MATERIALS AND METHODS: MR images of 21 subjects (13 women; mean age, 76 years; SD, 5), stratified for the degree of WMH, from a single center within the multinational Leukoaraiosis and Disability (LADIS) study, were investigated. CBF images were obtained by means of quantitative imaging of perfusion by using a single-subtraction second version, with thin-section TI periodic saturation PASL. Values of cortical gray matter, subcortical (including white matter and deep gray matter), and global CBF were calculated. CBF measurements of subjects with diffuse confluent WMH (n = 7) were compared with those of subjects with punctiform or beginning confluent WMH (n = 14).

RESULTS: Subjects with diffuse confluent WMH were found to have approximately 20% lower mean global CBF (43.5 mL/100 mL/min; SD, 6.3) than subjects with punctiform or beginning confluent WMH (57.9 mL/100 mL/min; SD, 8.6; P < .01), as well as approximately 20% lower mean subcortical (P < .01) and cortical gray matter CBF (P < .05).

CONCLUSION: PASL revealed a significant reduction of CBF measurements in elderly subjects with diffuse confluent WMH.