Test–retest reliability of arterial spin labelling for cerebral blood flow in older adults with small vessel disease

• Published in: Translational stroke research Vol. 13; no. 4; pp. 583 - 594
• Main Authors: Binnie, Lauren R., Pauls, Mathilde M. H., Benjamin, Philip, Dhillon, Mohani-Preet K., Betteridge, Shai, Clarke, Brian, Ghatala, Rita, Hainsworth, Fearghal A. H., Howe, Franklyn A., Khan, Usman, Kruuse, Christina, Madigan, Jeremy B., Moynihan, Barry, Patel, Bhavini, Pereira, Anthony C., Rostrup, Egill, Shtaya, Anan B. Y., Spilling, Catherine A., Trippier, Sarah, Williams, Rebecca, Isaacs, Jeremy D., Barrick, Thomas R., Hainsworth, Atticus H.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.08.2022; Springer Nature B.V
• Subjects: Aged; Biomedical and Life Sciences; Biomedicine; Blood pressure; Brain - blood supply; Cardiology; Carotid arteries; Cerebrovascular Circulation - physiology; Clinical trials; Clinical Trials as Topic; Cognitive ability; Consent; Dementia; Education; Female; Females; Humans; Labeling; Leukoaraiosis; Magnetic Resonance Imaging - methods; Male; Medical imaging; Neurology; Neurosciences; Neurosurgery; Older people; Original; Original Article; Reproducibility of Results; Scanners; Software; Spin Labels; Transient ischemic attack; Vascular Surgery; White Matter - diagnostic imaging; Canada; Montreal Quebec Canada; Vascular aging; White matter lesions; Arterial spin labelling; Small vessel disease; Cerebral blood flow
• ISSN: 1868-4483; 1868-601X; 1868-601X
• DOI: 10.1007/s12975-021-00983-5

Cerebral small vessel disease (SVD) is common in older people and is associated with lacunar stroke, white matter hyperintensities (WMH) and vascular cognitive impairment. Cerebral blood flow (CBF) is reduced in SVD, particularly within white matter. Here we quantified test–retest reliability in CBF measurements using pseudo-continuous arterial spin labelling (pCASL) in older adults with clinical and radiological evidence of SVD (N=54, mean (SD): 66.9 (8.7) years, 15 females/39 males). We generated whole-brain CBF maps on two visits at least 7 days apart (mean (SD): 20 (19), range 7-117 days). Test–retest reliability for CBF was high in all tissue types, with intra-class correlation coefficient [95%CI]: 0.758 [0.616, 0.852] for whole brain, 0.842 [0.743, 0.905] for total grey matter, 0.771 [0.636, 0.861] for deep grey matter (caudate-putamen and thalamus), 0.872 [0.790, 0.923] for normal-appearing white matter (NAWM) and 0.780 [0.650, 0.866] for WMH (all p<0.001). ANCOVA models indicated significant decline in CBF in total grey matter, deep grey matter and NAWM with increasing age and diastolic blood pressure (all p<0.001). CBF was lower in males relative to females (p=0.013 for total grey matter, p=0.004 for NAWM). We conclude that pCASL has high test–retest reliability as a quantitative measure of CBF in older adults with SVD. These findings support the use of pCASL in routine clinical imaging and as a clinical trial endpoint. All data come from the PASTIS trial, prospectively registered at: https://eudract.ema.europa.eu (2015-001235-20, registered 13/05/2015), http://www.clinicaltrials.gov (NCT02450253, registered 21/05/2015).