In vivo visualization of the PICA perfusion territory with super-selective pseudo-continuous arterial spin labeling MRI

• Published in: NeuroImage (Orlando, Fla.) Vol. 83; pp. 58 - 65
• Main Authors: Hartkamp, Nolan S., De Cocker, Laurens J., Helle, Michael, van Osch, Matthias J.P., Kappelle, L. Jaap, Bokkers, Reinoud P.H., Hendrikse, Jeroen
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2013; Elsevier Limited
• Subjects: ASL; Blood Flow Velocity; Cerebellar; Cerebellum - blood supply; Cerebellum - physiopathology; Cerebral Arteries - physiology; Cerebrovascular Circulation - physiology; Colonies & territories; Female; Humans; Image Enhancement - methods; Image Interpretation, Computer-Assisted - methods; Magnetic Resonance Angiography - methods; Male; Medical imaging; MRI; Perfusion; PICA; Reproducibility of Results; Sensitivity and Specificity; Spin Labels; Veins & arteries; Vertebral Artery - physiology; SCA; PICA; MRI; Perfusion; VBS; AICA; Cerebellar; ASL; CoW; VA; p-CASL; BA; basilar artery; vertebral artery; posterior inferior cerebellar artery; arterial spin labeling; pseudo-continuous ASL; anterior inferior cerebellar artery; vertebrobasilar system; circle of Willis; superior cerebellar artery
• ISSN: 1053-8119; 1095-9572; 1095-9572
• DOI: 10.1016/j.neuroimage.2013.06.070

In this work a method is described to discern the perfusion territories in the cerebellum that are exclusively supplied by either or both vertebral arteries. In normal vascular anatomy the posterior inferior cerebellar artery (PICA) is supplied exclusively by its ipsilateral vertebral artery. The perfusion territories of the vertebral arteries were determined in 14 healthy subjects by means of a super-selective pseudo-continuous ASL sequence on a 3T MRI scanner. Data is presented to show the feasibility of determining the PICA perfusion territory. In 10 subjects it was possible to accurately determine both PICA perfusion territories. In two subjects it was possible to determine the perfusion territory of one PICA. Examples in which it was not possible to accurately determine the PICA territory are also given. Additionally, the high variability of the extent of the PICA territory is illustrated using a statistical map. The posterior surface of the cerebellum is entirely supplied by the PICA in six subjects. The most posterior part of the superior surface is supplied by the PICA in eight subjects, and the inferior half of the anterior surface in six subjects. The inferior part of the vermis is supplied by the PICA in all subjects. Two subjects were found with interhemispheric blood flow to both tonsils from one PICA without contribution from the contralateral PICA. With the method as presented, clinicians may in the future accurately classify cerebellar infarcts according to affected perfusion territories, which might be helpful in the decision whether a stenosis should be considered symptomatic. •The feasibility of determining the PICA perfusion territory in vivo is shown.•The variations of PICA territories in normal vascular anatomy are examined.•The variations of PICA territories due to vascular variants are explored.