Comparison of global cerebral blood flow measured by phase-contrast mapping MRI with 15 O-H2 O positron emission tomography

Mark Bitsch Vestergaard, Ulrich Lindberg, Niels Jacob Aachmann-Andersen, Kristian Lisbjerg, Søren Just Christensen, Peter Rasmussen, Niels Vidiendal Olsen, Ian Law, Henrik Bo Wiberg Larsson, Otto Mølby Henriksen, Mark Bitsch Vestergaard, Ulrich Lindberg, Niels Jacob Aachmann-Andersen, Kristian Lisbjerg, Søren Just Christensen, Peter Rasmussen, Niels Vidiendal Olsen, Ian Law, Henrik Bo Wiberg Larsson, Otto Mølby Henriksen

Abstract

Purpose: To compare mean global cerebral blood flow (CBF) measured by phase-contrast mapping magnetic resonance imaging (PCM MRI) and by 15 O-H2 O positron emission tomography (PET) in healthy subjects. PCM MRI is increasingly being used to measure mean global CBF, but has not been validated in vivo against an accepted reference technique.

Materials and methods: Same-day measurements of CBF by 15 O-H2 O PET and subsequently by PCM MRI were performed on 22 healthy young male volunteers. Global CBF by PET was determined by applying a one-tissue compartment model with measurement of the arterial input function. Flow was measured in the internal carotid and vertebral arteries by a noncardiac triggered PCM MRI sequence at 3T. The measured flow was normalized to total brain weight determined from a volume-segmented 3D T1 -weighted anatomical MR-scan.

Results: Mean CBF was 34.9 ± 3.4 mL/100 g/min measured by 15 O-H2 O PET and 57.0 ± 6.8 mL/100 g/min measured by PCM MRI. The measurements were highly correlated (P = 0.0008, R2 = 0.44), although values obtained by PCM MRI were higher compared to 15 O-H2 O PET (absolute and relative differences were 22.0 ± 5.2 mL/100 g/min and 63.4 ± 14.8%, respectively).

Conclusion: This study confirms the use of PCM MRI for quantification of global CBF, but also that PCM MRI systematically yields higher values relative to 15 O-H2 O PET, probably related to methodological bias.

Level of evidence: 3 J. Magn. Reson. Imaging 2017;45:692-699.

Keywords: cerebral blood flow; phase-contrast mapping; positron emission tomography.

© 2016 The Authors Journal of Magnetic Resonance Imaging published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine.

Figures

Figure 1
Figure 1
Fusion and segmentation of structural MRI and CBF PET maps. The brain extracted 3D T1‐weighted structural MRI scan (a) was segmented into gray and white matter using FSL FAST (b) and coregistered to the CBF PET map (c) of the subject using PVElab software (d). Mean global CBF was calculated as the average of all brain voxels. Note spill‐out of PET signal not covered by the brain mask on the fused image.
Figure 2
Figure 2
Phase‐contrast measurements. (a) Example of lateral and anteroposterior maximal intensity projections of the carotid and vertebral arteries with the imaging plane visualized. (b) Example of velocity map measurement perpendicular to the carotids and vertebral arteries. The four arteries are clearly visible. In the lower panel examples of regions of interest (white contours) of the left (c) and right (d) carotid and vertebral arteries are demonstrated.
Figure 3
Figure 3
Agreement of CBF measurements. (a) Correlation between global cerebral blood flow (CBF) measured by 15O‐H2O PET and phase‐contrast mapping (PCM) MRI. (b) Bland–Altman plot showing difference against mean of the methods. Measurement by PCM MRI resulted in higher values compared to 15O‐H2O PET. The positive slope of the regression line of the Bland–Altman plot was significantly different from zero (P = 0.0014), indicating a perfusion‐dependent relative difference between CBF values obtained by the two methods.

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