This review provides a summary statement of recommended implementations of arterial spin labeling (ASL) for clinical applications. It is a consensus of the ISMRM Perfusion Study Group and the European ASL in Dementia consortium, both of whom met to reach this consensus in October 2012 in Amsterdam. Although ASL continues to undergo rapid technical development, we believe that current ASL methods are robust and ready to provide useful clinical information, and that a consensus statement on recommended implementations will help the clinical community to adopt a standardized approach. In this review, we describe the major considerations and trade‐offs in implementing an ASL protocol and provide specific recommendations for a standard approach. Our conclusion is that as an optimal default implementation, we recommend pseudo‐continuous labeling, background suppression, a segmented three‐dimensional readout without vascular crushing gradients, and calculation and presentation of both label/control difference images and cerebral blood flow in absolute units using a simplified model. Magn Reson Med 73:102–116, 2015.

It is important to determine the longitudinal relaxation time of blood for black blood imaging, as well as for quantifying blood flow by arterial spin labeling (ASL). In this study a circulation system was used to measure blood T₁ under physiological conditions at the new clinical field strength of 3.0T. It was found that 1/T₁ in s⁻¹ was linearly dependent (P < 0.05) on hematocrit (Hct) within a normal range of 0.38–0.46. The relationships were 1/T₁ = (0.52 ± 0.15) · Hct + (0.38 ± 0.06) and 1/T₁ = (0.83 ± 0.07) · Hct + (0.28 ± 0.03) for arterial (oxygenation = 92% ± 7%) and venous blood (69% ± 8%), respectively, which led to estimated T₁ values of 1664 ± 14 ms (arterial) and 1584 ± 5 ms (venous) at a typical human Hct of 0.42. The temperature dependencies of blood T₁ were 22.3 ± 0.6 ms/°C and 19.8 ± 0.8 ms/°C for Hct values of 0.42 and 0.38, respectively. When a head coil transmit/receive setup was used, radiation damping caused a slight reduction (19 ms) of the measured T₁ values. Magn Reson Med 52:679–682, 2004.

For many diseases, including dementia, vascular diseases, neoplasms, and various psychiatric diseases, arterial spin labeling provides additional and complimentary information to that available from structural MR imaging. Arterial spin labeling (ASL) is a magnetic resonance (MR) imaging technique used to assess cerebral blood flow noninvasively by magnetically labeling inflowing blood. In this article, the main labeling techniques, notably pulsed and pseudocontinuous ASL, as well as emerging clinical applications will be reviewed. In dementia, the pattern of hypoperfusion on ASL images closely matches the established patterns of hypometabolism on fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) images due to the close coupling of perfusion and metabolism in the brain. This suggests that ASL might be considered as an alternative for FDG, reserving PET to be used for the molecular disease-specific amyloid and tau tracers. In stroke, ASL can be used to assess perfusion alterations both in the acute and the chronic phase. In arteriovenous malformations and dural arteriovenous fistulas, ASL is very sensitive to detect even small degrees of shunting. In epilepsy, ASL can be used to assess the epileptogenic...

There is a pressing need for techniques that can be used for the noninvasive assessment of response to therapy and staging of disease. As many pathological conditions are associated with disordered glucose metabolism, such as diabetes, stroke and cancer, Simon Walker-Samuel and his colleagues have developed a noninvasive MRI-based method for imaging glucose uptake in vivo termed glucose chemical exchange saturation transfer (glucoCEST). This potentially cost-effective approach does not require the use of radiolabeled glucose analogs or ionizing radiation and allows nonlabeled glucose to be imaged at physiological quantities. Tumors have a greater reliance on anaerobic glycolysis for energy production than normal tissues. We developed a noninvasive method for imaging glucose uptake in vivo that is based on magnetic resonance imaging and allows the uptake of unlabeled glucose to be measured through the chemical exchange of protons between hydroxyl groups and water. This method differs from existing molecular imaging methods because it permits detection of the delivery and uptake of a metabolically active compound in physiological quantities. We show that our technique, named glucose chemical exchange saturation transfer (glucoCEST), is sensitive to tumor glucose accumulation in colorectal tumor models and can distinguish tumor types with differing metabolic characteristics and pathophysiologies. The results of this study suggest that glucoCEST has potential as a useful and cost-effective method for characterizing disease and assessing response to therapy in the clinic.

During brain activation, local control of oxygen delivery is facilitated through microvascular dilatation and constriction. A new functional MRI (fMRI) methodology is reported that is sensitive to these microvascular adjustments. This contrast is accomplished by eliminating the blood signal in a manner that is independent of blood oxygenation and flow. As a consequence, changes in cerebral blood volume (CBV) can be assessed through changes in the remaining extravascular water signal (i.e., that of parenchymal tissue) without need for exogenous contrast agents or any other invasive procedures. The feasibility of this vascular space occupancy (VASO)‐dependent functional MRI (fMRI) approach is demonstrated for visual stimulation, breath‐hold (hypercapnia), and hyperventilation (hypocapnia). During visual stimulation and breath‐hold, the VASO signal shows an inverse correlation with the stimulus paradigm, consistent with local vasodilatation. This effect is reversed during hyperventilation. Comparison of the hemodynamic responses of VASO‐fMRI, cerebral blood flow (CBF)‐based fMRI, and blood oxygenation level‐dependent (BOLD) fMRI indicates both arteriolar and venular temporal characteristics in VASO. The effect of changes in water exchange rate and partial volume contamination with CSF were calculated to be negligible. At the commonly‐used fMRI resolution of 3.75 × 3.75 × 5 mm³, the contrast‐to‐noise‐ratio (CNR) of VASO‐fMRI was comparable to that of CBF‐based fMRI, but a factor of 3 lower than for BOLD‐fMRI. Arguments supporting a better gray matter localization for the VASO‐fMRI approach compared to BOLD are provided. Magn Reson Med 50:263–274, 2003.