原著_板垣先生.indd

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1 原著 O-PET MI ASLarterial spin labeling multiphase PLDpost labeling delay 要旨 MI arterial spin labelingasl arterial transit time SPECT PET ASL 20 multiple post-labeling delaypldasl O-PET CBF/CBV CBF PLD short PLD CBV CBF 10 PLD OC 5 phase PLD PLD 1000 area under curveauc 0.987p=0.001CBF 10 PLD 1000 ASL short PLD PLD 1000 ASL キーワード : ASL O-PETmultiple PLD はじめに MI arterial spin labelingasl 1 O-PET SPECT CBF 2, 3 ASL arterial transit timeatt 4 long PLD post labeling delay TEL: FAX: i.hiroshi19@gmail.com doi: /cbfm.28.2_273 short PLD O-PET 5 short PLD PLD PLD 2 PLD 5, 6 multiple PLD ASL O-PET ASL 対象と方法 ASL 5phase PLD1000, 00, 2000, 2500, 3000 msec O-PET

2 28 2 Fig. 1.3DST 3DSTthree-dimensional stereotacxic OI templatebe 48.2± MI ASL MI 3.0TDiscovery M 750W, GE pcaslpulsed continuous ASL labeling 3D fast spin echo 1, 7 PLD 1000, 00, 2000, 2500, 3000 msec 5 T 4640 msecfov 240 mm 4 mm O-PET PET SIEMENS Biograph LSO PET/CT FOV 300 mm mm O steady state 8, 9 C O 2 10 O 2 10 C O 2 C O 2 O PET OSEMordered subsets expectation maximizationcbf, CBV, CMO2, CBF/CBV ASL O-PET 3DSTthree-dimensional stereotaxic OI template 10 MCAmiddle cerebral artery BF Fig. 1 SPSS 20.0Windows OC 1 結果 ASL 5phase PLD O-PET Fig. 2 CBF/CBV Fig. 2A PLD 1000 msec r=0.77p<0.01 PLD 00 msec r=0.72p<0.01 PLD 2000 msec r=0.40p<0.01pld 2500 msec r=0.32p=0.89 PLD 3000 msec r=0.43p=0.06 CBF Fig. 2B PLD 1000 msec r=0.78 P<0.01 PLD 00 msec r=0.59p<0.01 CBF/CBV 3.34 CBF/CBV 1.13 PLD 1000 msec CBF PLD 2000 msec r=0.18p=0.44 PLD 2500 msec r=0.16p=0.49 PLD 3000 msec r=0.52p= 0.02 CBV Fig. 2C PLD 1000 msec r=0.62 P<0.01 PLD 00 msec r=0.66p<0.01 PLD 2000 msec r=0.38p=0.10 PLD 2500 msec r=0.04p=0.86 PLD 3000 msec r=0.39p=0.09 CMO 2 Fig. 2D PLD 1000 msec r=0.81p<0.01 PLD 00 msec r=0.74p<0.01 PLD 2000 msec r=0.45p=0.05 PLD 2500 msec r=0.02p= 0.95 PLD 3000 msec r=0.40p=

3 MI ASL multiphase PLD ASL (PLD1000msec) (%) y=1.13x-4.24 r=0.77(p<0.01) ASL (PLD00msec) y=0.78x r=0.72 (p<0.01) ASL (PLD2000msec) y=0.35x r=0.40 (p=0.08) ASL (PLD2500msec) y=-0.21x r=0.32 (p=0.89) ASL (PLD3000msec) y=-0.22x r=0.43 (p=0.06) A CBF/CBV (%) y=3.34x r=0.78 (p<0.01) y=1.87x r=0.59 (p<0.01) y=0.47x r=0.18 (p=0.44) y=-0.31x r=0.16 (p=0.49) y=-0.77x r=0.52 (p=0.02) B CBF y=-2.08x r=0.62 (p<0.01) y=-1.64x r=0.66 (p<0.01) y=-0.76x r=0.38 (p=0.10) y=0.07x r=0.04 (p=0.86) y=0.45x+53.3 r=0.39 (p=0.09) C CBV y=3.56x r=0.81 (p<0.01) y=2.42x r=0.74 (p<0.01) y=1.18x r=0.45 (p=0.05) y=0.03x r=0.02 (p=0.95) y=-0.30x+9.54 r=0.40 (p=0.09) D CMO2 Fig. 2. PLD ASL PET A: CBF-CBV ASL PLD msec B: CBF ASL PLD msec C: CBV ASL PLD msec D: CMO 2 ASL PLD msec Fig TIA FLAIFig. 3A MAFig. 3B Fig. 3C, D O-PET PLD ASL PLD 1000 msec 00 msec CBF/CBV CBF Fig. 4 PET-CBF 10 PLD OC 5 PLD 1000 msec AUCarea under curve 0.987P=0.001 PET-CBF 10 PLD 1000 msec ASL 考察 ASL ATT PLD 11 PLD msec 12 ATT short PLD CBF 5 ATT ASL O-PET Acomanterior communicating artery Pcomposte- 275

28 2 A B C D CBF CBF/CBV CBV CMO 2 OEF 1000 00 2000 2500 30

12 MI O-PET A: MI FLAI B: MA MCA C: O-PET MCA CBF/CBV, CBF, CMO 2 CBV OEF D: multiple PLD

4 28 2 A B C D CBF CBF/CBV CBV CMO 2 OEF Fig MI O-PET A: MI FLAI B: MA MCA C: O-PET MCA CBF/CBV, CBF, CMO 2 CBV OEF D: multiple PLD ALSPLD 1000, 00 msec CBF/CBV rior communicating artery short PLD CBF PLD ASL labeling pulse T1 signal/noise PLD 3.0TMI 3000 msec 14 ASL PLD 1000 msec O-PET CBF/CBV CBF PLD msec OC CBF 10 PLD 1000 msec ASL AUC 31 ASL ASL short PLD1000/00 msec CBF/CBV 1/ MTTmean transit time ASL perfusion CT MI TTPtime to peak MTT CMO 2 matched hypoperfusion CBF long PLD 3000 msec short PLD 276

5 MI ASL multiphase PLD CBF10% 左右差 10% 以上 PLD1000 PLD00 PLD2000 PLD 1000 msec ASL O-PET SPECT ATT COI 文献 1Williams DS, Detre JA, Leigh JS, Koretsky AP: Magnetic resonance imaging of perfusion using spin inversion of arterial water. Proc Natl Acad Sci USA 89: , Bokkers P, Bremmer JP, van Berckel BN, Lammertsma AA, Hendrikse J, Pluim JP, Kappelle LJ, Boellaard, Klijn CJ: Arterial spin labeling perfusion MI at multiple delay times: a correlative study with H 2 O positron emission tomography in patients with symptomatic carotid artery occlusion. J Cereb Blood Flow Metab 30: , Uchihashi Y, Hosoda K, Zimine I, Fujita A, Fujii M, Sugimura K, Kohmura E: Clinical application of arterial spinsensitivity PLD2500 PLD specificity AUC P=0.001 Fig. 4.CBF 10 PLD OC PLD 1000 msec AUC 0.987p=0.001CBF ±21.5 ATT 12 multiple PLD 16 multiple PLD ATT PLD ASL 4, 17 ASL PLD short PLD ASL SPECT PET multiple PLD 結語 20 5 PLD ASL O-PET short PLD 277

6 28 2 labeling M imaging in patients with carotid stenosis: quantitative comparative study with single-photon emission CT. AJN Am J Neuroradiol 32: 45 51, Yoshiura T, Hiwatashi A, Yamashita K, Ohyagi Y, Monji A, Takayama Y, Nagao E, Kamano H, Noguchi T, Honda H: Simultaneous measurement of arterial transit time, arterial blood volume, and cerebral blood flow using arterial spin-labeling in patients with Alzheimer disease. AJN Am J Neuroradiol 30: , MI ASLarterial spin labeling O-PET 2 in press 6Haga S, Morioka T, Shimogawa T, Akiyama T, Murao K, Kanazawa Y, Sayama T, Arakawa S: Arterial spin labeling perfusion magnetic resonance image with dual postlabeling delay: a correlative study with acetazolamide loading (123)I-iodoamphetamine single-photon emission computed tomography. J Stroke Cerebrovasc Dis 25: 1 6, Dai W, Garcia D, de Bazelaire C, Alsop DC: Continuous flow-driven inversion for arterial spin labeling using pulsed radio frequency and gradient fields. Magn eson Med 60: , Frackowiak S, Lenzi GL, Jones T, Heather JD: Quantitative measurement of regional cerebral blood flow and oxygen metabolism in man using O and positron emission tomography: theory, procedure, and normal values. J Comput Assist Tomogr 4: , Okazawa H, Yamauchi H, Sugimoto K, Takahashi M, Toyoda H, Kishibe Y, Shio H: Quantitative comparison of the bolus and steady-state methods for measurement of cerebral perfusion and oxygen metabolism: positron emission tomography study using O-gas and water. J Cereb Blood Flow Metab 21: , Takeuchi, Yonekura Y, Matsuda H, Konishi J: Usefulness of a three-dimensional stereotaxic OI template on anatomically standardised 99mTc-ECD SPET. Eur J Nucl Med Mol Imaging 29: , Yun TJ, Sohn CH, Han MH, Kang HS, Kim JE, Yoon BW, Paeng JC, Choi SH, Kim JH, Song IC, Chang KH: Effect of delayed transit time on arterial spin labeling: correlation with dynamic susceptibility contrast perfusion magnetic resonance in moyamoya disease. Invest adiol 48: , Campbell AM, Beaulieu C: Pulsed arterial spin labeling parameter optimization for an elderly population. J Magn eson Imaging 23: , Kimura H, Kado H, Koshimoto Y, Tsuchida T, Yonekura Y, Itoh H: Multislice continuous arterial spin-labeled perfusion MI in patients with chronic occlusive cerebrovascular disease: a correlative study with CO2 PET validation. J Magn eson Imaging 22: , Alsop DC, Detre JA: Multisection cerebral blood flow M imaging with continuous arterial spin labeling. adiology 208: , 1998 Schumann P, Touzani O, Young A, Morello, Baron JC, MacKenzie ET: Evaluation of the ratio of cerebral blood flow to cerebral blood volume as an index of local cerebral perfusion pressure. Brain 121 (Pt 7): , Martin SZ, Madai VI, von Samson-Himmelstjerna FC, Mutke MA, Bauer M, Herzig CX, Hetzer S, Günther M, Sobesky J: 3D GASE pulsed arterial spin labeling at multiple inflow times in patients with long arterial transit times: comparison with dynamic susceptibility-weighted contrast-enhanced MI at 3 Tesla. J Cereb Blood Flow Metab 35: , 20 17Wang, Yu S, Alger J, Zuo Z, Chen J, Wang, An J, Wang B, Zhao J, Xue, Wang DJ: Multi-delay arterial spin labeling perfusion MI in moyamoya diseasecomparison with CT perfusion imaging. Eur adiol 24: ,

7 MI ASL multiphase PLD Abstract The significance of multiple post-labeling delay for arterial spin labeling based on the comparison with O-PET Hiroshi Itagaki, Yasuaki Kokubo, Kanako Saso, Shinji Sato, Yuki Yamada, Shinya Sato, and Yukihiko Sonoda Department of Neurosurgery, Yamagata University Faculty of Medicine, Yamagata, Japan ecently, MI arterial spin labeling (ASL) is attracting attention as the noninvasive and convenient imaging technique to evaluate cerebral circulation. However, since there is a problem regarding to arterial transit time, it remains unclear that the reliability of this new modality is equivalent to the established one, such as SPECT or PET. In this study, we analyzed cerebral circulation for 20 cases with chronic ischemic cerebrovascular disease by multiple post-labeling delay (PLD) ASL and O-PET to determine if ASL can truly evaluate cerebral circulation. As the results, both CBF/CBV and CBF obtained by O-PET were significantly correlated with PLD (1000 and 00 msec) by ASL. In addition, there was significantly negative correlation between CBV by O-PET and PLD (1000 and 00 msec) by ASL. In the cases whose right-and-left difference of CBF was more than 10%, the receiver operating characteristic (OC) analysis of revealed area under curve (AUC) of PLD (1000 msec) was as the highest as (p=0.001) among all PLD. The cut off value of right-and-left difference by ASL PLD (1000 msec) was 31% in the cases whose right-and-left difference of CBF was more than 10%. The sensitivity and specificity of this analysis was 100% and 93.3%, respectively. In conclusion, we suggest that short PLD, especially PLD (1000 msec) reflects the cerebral perfusion pressure. Therefore, ASL could be useful for the screening of the cerebral circulation in cases of the chronic ischemic cerebrovascular disease. Key words: ASL, O-PET, multiple PLD, chronic ischemic cerebrovascular disease, cerebral perfusion pressure 279

０３７３１０　医用画像‐３２‐４／３２‐４‐特集１１‐一般総説‐藤原様

０３７３１０　医用画像‐３２‐４／３２‐４‐特集１１‐一般総説‐藤原様 862-0976 4-24-1 910-1193 23-3 2015 9 25 2015 10 13 MR perfusion Imaging using arterial spin labeling Yasuhiro FUJIWARA, Hirohiko KIMURA Department of Medical Imaging, Faculty of Life Sciences, Kumamoto