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Arterial spin labeling for head and neck lesion assessment: technical adjustments and clinical applications

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Abstract

Purpose

Despite, currently, “state-of-the-art” magnetic resonance imaging (MRI) protocols for head and neck (H&N) lesion assessment incorporate perfusion sequences, these acquisitions require the intravenous injection of exogenous gadolinium-based contrast agents (GBCAs), which may have potential risks. Alternative techniques such as arterial spin labeling (ASL) can provide quantitative microvascular information similar to conventional perfusion sequences for H&N lesions evaluation, as a potential alternative without GBCA administration.

Methods

We review the existing literature and analyze the latest evidence regarding ASL in H&N area highlighting the technical adjustments needed for a proper ASL acquisition in this challenging region for lesion characterization, treatment monitoring, and tumor recurrence detection.

Results

ASL techniques, widely used for central nervous system lesions evaluation, can be also applied to the H&N region. Technical adjustments, especially regarding post-labeling delay, are mandatory to obtain robust and reproducible results. Several studies have demonstrated the feasibility of ASL in the H&N area including the orbits, skull base, paranasal sinuses, upper airway, salivary glands, and thyroid.

Conclusion

ASL is a feasible technique for the assessment of H&N lesions without the need of GBCAs. This manuscript reviews ASL’s physical basis, emphasizing the technical adjustments necessary for proper ASL acquisition in this unique and challenging anatomical region, and the main applications in evaluating H&N lesions.

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Authors and Affiliations

  1. MRI Unit, Radiology Department, HT Medica, Carmelo Torres 2, 23007, Jaén, Spain

    Teodoro Martín-Noguerol & Antonio Luna

  2. Department of Radiology, Northwell Health, Zucker Hofstra School of Medicine At Northwell, North Shore University Hospital, 300 Community Drive, Manhasset, NY, 11030, USA

    Claudia F. E. Kirsch

  3. Philips Iberia, Calle de María de Portugal, 1, 28050, Madrid, Spain

    Paula Montesinos

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  1. Teodoro Martín-Noguerol
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  2. Claudia F. E. Kirsch
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  3. Paula Montesinos
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  4. Antonio Luna
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Correspondence to Teodoro Martín-Noguerol.

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Conflict of interest

The authors declare conflict of interest.

Claudia Kirsch is a consultant of Primal Pictures 3D Anatomy-Informa and receives royalties. Paula Montesinos, PhD, is a clinical scientist of Philips Iberia. Antonio Luna, MD, PhD, is an occasional lecturer of Philips, Siemens Healthineers, Bracco, and Canon and receives royalties as book editor from Springer-Verlag.

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Video 1 Scheme with necessary steps for ASL acquisition. Labeling plane is usually located at CCA and encompass an inversion pulse that conditions a change in blood water molecules spin magnetization. After spins are labeled, a time labeling delay must be waited till tagged blood reaches the anatomical region of interest. The readout sequence, acquired after the PLD time, can detect and read the changes in local tissue magnetization that labeled blood induces. (MP4 1333 KB)

Video 2 Scheme with different types of ASL acquisitions. CASL uses a large duration narrow labeling plane with a large readout FOV. PCASL uses a train of short RF and gradient pulses with a reduced readout FOV. PASL uses a single large label plane for a short time with a reduced FOV. (MP4 1326 KB)

Video 3 Invasive orbital melanoma. 90 y–o female with a large mass on the left globe underwent an MRI study. (a) Axial STIR image confirms the presence of a large ill-defined mass that invades the left globe. (b) Overlay of axial T1 FFE and TBF map from pCASL shows a severe increase of TBF within the globe mass. (c) Axial contrast-enhanced water only T1 Dixon shows patchy enhancement of the lesion (arrows). (d) Relative enhancement map from DCE-MRI sequence demonstrates a marked increase of perfusion within the lesions. Notice the comparable results regarding the degree of perfusion increase within the mass on both pCASL and DCE-MRI sequences. (MP4 961 KB)

Video 4 Autoimmune Thyroiditis. 20 y–o female with neck pain. Diffuse increase of thyroid gland is identified on axial STIR image (upper left corner of the video). Using a PLD of 1000 ms (right scheme), a better identification of patchy areas of blood flow increase within the thyroid is achieved (arrows), as the thyroid gland is near to labeling and readout planes so labeled blood can be detected in comparison to 1800 ms acquisition (left scheme) whereas labeling effect disappears if large PLD is waited. (MP4 3334 KB)

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Martín-Noguerol, T., Kirsch, C.F.E., Montesinos, P. et al. Arterial spin labeling for head and neck lesion assessment: technical adjustments and clinical applications. Neuroradiology 63, 1969–1983 (2021). https://doi.org/10.1007/s00234-021-02772-1

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