Articles Vol. 67 No. 2 02/03/2026

CHARACTERISTICS OF THE PENUMBRA AND HYPOPERFUSED LESIONS ON ARTERIAL SPIN LABELING PERFUSION SEQUENCES ACCORDING TO LARGE VESSEL OCCLUSION SITES IN ACUTE ISCHEMIC STROKE

Nguyen Thi Hong Luong1,2, Le Thi Hoa1,2, Tran Quang Trung3,4, Le Tuan Linh3,4,5,6, Hoang Dinh Au1,2,3,4
1 Central Geriatric Hospital
2 Bệnh viện Lão khoa Trung ương
3 Hanoi Medical University Hospital
4 Bệnh viện Đại học Y Hà Nội
5 Hanoi Medical University
6 Trường Đại học Y Hà Nội
DOI: 10.52163/yhc.v67i2.4406
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Keywords
MRI, Arterial spin labeling, Acute ischemic stroke, large vessel occlusion
Abstract

Objective: this study aims to describe arterial spin labeling (ASL) perfusion characteristics in acute ischemic stroke due to large vessel occlusion, according to the site of vascular obstruction.

Subjects and Methods: We conducted a cross-sectional study on 55 patients with LVO who underwent emergency MRI including DWI, TOF-MRA, and ASL. Infarct core volume, penumbra volume, and ASL hypoperfused volume were compared across vascular occlusion sites using the Kruskal–Wallis test. Ratios of penumbra-to-core and ASL-to-core volumes were calculated to assess the extent of perfusion mismatch.

Results: Infarct core volumes did not differ significantly among occlusion sites (p = 0.453). In contrast, penumbra volumes differed significantly, being largest in ICA and ICA+MCA occlusions and smallest in MCA occlusions (p = 0.030). ASL hypoperfused volume showed a borderline difference (p = 0.052). Both penumbra/core and ASL/core ratios differed significantly (p = 0.018 and 0.021), indicating greater perfusion mismatch in proximal occlusions compared with MCA occlusions.

Conclusion: ASL effectively distinguishes perfusion abnormalities according to the site of vascular occlusion. ASL is a valuable non-contrast technique for identifying hypoperfused but salvageable tissue in acute stroke.

References
[1]
B. C. Campbell et al., "Failure of collateral blood flow is associated with infarct growth in ischemic stroke," (in eng), J Cereb Blood Flow Metab, vol. 33, no. 8, pp. 1168-72, Aug 2013, doi: 10.1038/jcbfm.2013.77. Google Scholar
[2]
G. W. Albers et al., "Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging," (in eng), N Engl J Med, vol. 378, no. 8, pp. 708-718, Feb 22 2018, doi: 10.1056/NEJMoa1713973. Google Scholar
[3]
M. Goyal et al., "Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials," (in eng), Lancet, vol. 387, no. 10029, pp. 1723-31, Apr 23 2016, doi: 10.1016/s0140-6736(16)00163-x. Google Scholar
[4]
G. Zaharchuk, "Arterial spin labeling for acute stroke: practical considerations," (in eng), Transl Stroke Res, vol. 3, no. 2, pp. 228-35, Jun 2012, doi: 10.1007/s12975-012-0159-8. Google Scholar
[5]
A. Bivard et al., "Defining acute ischemic stroke tissue pathophysiology with whole brain CT perfusion," (in eng), J Neuroradiol, vol. 41, no. 5, pp. 307-15, Dec 2014, doi: 10.1016/j.neurad.2013.11.006. Google Scholar
[6]
R. Ukai et al., "Arterial transit artifacts observed by arterial spin labeling in Moyamoya disease," (in eng), J Stroke Cerebrovasc Dis, vol. 29, no. 9, p. 105058, Sep 2020, doi: 10.1016/j.jstrokecerebrovasdis.2020.105058. Google Scholar
[7]
R. G. Nogueira et al., "Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct," (in eng), N Engl J Med, vol. 378, no. 1, pp. 11-21, Jan 4 2018, doi: 10.1056/NEJMoa1706442. Google Scholar
[8]
G. Zaharchuk, "Arterial spin-labeled perfusion imaging in acute ischemic stroke," (in eng), Stroke, vol. 45, no. 4, pp. 1202-7, Apr 2014, doi: 10.1161/strokeaha.113.003612. Google Scholar