Timing dependence of peripheral pulse-wave-triggered pulsed arterial spin labeling

Arterial spin labeling (ASL) has been developed into a useful technique that is capable of quantifying noninvasively local cerebral blood flow (CBF) using the water molecules in arterial blood as diffusible tracers. Pulsed ASL (PASL) is more strongly affected than continuous ASL (CASL) by cardiac pulsation, because the tag bolus is shorter than the cardiac cycle in most cases. No reports have yet clarified the effects of multiple cardiac phases on the quantification of CBF in PASL when triggering is used. Fourteen subjects participated in this study. Peripheral pulse-wave-triggered (PPWT)-ASL was performed at various time points at the carotid artery (delay 0 ms, second point, foot, peak and tail) and compared with nontriggered (NT)-ASL. Regions of interest (ROIs) were applied based on the anterior, middle and posterior cerebral artery (ACA, MCA, PCA) territories, and CBFs were compared among different time points and ROIs. PPWT-ASL strongly affects CBF values compared with NT-ASL in ACA and MCA territories, especially when measured at the foot of the carotid artery flow phase. CBF_NT was assumed to lie approximately between the minimum and maximum CBFs, with clear statistical significance in several ROIs at several time points of PPWT-ASL, and CBF_NT was assumed to resemble 'randomly triggered' PPWT-ASL. In conclusion, PPWT-ASL strongly affects CBF values compared with NT-ASL, particularly at the foot of the carotid artery flow in ACA and MCA territories.