ASL rapidly detects cerebral hypoperfusion induced by traumatic brain injury: two case rep

Abstract

  In traumatic brain injury, especially in serious cases, brain perfusion may decline and brain hypoxia may occur immediately after an injury. These symptoms are likely to enhance secondary brain injuries such as cerebral edema and cerebral hemorrhage. Therefore, an estimation of brain perfusion during the patient’s initial scan is crucial to predict his or her outcome. Single‒photon emission computed tomography is a traditional method for assessing perfusion and, more recently, arterial spin labeling (ASL) has been proposed as a non‒invasive perfusion technique using magnetic resonance imaging (MRI). ASL can be applied even in acute stages. In patients with mild or moderate brain injury, we have detected abnormal brain perfusion on initial MRI including ASL. In one of our two patients, ASL findings suggested low brain perfusion derived from traumatic cerebral vasospasm due to a mechanical injury of the vessel wall. Using ASL, we diagnosed the patients rapidly and were able to provide appropriate treatment. 1) We also used ASL in these patients’ follow‒up examinations. 2) ASL has traditionally been used for follow‒up examination.. The MRI protocol including ASL provides not only anatomical imaging but also perfusion imaging. ASL is highly useful in the acute clinical field.