Imaging Pulmonary Blood Flow Using Pseudocontinuous Arterial Spin Labeling (Pcasl) With Balanced Steady-State Free-Precession (Bssfp) Readout At 1.5t

Background Quantitative assessment of pulmonary blood flow and visualization of its temporal and spatial distribution without contrast media is of clinical significance. Purpose To assess the potential of electrocardiogram (ECG)-triggered pseudocontinuous arterial spin labeling (PCASL) imaging with balanced steady-state free-precession (bSSFP) readout to measure lung perfusion under free-breathing (FB) conditions and to study temporal and spatial characteristics of pulmonary blood flow. Study Type Prospective, observational. Subjects Fourteen volunteers; three patients with pulmonary embolism. Field Strength/Sequences 1.5T,PCASL-bSSFP. Assessment The pulmonary trunk was labeled during systole. The following examinations were performed: 1) FB and timed breath-hold (TBH) examinations with a postlabeling delay (PLD) of 1000 msec, and 2) TBH examinations with multiple PLDs (100-1500 msec). Scan-rescan measurements were performed in four volunteers and one patient. Images were registered and the perfusion was evaluated in large vessels, small vessels, and parenchyma. Mean structural similarity indices (MSSIM) was computed and time-to-peak (TTP) of parenchymal perfusion in multiple PLDs was evaluated. Image quality reading was performed with three independent blinded readers. Statistical Tests Wilcoxon test to compare MSSIM, perfusion, and Likert scores. Spearman's correlation to correlate TTP and cardiac cycle duration. The repeatability coefficient (RC) and within-subject coefficient of variation (wCV) for scan-rescan measurements. Intraclass correlation coefficient (ICC) for interreader agreement. Results Image registration resulted in a significant (P < 0.05) increase of MSSIM. FB perfusion values were 6% higher than TBH (3.28 +/- 1.09 vs. 3.10 +/- 0.99 mL/min/mL). TTP was highly correlated with individuals' cardiac cycle duration (Spearman = 0.89,P< 0.001). RC and wCV were better for TBH than FB (0.13-0.19 vs. 0.47-1.54 mL/min/mL; 6-7 vs. 19-60%). Image quality was rated very good, with ICCs 0.71-0.89. Data Conclusion ECG-triggered PCASL-bSSFP imaging of the lung at 1.5T can provide very good image quality and quantitative perfusion maps even under FB. The course of labeled blood through the lung shows a strong dependence on the individuals' cardiac cycle duration. Level of Evidence 2 Technical Efficacy Stage 2