Clinical usefulness of multiphase arterial spin labeling imaging for evaluating cerebral hemodynamic status in a patient with symptomatic carotid stenosis by comparison with single-photon emission computed tomography: A case study

Multiphase arterial spin labeling (ASL), which obtains the imaged slices with various postlabeling delays, allows for the noninvasive assessment of cerebral hemodynamics that cannot be adequately acquired by single-photon emission computed tomography (SPECT) imaging. We describe the clinical usefulness of multiphase ASL in a patient with symptomatic carotid stenosis by comparison with SPECT at rest using iodoamphetamine. A 75-year-old man was referred to our hospital with severe stenosis of the left internal carotid artery (ICA). While SPECT showed no significant laterality of cerebral blood flow (CBF), multiphase ASL demonstrated relatively delayed perfusion in the left ICA territory. The patient underwent stent placement for the left ICA stenosis. Postoperatively, while SPECT demonstrated no significant laterality of CBF, multiphase ASL revealed improved perfusion in the left ICA territory. This case showed that multiphase ASL could accurately evaluate the cerebral hemodynamic status which could not be detected using pre- and postoperative SPECT.