Migraine Associated Cerebral Hyperperfusion with Arterial Spin-Labeled MR Imaging

Patient 1. A, Quantitative CBF map generated from the ASL sequence shows significant hyperperfusion (arrow) within the cortex of the right cerebral hemisphere corresponding to the signal intensity abnormalities on the conventional MR imaging sequences. Region of interest placed over the frontal gray matter shows a mean CBF in the right hemisphere of 128.9 compared with the left frontal hemisphere mean CBF of 56.6 mL/100 g tissue/min. B, Quantitative CBF map obtained 6 days after the initial examination shows resolution of the hyperperfusion within the cortex of the right frontal and parietal lobes. Mean gray matter CBF in the right and left frontal lobe decreased to 57.7 and 61.6 mL/100 g tissue/min, respectively.

Patient 2. A, Quantitative ASL CBF map shows regional hyperperfusion (arrows) in the medial occipital lobes on a background of global hyperperfusion in this patient who underwent imaging examination during a migraine episode. Mean gray matter CBF measured 162.2 and 138.7 mL/100 g tissue/min, respectively, in the medial left and right occipital cortex. B, Quantitative CBF map obtained 6 months after the migraine episode shows resolution of the regional hyperperfusion in the medial occipital lobes (arrowheads). The underlying global hyperperfusion also resolved. Mean gray matter CBF decreased from 162.2 to 107.5 mL/100 g tissue/min in the medial left occipital cortex and from 138.7 to 112.9 mL/100 g tissue/min in the medial right occipital cortex.