Comparison of Quantitative Cerebral Blood Flow Measurements Performed by Bookend Dynamic Susceptibility Contrast and Arterial Spin-Labeling MRI in Relapsing-Remitting Multiple Sclerosis

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Fig 1.
Average CBF maps for 19 HC registered to a standard Montreal Neurological Institute template for pCASL (A) and bookend (B) techniques. Images are presented in sequential axial sections from the skull base to vertex.
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Fig 2.
A, Upper Row: voxelwise comparison of ROIs of pCASL versus bookend techniques by using Pearson correlations for mean HC CBF. Red lines indicate linear Pearson correlation fits. B, Lower row: Bland-Altman plots for each ROI. Horizontal axis shows the means of pCASL and bookend measurements in milliliters per 100 g per minute, and pCASL CBF minus bookend CBF is shown on the vertical axis in milliliters per 100 g per minute. The blue horizontal solid line represents the mean difference. The red horizontal lines represent the mean difference ± 2 SDs.
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Fig 3.
An example of a Brodmann area Pearson correlation for the right hemisphere of the RRMS-NI subject group. Each data point represents the average CBF intensity within 1 Brodmann area.

Table 1:

Demographic and clinical characteristics of HC and patients with RRMS^{^a}

Parameter	Healthy Controls (n = 19)	RRMS-NI (n = 19)	RRMS-I (n = 20)
Age (yr)	49.0 ± 7.1	46.4 ± 7.2	48.1 ± 4.7
Women (No.) (%)	14 (73.68)	15 (78.95)	12 (60)
Education (yr)	16.9 ± 2.9^{^b}	16.1 ± 1.3	14.6 ± 1.9^{^b}
Disease duration (yr)	NA	11.8 ± 5.4	11.6 ± 4.9
HADS-A (log; median [IQR])	3 (1, 6)^{^b,^c}	6 (5, 7)^{^c}	8 (7, 10)
HADS-D (log; median [IQR])	2.3 ± 2.3^{^b}	3.5 ± 3.2^{^d}	7.6 ± 2.9^{^b,^d}
EDSS (median [IQR])	NA	1.5 (1, 2)^{^d}	2.5 (2, 3)^{^d}
Cognitive tests (z score)
BVMT-R_IR	0.37 ± 1.15^{^b}	-0.07 ± 1.04^{^d}	−1.68 ± 1.34^{^b,^d}
BVMT-R_DR	0.40 ± 1.14^{^b}	0.42 ± 0.77^{^d}	−1.62 ± 1.48^{^b,^d}
COWAT_FAS	−0.67 ± 0.83	−0.26 ± 1.06^{^d}	−1.16 ± 0.89^{^d}
CVLT-II_IR	−0.25 ± 1.05^{^b}	−0.23 ± 1.04^{^d}	−1.94 ± 1.36^{^b,^d}
CVLT-II_DR	−0.11 ± 0.66^{^b}	0.21 ± 0.92^{^d}	−2.20 ± 1.61^{^b,^d}
PASAT-2	−0.21 ± 0.88^{^b}	−0.26 ± 0.66^{^d}	−1.80 ± 0.57^{^b,^d}
JLO	0.98 ± 0.19^{^b}	0.83 ± 0.59	0.40 ± 0.67^{^b}
SDMT	−0.14 ± 0.92^{^b}	0.02 ± 0.75^{^d}	−1.80 ± 1.17^{^b,^d}
DK-EFS	0.51 ± 0.73^{^b}	0.26 ± 0.61	−0.20 ± 1.25^{^b}

Note:—BVMT-R_IR indicates Brief Visuospatial Test-Revised_Immediate Recall: BVMT-R_DR, Brief Visuospatial Test-Revised_Delayed Recall; HADS-A, Hospital Anxiety; HADS-D, Hospital Depression; IQR, interquartile range; NA, not applicable; EDSS, Expanded Disability Status Scale; COWART_FAS, Controlled Oral Work Association Test_Word Recall; CLVT-II_IR, California Verbal Learning Test-Second Edition_Immediate Recall: CVLT-II_DR, California Verbal Learning Test-Second edition_Delayed Recall; PASAT-2, Paced Auditory Serial Addition-Part 2; JLO, Judgment of Line Orientation Test; SDMT, Symbol Digit Modalities Test; DK-EFS, Delis-Kaplan Executive Function System.
↵a Clinical demographics of participating patients. Significance P < .05. All values are mean ± SD unless specified.
↵b HC vs RRMS-I.
↵c HC vs RRMS-NI.
↵d RRMS-NI vs RRMS-I.

Table 2:

Voxelwise Pearson correlation^{^a}

	Slope	Corr. Coef. (r)	SE of r (±)	No. of Voxels	Fischer Z	P Value
HC
GM	0.56	0.56	0.02	4678	0.64	<.0001
WM	0.37	0.50	0.02	4421	0.57	<.0001
BG	0.90	0.73	0.04	392	0.98	<.0001
TH	0.56	0.61	0.08	197	0.75	<.0001
RRMS-NI
GM	0.57	0.57	0.02	4521	0.70	<.0001
WM	0.43	0.55	0.02	4324	0.66	<.0001
BG	0.70	0.65	0.05	356	0.82	<.0001
TH	0.76	0.70	0.06	192	0.90	<.0001
WML	0.61	0.60	0.03	1515	0.69	<.0001
CL	0.28	0.43	0.24	34	0.47	.005
RRMS-I
GM	0.41	0.46	0.02	4717	0.54	<.0001
WM	0.35	0.54	0.02	4501	0.64	<.0001
BG	0.64	0.68	0.05	367	0.86	<.0001
TH	0.43	0.59	0.08	204	0.70	<.0001
WML	0.48	0.65	0.03	1800	0.77	<.0001
CL	0.19	0.35	0.16	95	0.37	.0002

Note:—Corr. Coef. indicates correlation coefficient; SE, standard error of correlation coefficients.
↵a Summary of Pearson correlation coefficient, standard error of correlation coefficients, z scores, and P values for all subject groups and ROIs, for voxelwise analysis.

Table 3:

Coefficient of variation and SNR^{^a}

↵a Summary of mean difference of pCASL CBF minus bookend CBF (Bland-Altman plots, Fig. 2B), CV, and estimated SNR for all subject groups and ROIs.

Table 4:

Brodmann area Pearson correlation^{^a}

	Slope	Corr. Coef. (r)	SE of r (±)	Fischer Z	Standard Z	P Value
HC
Right	0.40	0.67	0.13	0.81	5.71	<.0001
Left	0.36	0.64	0.14	0.76	5.38	<.0001
RRMS-NI
Right	0.44	0.67	0.13	0.80	5.67	<.0001
Left	0.33	0.55	0.17	0.61	4.34	<.0001
RRMS-I
Right	0.33	0.68	0.12	0.83	5.89	<.0001
Left	0.33	0.57	0.16	0.65	4.57	<.0001