Prognostic Utility of Arterial Spin Labeling in Traumatic Brain Injury: From Pathophysiology to Precision Imaging.

IF 2 Q3 CLINICAL NEUROLOGY
NeuroSci Pub Date : 2025-08-04 DOI:10.3390/neurosci6030073
Silvia De Rosa, Flavia Carton, Alessandro Grecucci, Paola Feraco
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Abstract

Background: Traumatic brain injury (TBI) remains a significant contributor to global mortality and long-term neurological disability. Accurate prognostic biomarkers are crucial for enhancing prognostic accuracy and guiding personalized clinical management.

Objective: This review assesses the prognostic value of arterial spin labeling (ASL), a non-invasive MRI technique, in adult and pediatric TBI, with a focus on quantitative cerebral blood flow (CBF) and arterial transit time (ATT) measures. A comprehensive literature search was conducted across PubMed, Embase, Scopus, and IEEE databases, including observational studies and clinical trials that applied ASL techniques (pCASL, PASL, VSASL, multi-PLD) in TBI patients with functional or cognitive outcomes, with outcome assessments conducted at least 3 months post-injury.

Results: ASL-derived CBF and ATT parameters demonstrate potential as prognostic indicators across both acute and chronic stages of TBI. Hypoperfusion patterns correlate with worse neurocognitive outcomes, while region-specific perfusion alterations are associated with affective symptoms. Multi-delay and velocity-selective ASL sequences enhance diagnostic sensitivity in TBI with heterogeneous perfusion dynamics. Compared to conventional perfusion imaging, ASL provides absolute quantification without contrast agents, making it suitable for repeated monitoring in vulnerable populations. ASL emerges as a promising prognostic biomarker for clinical use in TBI.

Conclusion: Integrating ASL into multiparametric models may improve risk stratification and guide individualized therapeutic strategies.

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动脉自旋标记在创伤性脑损伤中的预后应用:从病理生理学到精确成像。
背景:外伤性脑损伤(TBI)仍然是全球死亡率和长期神经功能障碍的重要因素。准确的预后生物标志物对于提高预后准确性和指导个性化临床管理至关重要。目的:本综述评估动脉自旋标记(ASL),一种无创MRI技术,在成人和儿童TBI中的预后价值,重点是定量脑血流量(CBF)和动脉传递时间(ATT)的测量。在PubMed、Embase、Scopus和IEEE数据库中进行了全面的文献检索,包括观察性研究和临床试验,这些研究和临床试验将ASL技术(pCASL、PASL、VSASL、多pld)应用于有功能或认知结果的TBI患者,并在损伤后至少3个月进行结果评估。结果:asl衍生的CBF和ATT参数显示了作为急性和慢性TBI预后指标的潜力。低灌注模式与较差的神经认知结果相关,而区域特异性灌注改变与情感性症状相关。多延迟和速度选择性ASL序列增强了非均匀灌注动力学的TBI诊断敏感性。与传统灌注成像相比,ASL无需造影剂即可提供绝对定量,适用于易感人群的重复监测。ASL是一种很有希望用于TBI临床预后的生物标志物。结论:将ASL纳入多参数模型可改善风险分层,指导个体化治疗策略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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