A novel 5-stage visual rating scale for global arterial spin labeling perfusion assessment in the brain: Simplifying evaluation for clinical implementation

Abstract

Objectives: The aim of this study was to develop and validate a visual rating scale for evaluating global arterial spin labeling (ASL) perfusion changes in the brain, with potential applications in a variety of conditions that impact general brain blood supply and perfusion. Methods: We employed a five-stage scale (0 being normal and 4 indicating the most severe perfusion decline) to assess 156 patients using a 3D pulsed ASL technique. Three radiologists independently reviewed the images, and inter-rater reliability of the visual rating scale was evaluated. Results: The ASL stages showed a consistent distribution among the patients. The inter-rater reliability among the three radiologists, as measured by the Intraclass Correlation Coefficient (ICC), was 0.982. Conclusion: Our findings suggest that this visual rating scale can be effectively implemented in everyday practice to evaluate global perfusion changes in the context of cardiovascular diseases, cerebrovascular diseases, cerebral small vessel disease, and other conditions that alter brain vascularization and perfusion. Further research is needed to explore the full range of clinical applications and to refine the scale for optimal utility.

Keywords

• Magnetic resonance imaging
• Arterial spin labeling (ASL)
• Cerebrovascular circulation
• Cerebral small vessel disease