Underestimation of cerebral perfusion on flow-sensitive alternating inversion recovery image: Semiquantitative evaluation with time-to-peak values

BACKGROUND AND PURPOSE: We assessed the underestimation of cerebral perfusion measured by the flow-sensitive alternating inversion recovery (FAIR) technique in patients with carotid stenosis and compared the technique with dynamic susceptibility contrast (DSC) MR images. MATERIALS AND METHODS: We studied 42 areas of decreased cerebral blood flow (CBF) using 3 FAIR images with different inversion times (TIs) in 42 consecutive patients with unilateral carotid stenosis of more than 50%. The width of decreased CBF area (wCBF) was qualitatively assessed. We analyzed the ratio of CBF (rCBF) and the time-to-peak (TTP) difference (dTTP) between the ipsilateral hemisphere to carotid stenosis and contralateral normal area using regions of interest (ROIs) at the same location. RESULTS: In the areas with more prolonged TTP (dTTP >= 3.2 s), the wCBF obtained from the FAIR images with TI of 1600 ms was smaller than those from the FAIR images with a TI of 800 ms and 1200 ms in all cases. The mean rCBF obtained from the FAIR images with a TI of 1200 ms was significantly lower than that obtained from the FAIR images with a TI of 1600 ms (P <.01) in the areas with more prolonged TTP. In the areas with less prolonged TTP (dTTP < 3.2 s), the wCBF and mean rCBF were not significantly different between the 2 FAIR images (TI, 1200 and 1600 ms). CONCLUSION: If TTP is delayed significantly (dTTP >= 3.2 s), the FAIR with intermediate or short TI showed underestimation of perfusion in the same area with delay in TTP.