The actual gold standard stroke risk assessment is cerebral blood flow (CBF) measured with [15O]-H2O-PET, which is available only in few specialized centers and requires ~1mSv radioactive dose.
Otherwise, quantitative CVR measurements derived (with our temporal decomposition iterative algorithm) from Blood-Oxygen-Level-Dependent (BOLD) fMRI with CO2 challenge might apply as a surrogate imaging-marker for hemodynamic failure, as the <7 minutes acquisition can easily be clinically implemented, and has – as proved in this study – twice higher specificity*sensitivity for staging hemodynamic failure in chronic cerebrovascular steno-occlusive diseases than PET.
Therefore, BOLD CVR shall be widely implemented for assessing stroke risk.
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