Traditional pulsed ASL (PASL) suffers from arterial transit delay (ATD) effects, often resulting in inaccurate perfusion measurements in cerebral ischemia. Velocity selective ASL (VSASL), on the other hand, accurately measures perfusion independent of ATD. In this study, we compare VSASL and PASL perfusion in 27 patients with suspected cerebral cortical ischemia. Normal perfusion on VSASL and PASL had nearly perfect negative predictive value for ischemia, abnormal PASL perfusion had a high false positive rate for ischemia (25-35%), and abnormal VSASL perfusion had a ~0% false positive rate for ischemia.
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