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 > or =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 > or =3.2 s), the FAIR with intermediate or short TI showed underestimation of perfusion in the same area with delay in TTP.