ROLE OF 3D ASL TO STUDY PERFUSION CHANGES IN WHITE MATTER IN PATIENTS OF MILD TO MODERATE HYPERTENSION.

Dr. Ishan Dogra, Dr. Hitesh Kumar* and Dr. Esha Singh

ABSTRACT

Background: There is a global decrease in cerebral blood flow (CBF) in grey as well as normal appearing white matter in patients of hypertension. This hypoperfusion leads to development of leuko-ariosis over time in normal appearing white matter. The decreased perfusion in white matter (WM) in early stages of hypertension can be assessed by 3D pseudo-continuous Arterial Spin Labeling (pCASL) even when it appears normal on conventional MRI sequences. Methods :It was as a hospital based analytic cross sectional study based on 60 patients divided into two groups, 30 patients in each (hypertensive and non-hypertensive) to study perfusion changes by 3D ASL MRI, in patients of hypertension and whether Perfusion parameters correlate better with Systolic blood pressure(SBP) or Diastolic blood pressure(DBP). Results: ASL parameters decreased with increasing SBP across the spectrum of normal and high BP. In subjects with hypertension, there appeared to be a window of optimal mid-range SBP where brain perfusion was the highest. Statistically significant negative association was observed between SBP and Right centrum semiovale (-0.423) and Left centrum semiovale (-0.423) while statistically significant positive association was seen between DBP and Left posterior horn of periventricular white matter. Positive correlation was seen between SBP and Right posterior horn of periventricular grey matter, Left posterior horn of periventricular white matter only. Conclusion:.3D ASL is a non invasive technique and has the ability to detect subtle White Matter hemodynamic abnormalities even at the early stage of hypertension, even when these white Matter regions appear normal in conventional MR images. Hence with ASL, early management can be initiated to prevent the catastrophic events occurring in late stages of hypertension.

Keywords: 3D ASL, Perfusion Changes, White Matter, Mild to moderate Hypertension.