# Simultaneous multiple post-labelling delay ASL MRI and [18F]FDG PET in a mixed memory clinic population and healthy controls

## TL;DR

This study compares ASL MRI and FDG PET brain imaging in memory clinic patients and healthy controls, finding limited agreement between the two methods.

## Contribution

The study introduces multi-PLD ASL MRI in a mixed memory clinic population and evaluates its concordance with FDG PET.

## Key findings

- ASL CBF maps were non-comparable to FDG PET in 53% of patients and 37% of elderly controls.
- Z-score maps were useful in partially concordant scans, and sCOV predicted uninterpretable scans with high accuracy.

## Abstract

To assess the quantitative and visual concordance of multiple post-labelling delay (multi-PLD) arterial spin labelling (ASL) MRI cerebral blood flow (CBF) measurements and [18F]-fluoro-deoxyglucose (FDG) PET in a mixed memory clinic population.

Hybrid [18F]FDG PET/MRI including multi-PLD pseudo continuous ASL from 96 memory clinic patients and 38 elderly controls were analysed along with ASL data from 12 healthy young volunteers. ASL image interpretability, concordance with [18F]FDG PET, and value of Z-score maps were rated visually. Regional associations of CBF with [18F]FDG uptake ratio (SUVr) were investigated by univariate regression and mixed linear models. Also influences of age, disease stage and vascular pathology on ASL interpretability and concordance, and whole cortex spatial coefficient of variation (sCOV) were analysed.

ASL CBF maps were non-comparable to [18F]FDG PET, i.e. uninterpretable or discordant, in 53% of patients, 37% of elderly controls, and 8% of young controls. Only 14% of patient ASL MRI scans were concordant with [18F]FDG PET. Z-score maps were mainly of value in partially concordant scans. Increasing sCOV was strongly associated both with disease severity and with decreasing ASL interpretability and concordance, and allowed for identification of uninterpretable scans with 95% sensitivity and 90% specificity. Whole cortex CBF and [18F]FDG SUVr values showed similar distribution across groups, but low to moderate regional associations.

Multi-PLD ASL provided quantitative CBF measurements correlating with disease severity, but poor image quality and low regional concordance in head-to-head comparison with [18F]FDG PET imaging restricts the clinical use in memory clinic patients.

The online version contains supplementary material available at 10.1007/s00259-025-07736-8.