A new inflow based VASO fMRI method was designed that greatly increased SNR and CNR with respect to the conventional VASO approach, which suffers from low SNR due to the small residual tissue signal after a non-selective inversion. Recently, there have been several efforts to design VASO approaches with higher SNR. One approach in which VASO SNR can be enhanced by 50-60% is by acquiring data at a time that blood is not nulled (
46-
48). However, the theoretical description of those methods becomes more sophisticated, mainly due to the need to include substantial intravascular BOLD effects. Another method achieved SNR enhancement of about 40% by using magnetization transfer (MT) effects to accelerate T
1 recovery of tissue signal (MT-VASO) (
49). However, MT-VASO has increased RF power deposition, which may become a limiting factor at high magnetic fields. As another alternative, Jin and Kim proposed the use of a narrow slab-selective inversion (SI-VASO) (
2) including the imaging slice, allowing SNR to be magnified by about 70%. The key in SI-VASO is to choose the slab thickness so that all blood water spins flowing into the imaging slice are fresh and experience only one inversion pulse before leaving the imaging slice, allowing images to be acquired at the equilibrium TI, which is longer than the steady state TI. However, fulfillment of such condition depends on various experimental and physiological parameters.
All current VASO approaches invert the tissue signal in the imaging slice, a fundamental constraint for SNR. In iVASO, the tissue signal is not affected by the blood-nulling preparation and SNR and CNR do not depend on the difference between T
1 of blood and tissue. At 3T, iVASO showed a 3-4 times higher SNR than VASO, a factor that is expected to increase with field strength, where diminishing T
1 difference will adversely affect the other VASO approaches. The two techniques measure complementary contrasts in that iVASO reflects predominately arteriolar effects and VASO total CBV. The arteriolar blood volume is only about 20% of total CBV at baseline. Therefore, even though relative increases in blood volume are reportedly much larger in arterioles than in capillaries and venules (
5,
6,
8,
9,
12,
13), the size of the signal change is reduced in absolute magnitude. Despite this, there is an overall CNR increase of 20-40% in iVASO with respect to VASO. In addition, a temporal resolution up to 1s could be achieved for iVASO, which is not possible in VASO due to overwhelming fresh blood effects that cancel out the small negative signal change at short TR (
21). Even though such fresh blood effects still affect the iVASO signal change at short TR (see Technical Considerations), they are less detrimental as for VASO due to the larger tissue signal in iVASO.
The fact that blood nulling in iVASO is achieved without inverting the imaging slice may be advantageous when detecting blood volume effects in diseased tissue. For instance, T1 increases have been found in many pathologies (cancer, ischemia), rendering it difficult to separate disease tissue from blood that also has a long T1 when using conventional VASO.
Another advantage of not inverting tissue signal is a strong reduction in partial volume effects with CSF and WM. Assuming a typical scenario of 10.5% CSF (
19) for GM voxels, our simulations show a decrease in Δ
S/S magnitude by about 10% (). This effect increases with TR, but still less than the experimental error range for TR<3s. In VASO, on the other hand, this same partial volume contribution increases Δ
S/S magnitude by 15-50% in our simulations, in line with previous reports (
19). The main reason for this large discrepancy between the methods is that, in iVASO, the CSF magnetization is positive with a short-TR magnitude much smaller than that of the GM magnetization, while, in VASO, the CSF magnetization is negative with an absolute magnitude that is larger than that of the positive GM magnetization (
19). When including increases or decreases in CSF volume during activation (), the size of the iVASO effects changes more dramatically at short TR but not at long TR. For instance, for a 2% change in CSF volume, the effect on signal change during activation can be up to 25%. Nevertheless, when comparing the experimental data with the simulations (), the data fall close to the curve for 10.5% CSF contamination with no CSF change upon activation. At TR of 1s, simulations show that a 6% CSF volume reduction during activation would result in a slightly positive Δ
S/S. Our measured Δ
S/S was significantly negative (P<0.01), which seems to imply that such large CSF volume reduction is not likely in the cortical regions that we were measuring. For WM, the magnetization is positive in both iVASO and VASO, and partial volume effects reduce Δ
S/S in both approaches. However, the WM magnetization is comparable in magnitude to that of GM in iVASO, while it is about three times more intense than GM magnetization in VASO, which leads to a more noticeable partial volume effect (
19).
Signal origins and spatial and temporal specificity
The signal origin of the proposed iVASO approach is different from the conventional VASO technique. Despite simulations showing negligible effects of exchange (
1), conventional VASO has been criticized in that exchange of water protons between tissue and blood may affect CBV quantification because capillary and venular spins may not be perfectly nulled. A major advantage of iVASO is that a proper choice of TR range () allows it to be predominantly sensitive to arteriolar blood effects, where no exchange between blood and tissue can occur due to limited permeability of the vessel wall. At longer TR/TI, the inflowing blood water spins may reach the capillary bed where exchange can occur. However, considering the fact that the longest iVASO TI at 3T is about 1.1s and typical arterial transit times are 0.8-1s, the inflowing spins can be in the capillaries for at most 300ms by the time images are acquired. On the other hand, the water exchange between capillary blood and tissue does not occur instantaneously, but takes on average 0.5-1s (
50,
51). These all imply that the exchange effect in iVASO should be very small, although further investigation is needed to incorporate this effect in the equations and quantify its contribution to the overall iVASO signal change.
In general, the interpretation of iVASO signal changes is complicated by vascular transit time effects that are strongly TR/TI dependent. However, an optimal TI/TR range of 1.5–2.5s could be derived for which the arteriolar blood volume effect is dominant (Eqs. [
3a,
b]), and at which partial volume effects from WM and CSF () are minor. Using these equations for our data at TR=2s, a Δ CBV
a/CBV
a of 58 ± 7% (mean ± SD, n=7) could be estimated. This arteriolar volume change is consistent with the range of values reported in previous studies, including MRI in animal (79% (
5), 41% (
9), 46% (
11), 35% (
12)), MRI in humans (33% (
7), 61% (
10)), and high resolution optical imaging studies (59% (
4), 39% (
6), 37% (
8)).
Depending on the inflow time, the blood nulled in iVASO includes blood in arterial vessels of all sizes as well as in capillaries before the blood water exchanges with tissue water. As neuronal activation related vasodilation occurs mostly in microvasculature (
52), the signal change in iVASO is expected to reflect predominately arteriolar blood effects at short TR (<2.5s where
TI ≈ {Δ + δ
a}
act) and will contain some capillary blood effects at longer TR. When very high spatial resolution is available (such as in the animal studies by Kim et al. (
2,
9,
12)), iVASO should be able to provide arteriolar/capillary specificity. However, for the typical human fMRI resolution we used in this study (3mm isotropic voxel), even though the mechanistic specificity is arteriolar and capillary, the experimental spatial specificity for iVASO is expected to be similar to VASO, in which total microvascular blood volume changes are measured (
1,
2). This is confirmed by the finding of comparable numbers of activated voxels () and similar appearance of the activation maps () between the two methods.
The iVASO hemodynamic response for visual stimulation at TR=2s was significantly faster and returned to baseline more rapidly than the one for conventional VASO, which provides additional support for the arteriolar origin of the iVASO contrast in the optimal TR range. The half maximum time difference (1.23-1.53s) between iVASO and VASO responses probably reflects the difference in delay between arteriolar and combined (average) microvascular compartments. This accords with recent high-resolution optical imaging results in rat somatosensory cortex (
8), where prompt stimulus onset and post-stimulus decay in the arteriolar response and delayed return in capillary and venular compartments were observed. Vanzetta et al (
53) reported a uniform lag (~0.5-1s) of blood volume change in capillaries, venules and veins after the arterioles and arteries in the cat superficial cortical vasculature. They also observed that the response of larger arteries is slower than that of arterioles, which strengthens our belief that large artery dilation has limited contribution to the iVASO signal change during visual stimulation.
A major limitation of the current iVASO approach is that estimation of CBV
a changes requires the derivation of an optimal TR/TI range based on a priori knowledge of the arterial transit time (Δ + δ
a) and CBF (
Eq. [4]). Depending on the cortical region studied, the optimal TR/TI range would need to be adjusted accordingly. Therefore, in general, the application of the current iVASO approach seems to be confined to detecting predominantly CBV
a-weighted signal changes. For more accurate CBV
a quantification, it will be necessary to perform multiple experiments with different TR/TI and numerically fit the signal changes to the exact theory, which is the topic of future work. Besides, due to the existence of residue arterial blood at the optimal TI, it is possible that the temporal and spatial responses in iVASO may not be exactly the same as the actual physiological CBV
a change. This potential discrepancy remains to be investigated and characterized at a higher spatial resolution and possibly with the aid from multi-modality neuroimaging techniques such as optical imaging.
Comparison of iVASO and ASL
There are multiple MRI approaches to measure CBF and CBV effects and most of these use inversion approaches. Actually, the preparatory inversion schemes in iVASO are similar to those used in the labeling scans of some ASL techniques such as EPISTAR (
22), PICORE (
23), DIPLOMA (
24), UNFAIR (
25,
26), EST (
27), and IDOL (
28). However, ASL and iVASO differ fundamentally with respect to the contrast mechanism used. ASL measures tissue perfusion based on the exchange between magnetically labeled blood water spins and tissue water spins in the capillary bed. As such, its quantification is hampered by residual arteriolar blood label, which can be eliminated using crusher gradients or a long post-labeling delay (
29-
31). VASO employs blood labeling (nulling) to monitor changes in blood volume. Particularly, by using a short delay (TI<1s), iVASO is designed to be predominantly sensitive to arterial blood effects, where no exchange between blood and tissue can occur due to limited permeability of the vessel wall. Besides, iVASO images are acquired only at the blood nulling time, so that the vascular contribution is highlighted.
Comparison of iVASO and existing CBVa methods
Noninvasive determination of CBV
a has been shown to be possible by using ASL techniques with and without crusher gradients (
54-
57). A more recent approach (
7,
10) combines pulsed ASL (PASL) with Look-Locker echo-planar imaging (LL-EPI) with high flip angle and short pulse spacing to accelerate the acquisition while suppressing the tissue perfusion signal and quantifying CBV
a with an intravoxel arterial signal model at a temporal resolution of 6s. The modulation of tissue and vessel (MOTIVE) (
58) method exploits the difference in MT effects between tissue and blood to modulate tissue signal and calculate CBV
a and CBF. A model-free ASL approach named quantitative STAR labeling of arterial regions (QUASAR) (
57) employs deconvolution like that used in dynamic susceptibility contrast (DSC) MRI to calculate CBV
a and CBF. While all these approaches have been demonstrated useful in various applications, they all involve acquiring two series (label and control) of images at different post-labeling time and sophisticated numerical post-processing procedures including fitting to a quantitative model or deconvolution. On the other hand, the proposed iVASO approach in this paper, which employs inversion recovery to zero out blood signal in order to monitor blood volume alteration, does not require a control scan and acquires images only at the blood nulling TI. When detection of a relative CBV
a change is the only requirement, for instance for detecting neuronal activity or impaired perfusion in diseases, iVASO is expected to provide a useful alternate with improved SNR/CNR and temporal resolution (up to 1 s).
Technical Considerations
It is important to discuss the effects from fresh inflowing blood on the blood magnetization steady state in VASO and iVASO, which may lead to an erroneously large Δ
S/S (
19,
21). A recent VASO study (
21) has shown that for the blood water spins to experience sufficient inversion pulses for reaching steady state when entering the imaging slice in the cortex, the thickness of the inversion slab below imaging slice has to be greater than 150mm for TR longer or equal than 2s. In our iVASO experiments, the inversion slab is 7mm below the bottom of imaging slice and at least 150mm thick (body coil excitation), which is expected to cover the large arteries (e.g. carotid arteries) as well as smaller arteries proximal to arterioles, which have a large heterogeneity of flow velocity and trajectory. In addition, as the static tissue signal in iVASO is much larger than that in VASO, the influence from fresh inflowing blood should be smaller. Therefore, the contamination from fresh inflowing blood in iVASO is expected to be minimal, especially for TR of 5s and 2s. This is reflected in , which shows a reasonable match between the measured Δ
S/S and theory developed for steady state inflowing blood. Furthermore, such fresh blood effects can be alleviated by applying spatially non-selective saturation following the readout module (
47,
59), which resets the magnetization in all blood so that steady state is built immediately after the first TR. To evaluate the residual influence from fresh inflowing blood in our experiments, we repeated the visual stimulation experiments with iVASO sequence IIb on 3 subjects using a 90° RF pulse followed by crusher gradients immediately after the imaging module. The average Δ
S/S from voxels activated for all TRs were −0.83±0.11%, −0.62±0.09% and −0.27±0.10% for TR of 5s, 2s and 1s, respectively. Only Δ
S/S from the shortest TR (1s) showed a trend of being smaller (P<0.1) in absolute magnitude than the value measured without the global saturation after readout (−0.33±0.09%, see Results for ). It is therefore recommended to incorporate this magnetization reset (
47,
59) technique in short-TR iVASO sequences in order to minimize the contamination from fresh inflowing blood.
Three different preparatory inversion schemes (I, IIa, IIb) were compared with respect to nulling inflowing blood while leaving the static tissue in the imaging slice unaffected. Sequence I is the simplest with only one inversion pulse. Based on recent work, the thickness of the inversion slab has to be greater than 150mm to ensure the inverted inflow blood being in steady state (
21). However, such a broad slab results in less sharp edges of the inversion profile, requiring the use of a wider gap between the inversion slab and imaging slice. In sequence II, the gap can be narrower since the flip-back slab is much slimmer. Both sequences I and IIb ensure that only blood flowing in from the inferior direction is nulled. In sequence IIa, blood from both superior (mostly venous) and inferior (mostly arterial) direction is nulled, which may introduce some venous inflow effects, as confirmed by signal detected in the sagittal sinus. However, this is not expected to affect Δ
S/S as large-vessel venous flow is not expected to change during activation (
5,
6,
8,
9,
12,
13), an expectation borne out by the result of comparable signal changes for all three iVASO pulse sequences ().
BOLD effects reduce the negative signal change detected in both iVASO and VASO. In iVASO, where the signal change is only a few tenths of a percent while the blood in capillaries and venules is not nulled, the combined intra and extravascular BOLD contribution can be detrimental. When performing the same functional experiments with a gradient echo (GE) echo planar imaging (EPI) readout (data not shown), the number of voxels with negative signal change was much reduced. Therefore, TSE with short TE (6ms) was used to mitigate BOLD effects. Unfortunately compared to EPI, TSE has the disadvantages of longer acquisition time and higher specific absorption rate (SAR). For the future development of multi-slice sequences and application at higher magnetic field, gradient spin echo (GraSE) sequence would probably be a better choice (
60,
61). Another way to filter out the BOLD contamination is to acquire multiple echo EPI data and extrapolate the signal change to TE of 0.
In this proof-of-concept paper, we demonstrated the features of iVASO as a single-slice technique. It is not trivial to develop multi-slice sequence for inflow based approaches because the optimal inflow time may differ per slice, requiring the acquisition of a transit time map. However, the current single-slice approach has potential for the noninvasive study of mechanisms of microvascular activation patterns during brain activation in humans in a way similar to optical spectroscopy in animals.