Role of Arterial Spin Labeling (ASL) Images in Parkinson's Disease (PD): A Systematic Review

  • Dhanashri Joshi
    Symbiosis Center of Medical Image Analysis, Symbiosis International (Deemed) University, Pune,MH, India
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  • Shweta Prasad
    Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, KA, India

    Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bengaluru,, KA, India
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  • Jitender Saini
    Department of Neuroimaging & Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, KA, India
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  • Madhura Ingalhalikar
    Address correspondence to: Madhura Ingalhalikar, Symbiosis International (DEEMED UNIVERSITY), Near Lupin Research Park, Gram: Lavale, Mulshi, Pune, MH, 412 115, India.
    Symbiosis Center of Medical Image Analysis, Symbiosis International (Deemed) University, Pune,MH, India
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Published:November 23, 2022DOI:

      Rationale and Objectives

      Parkinson's disease is a chronic progressive neurodegenerative disorder with standard structural MRIs often showing no gross abnormalities. Quantitative perfusion MRI modality Arterial Spin Labeling (ASL) is helpful in identifying PD specific perfusion patterns. Absolute Cerebral blood flow (CBF) measurement using ASL provides insights into regional perfusion abnormalities. We reviewed the role of ASL to identify specific brain regions responsible for motor, non-motor symptoms and neurovascular changes observed in PD. Challenges in assessing the blood perfusion level are discussed with future development for improving the evaluation of ASL perfusion maps.

      Materials and Methods

      We included CBF quantification studies using ASL for PD diagnosis. A systematic search was performed in Pubmed, Scopus and Web of Science. The perfusion parameters CBF and arterial arrival time (AAT) measured using ASL were considered for brain region assessment. Clinical aspects of PD have been analyzed using ASL perfusion maps.


      The systematic search identified 153 unique records. Thirty articles were selected after verification of inclusion and exclusion criteria. Voxel and region-based analyses in white and gray matter tissues have been performed to identify PD-specific perfusion patterns by reported articles. Predominant brain regions such as basal ganglia sub-regions, frontoparietal network, precuneus, occipital lobe, sensory motor area regions, visual network, which are associated with motor and non-motor symptoms in PD, were identified with CBF hypoperfusion, indicating neuronal loss and cerebrovascular dysfunction.


      CBF and AAT values derived from ASL can potentially be used as biomarkers to discriminate PD from similar brain-related disorders.



      PD (Parkinson's disease), ASL (Arterial spin labeling), CBF (Cerebral blood flow), SNR (Signal-to-noise ratio), PLD (Post labeling delay), fMRI (Functional magnetic resonance imaging), AAT (Arterial arrival time), CVR (Cerebrovascular reactivity), WML (White matter lesion), DRT (Dopamine replacement therapy)
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