Using perfusion contrast for spatial normalization of ASL MRI images in a pediatric craniosynostosis population

Spatial normalization is an important step for image processing and quantification of regional brain perfusion values using arterial spin labeling (ASL) MRI and is typically performed via high-resolution structural brain scans. However, structural segmentation and/or registration to standard space is complicated when gray-white matter contrast in structural images is low due to on-going myelination in newborns and infants. This problem is particularly of clinical relevance for imaging infants with inborn or acquired disorders that impair normal brain development. We investigated if the ASL MRI perfusion contrast is a viable alternative for spatial normalization. Four registration approaches have been compared: 1) using the structural image contrast, or perfusion contrast with 2) rigid, 3) affine, and 4) non-linear transformations - in 16 healthy controls (median age 0.83 years, IQR ± 0.56) and 36 trigonocephaly patients (median age 0.50 years, IQR ± 0.30) - a non-syndromic type of craniosynostosis. Registration performance was compared quantitatively using the Tanimoto coefficient (TC), visually by three blinded readers, and eventually by the impact on regional CBF values. For both patients and controls, non-linear registration using perfusion contrast showed the highest TC, a 17.51 (CI 6.66-49.38) times more likely to have a higher rating, and 17.45-18.88 mL/100g/min higher CBF compared to the standard registration. Using perfusion based contrast improved spatial registration compared to the use of structural images, significantly affected the regional CBF, and may open up new possibilities for future large pediatric ASL brain studies.