Neuroimaging is an indispensable tool in the workup and management of patients with neurological disorders. Arterial spin labeling (ASL) is an imaging modality that permits the examination of blood flow and perfusion without the need for contrast injection. Noninvasive in nature, ASL provides a feasible alternative to existing vascular imaging techniques, including angiography and perfusion imaging. While promising, ASL has yet to be fully incorporated into the diagnosis and management of neurological disorders. This article presents a review of the most recent literature on ASL, with a special focus on its use in moyamoya disease, brain neoplasms, seizures, and migraines and a commentary on recent advances in ASL that make the imaging technique more attractive as a clinically useful tool.
Keywords: ASL = arterial spin labeling; CASL = continuous ASL; CBF = cerebral blood flow; DSC-PWI = dynamic susceptibility contrast–perfusion weighted imaging; ECA = external carotid artery; EEG = electroencephalography; ICA = internal carotid artery; MMD = moyamoya disease; PASL = pulsed ASL; PET = positron emission tomography; PLD = postlabeling delay; RF = radiofrequency; ROI = region of interest; SNR = signal-to-noise ratio; STA-MCA = superficial temporal artery–middle cerebral artery; T-ASL = territorial ASL; arterial spin labeling; cerebrovascular; functional MRI; mTI-ASL = multi-inversion time ASL; neurooncology; neuroradiology; pCASL = pseudo-continuous ASL.