ASFNR State-of-Practice: Arterial Spin Labeling MR Perfusion for EVT Selection in Acute Stroke

ASL MR perfusion is a contrast-free technique that may help assess penumbra and collaterals in acute stroke patients with contrast contraindications, but the ASFNR says multicenter validation and standardized protocols are required before routine integration into endovascular th…

• ASL can identify salvageable tissue and collateral status without gadolinium, making it suitable for patients with renal failure or contrast allergy.
• The 2026 AHA/ASA guidelines now incorporate MR perfusion, renewing interest in ASL, yet no prospective EVT-selection trial has validated ASL for acute treatment decisions.
• Barriers include lack of automated postprocessing quantification and standardized acquisition protocols.

Automated summary

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