Improved CBF and BBB Water Exchange Asymmetry in Vascular Territories Following Cranioplasty: A DP-pCASL MRI Study

Motivation: Brain injuries often cause cognitive decline, and while cranioplasty has been shown to improve function, the mechanisms are not fully understood. Studying cerebral perfusion changes post-surgery could reveal biomarkers for recovery. Goal(s): This study investigated changes in cerebral blood flow (CBF), arterial transit time (ATT), and blood-brain barrier (BBB) water exchange rate (Kw) asymmetry in cranioplasty patients. Approach: Using DP-pCASL MRI, we measured CBF, ATT, kw, and their asymmetries across brain hemispheres in 14 patients before and after cranioplasty. Results: Significant increases in asymmetry of CBF and kw were observed post-surgery, indicating enhanced blood flow and water exchange in the impacted brain hemisphere. Impact: This study suggests that cerebral perfusion markers may clarify mechanisms behind cognitive improvements after cranioplasty, potentially guiding future research into biomarkers for brain recovery and influencing clinical approaches to post-injury rehabilitation.