A Novel Vascular Risk Scoring Framework for Quantifying Sex-Specific Cerebral Perfusion from 3D pCASL MRI

The influence of sex and age on cerebral perfusion is recognized, but the specific impacts on regional cerebral blood flow (CBF) and vascular risk remain to be fully characterized. In this study, 3D pseudo-continuous arterial spin labeling (pCASL) MRI was used to identify sex and age related CBF patterns, and a vascular risk score (VRS) was developed based on normative perfusion profiles. Perfusion data from 186 cognitively healthy participants (89 males, 97 females; aged 8 to 92 years), obtained from a publicly available dataset, were analyzed. An extension of the 3D Simple Linear Iterative Clustering (SLIC) supervoxel algorithm was applied to CBF maps to group neighboring voxels with similar intensities into anatomically meaningful regions. Regional CBF features were extracted and used to train a convolutional neural network (CNN) for sex classification and perfusion pattern analysis. Global, age related CBF changes were also assessed. Participant specific VRS was computed by comparing individual CBF profiles to age and sex specific normative data to quantify perfusion deficits. A 95 percent accuracy in sex classification was achieved using the proposed supervoxel based method, and distinct perfusion signatures were identified. Higher CBF was observed in females in medial Brodmann areas 6 and 10, area V5, occipital polar cortex, and insular regions. A global decline in CBF with age was observed in both sexes. Individual perfusion deficits were quantified using VRS, providing a personalized biomarker for early hypoperfusion. Sex and age specific CBF patterns were identified, and a personalized vascular risk biomarker was proposed, contributing to advancements in precision neurology.