TY - JOUR T1 - Using Arterial Spin Labelling to Investigate Spontaneous and Evoked Ongoing Musculoskeletal Pain JF - bioRxiv DO - 10.1101/163196 SP - 163196 AU - Karolina A. Wartolowska AU - Daniel P. Bulte AU - Michael A Chappell AU - Mark Jenkinson AU - Thomas W Okell AU - Matthew Webster AU - Andrew J Carr Y1 - 2017/01/01 UR - http://biorxiv.org/content/early/2017/07/15/163196.abstract N2 - Clinical pain is difficult to study using standard blood oxygenation level dependent (BOLD) imaging. Arterial spin labelling (ASL) offers an attractive alternative as it can measure perfusion during a state or a prolonged stimulation. We propose a paradigm which uses arm repositioning to evoke clinically-relevant musculoskeletal pain in patients with shoulder impingement syndrome. We also present an analysis pipeline using tools from the FMRIB Software Library (FSL) optimised for analysis of perfusion images of middle-aged and elderly patients. Patients with shoulder pain and healthy controls were scanned using multi post-labelling delay pseudo-continuous ASL (pCASL), initially in the supine position and then with one arm raised to evoke clinical pain. The proposed paradigm resulted in increased perfusion in the patient group in cortical and subcortical regions known to be involved in sensory processing and movement integration, such as the ipsilateral primary somatosensory cortex, ipsilateral operculum/insular cortex, ipsilateral putamen and bilaterally in the thalamus, midbrain, and the cerebellum. Perfusion changes were not present in the control group, which suggests that they were related to pain rather than just arm repositioning. The optimised analysis improved registration of perfusion images in comparison to standard approaches. ER -