Noninvasive method for mapping CVR in moyamoya disease using ASL-MRI

https://doi.org/10.1016/j.ejrad.2015.03.011Get rights and content

Highlights

  • A clinical use of a pulse-wave-synchronized ASL-MRI (pulsy ASL-MRI) was proposed.

  • Resting IMP-SPECT correlated with pulsy ASL-MRI in moyamoya disease.

  • ASL-MRI could measure cerebrovascular reserve noninvasively in moyamoya disease.

Abstract

Purpose

To project a noninvasive method for mapping cerebrovascular reserve (CVR) in moyamoya disease (MMD) using ASL-MRI.

Methods

16 MMD patients underwent cerebral blood flow (CBF) examinations by standard ASL-MRI, pulse-wave-synchronized ASL-MRI (pulsy ASL-MRI) which tagged the arterial blood coincident with a peak of a pulse wave, and single photon emission computed tomography (SPECT) imagings with iodine-123-N-isopropyl-p-iodoamphetamine in the resting (rest-IMP) and after acetazolamide challenge (ACZ-IMP). Hemispheric 32-sided cerebral blood flow (CBF) values were measured with normalized CBF maps created from standard ASL-MRI (standard-ASL value), pulsy ASL-MRI (pulsy-ASL value), rest-IMP (rest-IMP value), and ACZ-IMP (ACZ-IMP value). CVR based on rest-IMP and ACZ-IMP values (IMP-CVR) was calculated. ASL-CVR was also calculated on the basis of corrected standard-ASL values and pulsy-ASL values, which were adjusted to the ACZ-IMP values and rest-IMP values, respectively, by the least-squares method. We assessed the relationships between rest-IMP values and pulsy-ASL values, ACZ-IMP values and standard-ASL values, and IMP-CVR and ASL-CVR.

Results

Significant relationships were observed between rest-IMP values and pulsy-ASL values (correlation coefficient (r = 0.557, p < 0.01)), ACZ-IMP values and standard-ASL values (r = 0.825, p < 0.01), and IMP-CVR and ASL-CVR (r = 0.736, p < 0.01).

Conclusions

ASL-MRI is equivalent to SPECT and that it might serve as a noninvasive method for mapping CVR in MMD.

Section snippets

What contribution will your article make to the field of radiology

ASL-MRI was compared to iodoamphetamine (IMP)-SPECT at rest and following Diamox in 16 patients with moyamoya disease (MMD). ASL-MRI was acquired using standard sequences and innovative pulse-wave-synchronized ASL (“pulsy-ASL”) which tags the arterial blood coincident with a peak of a pulse wave as guided by a pulse-wave-detector placed on a finger during MR acquisition. Results showed resting IMP-SPECT correlates best with pulsy-ASL, while Diamox-IMP correlates best with standard ASL;

Methods

The current retrospective research was approved by our institutional review board, and written informed consent was obtained from all patients.

Results

The measurements of perfusion values or CVR were as follows: rest-IMP value = 33.0 ± 7.1 (mL/100 g/min), ACZ-IMP value = 42.0 ± 10.1 (mL/100 g/min), IMP-CVR = 30.9 ± 40.4 (%), standard-ASL value = 26.2 ± 12.7 (mL/100 g/min), pulsy-ASL value = 23.6 ± 13.2 (mL/100 g/min), ASL-CVR = 26.8 ± 16.4 (%). Overall, the CBF values of standard-ASL and pulsy-ASL were lower than those of rest-IMP and ACZ-IMP, which might be due to the tendency to underestimate ASL in MMD, and which was consistent with those in the previous report [20].

Fig.

Discussion

In a previous comparison of the brain perfusion measurement by ASL-MRI compared with 123I-IMP SPECT in patients with MMD, the relationship in hemispheric CBF between standard ASL-MRI and ACZ-IMP was reported to have a high correlation coefficient [20]. In our study, ACZ-IMP was again significantly correlated with the standard ASL-MRI. Although the reason for this relationship was unclear, the prolonged ATT might be important.

Although MMD can have the impairment of the blood flow, the

Authors’ contribution

Noguchi T involved in Project development, data collection and manuscript writing. Kawashima M, Egashira Y and Azama S helped in data collection. Nishihara M analysed the data. Irie H involved in Project Management.

Conflict of interest

None declared.

Ethical approval

We declare that all human studies have been approved by the institutional review board of Saga University Hospital and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. The current retrospective research was approved by our institutional review board, and written informed consent was obtained from all patients.

Acknowledgement

The current article is partly supported by Grant-in-Aid for Scientific Research of Japan Society for the Promotion of Science (#24591774).

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