Prolonged Mean Transit Time Detected by Dynamic Susceptibility Contrast Magnetic Resonance Imaging Predicts Cerebrovascular Reserve Impairment in Patients with Moyamoya Disease

Abstract

Background: Evaluating cerebrovascular reserve (CVR) is important for patients with moyamoya disease (MMD). ¹²³I-iodoamphetamine single-photon emission CT (SPECT) with acetazolamide (ACZ) challenge is widely carried out, but using ACZ becomes problematic owing to its off-label use and its adverse effects. Here, we report the efficacy of dynamic susceptibility contrast MRI (DSC-MRI) for the evaluation of CVR in MMD patients. Methods: All 33 MMD patients underwent both SPECT and DSC-MRI at an interval of <10 days from each other (mean age 38.3 years). The region of interest (ROI) was the anterior cerebral artery (ACA) territory, middle cerebral artery (MCA) territory, basal ganglia and cerebellum hemisphere for cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) images. The ratios of the ROIs to the ipsilateral cerebellum were calculated for each parameter and evaluated. The CVR was calculated using images acquired by SPECT before and after ACZ administration. The ratios of DSC-MRI parameters and CVR were compared and evaluated for each ROI. Results: The MTT of the ACA and MCA territories significantly correlated with CVR (p < 0.0001). However, CBF and CBV had no correlation with CVR. The MTT ratio had a threshold of 1.966, with a sensitivity of 68.4% and a specificity of 91.5% for predicting decreased CVR (<10%). Conclusion: MTT had a negative correlation with CVR. DSC-MRI is easy, safe and useful for detecting decreased CVR and can be used as a standard examination in MMD patient's care.

Acetazolamide-augmented dynamic BOLD (aczBOLD) imaging for assessing cerebrovascular reactivity in chronic steno-occlusive disease of the anterior circulation: An initial experience

“…The findings from previous studies on the relationship between CVR and baseline perfusion parameters are not consistent (Bouvier et al, 2015, Kawano et al, 2016), probably due to different imaging methods and correlation measures used. In the present study, we applied a mixed-effects model to account for the intra-subject repeated-measure dependency.…”

Comparative study of MR mTI-ASL and DSC-PWI in evaluating cerebral hemodynamics of patients with Moyamoya disease

“…The relative parameters are usually calculated by dividing the value of drawn ROI by its mirror area in perfusion imaging analysis. [ 19 ] Considering that many MMD patients were involved in bilateral ICAs, ACAs, or MCAs, we chose cerebellum supplied by posterior circulation as the standardized reference to calculate relative parameters, [ 21 , 24 ] so that we could get more accurate data to reflect the degree of hypoperfusion in ROI. And in our study, all 45 patients were normal in posterior circulation according to clinical observation and MR examination.…”

“…Hemodynamic parameters (CBF-ASL, BAT-ASL, CBF-DSC, and TTP-DSC) were measured on each tomographic plane by manually placing the region of interest (ROI) for lateral MCA territories, BG, and cerebellum. [ 21 ] The diameter of the ROI was about 10 mm, and we carefully avoided great cerebral vessels and the area with ischemic or hemorrhage lesions when we put ROI (Fig. 1 ).…”

Can Arterial Spin-Labeling with Multiple Postlabeling Delays Predict Cerebrovascular Reserve?

“…The MTT determination based on perfusion CT or DSC-MR imaging showed a strong correlation with CVR in patients with chronic vascular occlusive disease. [31][32][33] The ATT is different from the MTT; however, it has been reported that there was significant correlation between the ATT and MTT (r ϭ 0.604, P ϭ .01). 16 To the best of our knowledge, there is no prior study about the correlation between the ATT and the CVR based on SPECT with acetazolamide challenge.…”