Estimation of Severity of Moyamoya Disease with [15O]Water-Positron Emission Tomography Compared with Magnetic Resonance Imaging and Angiography

Röder, Constantin; Bürkle, Eva; Ebner, Florian; Tatagiba, Marcos; Ernemann, Ulrike; Buck, Alfred; Meyer, Philipp T.; Khan, Nadia

doi:10.1016/j.wneu.2018.05.163

Cited by 12 publications

(8 citation statements)

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“…The studies performed to date have focused on the image-acquisition techniques and their optimization as well as aim at critically comparing it with other imaging modalities. In MMD where the patients vary in severity of angiopathy and collateral formation, the evaluation of cerebral reserve capacity is not possible with angiography and MRI alone (Roder et al, 2018), hence necessitating additional hemodynamic imaging such as H 2 15 O PET with ACZ challenge. Less expensive, without the need of an intravenous injection, more widely available and easy to implement BOLD MRI may be able to substitute these in the future.…”

Section: Discussionmentioning

confidence: 99%

“…Before indicating a surgical revascularization, identification of cerebral vascular territories with insufficient perfusion is crucial to ensure a successful tailored treatment for each patient. This, however cannot be achieved with routine MRI and digital subtraction angiography (DSA) alone, but hemodynamic modalities like H 2 15 O positron emission tomography (PET) or Single Photon Emission Computed Tomography (SPECT) with acetazolamide (ACZ) challenge, among others, remain indispensible (Pandey and Steinberg, 2011; Lee et al, 2009; Roder et al, 2018; Acker et al, 2018). Main disadvantages of H 2 15 O PET with ACZ challenge include high costs and limited availability.…”

Section: Introductionmentioning

confidence: 99%

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Hypercapnic BOLD MRI compared to H215O PET/CT for the hemodynamic evaluation of patients with Moyamoya Disease

Hauser

Seeger

Bender

et al. 2019

NeuroImage: Clinical

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Background and purposePatients with Moyamoya Disease (MMD) need hemodynamic evaluation of vascular territories at risk of stroke. Today's investigative standards include H215O PET/CT with pharmacological challenges with acetazolamide (ACZ). Recent developments suggest that CO2-triggered blood‑oxygen-level-dependent (BOLD) functional MRI might provide comparable results to current standard methods for evaluation of territorial hemodynamics, while being a more widely available and easily implementable method. This study examines results of a newly developed quantifiable analysis algorithm for CO2-triggered BOLD MRI in Moyamoya patients and correlates the results with H215O PET/CT with ACZ challenge to assess comparability between both modalities.MethodsCO2-triggered BOLD MRI was performed and compared to H215O PET/CT with ACZ challenge in patients with angiographically proven MMD. Images of both modalities were analyzed retrospectively in a blinded, standardized fashion by visual inspection, as well as with a semi-quantitative analysis using stimuli-induced approximated regional perfusion-weighted data and BOLD-signal changes with reference to cerebellum.Results20 consecutive patients fulfilled the inclusion criteria, a total of 160 vascular territories were analyzed retrospectively. Visual analysis (4-step visual rating system) of standardized, color-coded cerebrovascular reserve/reactivity maps showed a very strong correlation (Spearman's rho = 0.9, P < 0.001) between both modalities. Likewise, comparison of approximated regional perfusion changes across vascular territories (normalized to cerebellar change) reveal a highly significant correlation between both methods (Pearson's r = 0.71, P < 0.001).ConclusionsThe present analysis indicates that CO2-triggered BOLD MRI is a very promising tool for the hemodynamic evaluation of MMD patients with results comparable to those seen in H215O PET/CT with ACZ challenge. It therefore holds future potential in becoming a routine examination in the pre- and postoperative evaluation of MMD patients after further prospective evaluation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hypercapnic BOLD MRI compared to H215O PET/CT for the hemodynamic evaluation of patients with Moyamoya Disease

Hauser

Seeger

Bender

et al. 2019

NeuroImage: Clinical

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“…In some cases, initially uncertainly patent bypasses were displayed patent in the DSA after 6 to 12 months but didn't mature as much over time as expected. This might be a consequence of a lower intracranial blood demand than pre-operatively estimated despite extended pre-operative examinations (18).…”

Section: Discussionmentioning

confidence: 99%

Early Post-operative CT-Angiography Imaging After EC-IC Bypass Surgery in Moyamoya Patients

Hurth¹,

Hauser²,

Haas³

et al. 2021

Front. Neurol.

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Objective: To evaluate the clinical value of early post-operative computed tomographic angiography (CTA) after direct extracranial-intracranial (EC-IC) bypass surgery in moyamoya patients.Methods: A retrospective analysis of all adult moyamoya patients treated at our center from 2013 to 2019 with a direct EC-IC bypass was performed. Early post-operative CTA (within 24 h after surgery) was compared with conventional digital subtraction angiography (DSA) 6–12 months after surgery. If available, magnetic resonance time-of-flight angiography (MR-TOF) was evaluated 3 months and 6–12 months post-operatively as well. Imaging results were analyzed and compared with CTA, MR-TOF and DSA, whereat DSA was used as the final and definite modality to decide on bypass patency.Results: A total of 103 direct EC-IC bypasses in 63 moyamoya patients were analyzed. All inclusion criteria were met in 32 patients (53 direct bypasses). In 84.9% the bypass appeared definitively, in 5.7% uncertainly and in 9.4% not patent according to early post-operative CTA. MR-TOF suggested definitive bypass patency in 86.8% 3 months after surgery and in 93.5% 6–12 months after surgery. DSA 6–12 months post-operatively showed a patency in 98.1% of all bypasses. The positive predictive value (to correctly detect an occluded bypass) on post-operative CTA was 12.5%, the negative predictive value (to correctly detect a patent bypass) was 100% with a sensitivity of 100% and a specificity of 86.5%.Conclusion: Early post-operative CTA has a high predictive value to confirm the patency of a bypass. On the other hand, a high false positive rate of (according to CTA) occluded bypasses after direct EC-IC bypass surgery can be seen. This must be considered critically when initiating possible therapeutic measures.

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“…There was no isolated cutoff value for any of the modalities. Generally spoken, results of PET-CT with ACZ challenge were of highest importance for the decision-making [2]. If the cerebrovascular reserve measured in PET-CT was reduced >50% compared to the cerebellum (e.g., if the increase of blood flow of the cerebellum after ACZ is 30%, but in the MCA territory only 10%), usually revascularization was indicated.…”

Section: Methodsmentioning

confidence: 99%

“…Precise evaluation of cerebral perfusion is crucial for adequate treatment and follow-up of patients with moyamoya angiopathy. Based on this information, surgical revascularization is indicated and performed in hemodynamically affected patients [1,2]. For patients with disease-affected territories and as yet normal perfusion and reserves (not hemodynamically affected patients), strict and regular follow-ups are recommended [1,3,4].…”

Section: Introductionmentioning

confidence: 99%

Longitudinal Reproducibility of CO2-Triggered BOLD MRI for the Hemodynamic Evaluation of Adult Patients with Moyamoya Angiopathy

et al. 2021

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Background and Purpose: Hemodynamic evaluation of moyamoya patients is crucial to decide the treatment strategy. Recently, CO2-triggered BOLD MRI has been shown to be a promising tool for the hemodynamic evaluation of moyamoya patients. However, the longitudinal reliability of this technique in follow-up examinations is unknown. This study aims to analyze longitudinal follow-up data of CO2-triggered BOLD MRI to prove the reliability of this technique for long-term control examinations in moyamoya patients. Methods: Longitudinal CO2 BOLD MRI follow-up examinations of moyamoya patients with and without surgical revascularization have been analyzed for all 6 vascular territories retrospectively. If revascularization was performed, any directly (by the disease or the bypass) or indirectly (due to change of collateral flow after revascularization) affected territory was excluded based on angiography findings (group 1). In patients without surgical revascularization between the MRI examinations, all territories were analyzed (group 2). Results: Eighteen moyamoya patients with 39 CO2 BOLD MRI examinations fulfilled the inclusion criteria. The median follow-up between the 2 examinations was 12 months (range 4–29 months). For 106 vascular territories analyzed in group 1, the intraclass correlation coefficient was 0.784, p < 0.001, and for group 2 (84 territories), it was 0.899, p < 0.001. Within the total follow-up duration of 140 patient months, none of the patients experienced a new stroke. Conclusions: CO2 BOLD MRI is a promising tool for mid- and long-term follow-up examinations of cerebral hemodynamics in moyamoya patients. Systematic prospective evaluation is required prior to making it a routine examination.

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Estimation of Severity of Moyamoya Disease with [15O]Water-Positron Emission Tomography Compared with Magnetic Resonance Imaging and Angiography

Cited by 12 publications

References 12 publications

Hypercapnic BOLD MRI compared to H215O PET/CT for the hemodynamic evaluation of patients with Moyamoya Disease

Hypercapnic BOLD MRI compared to H215O PET/CT for the hemodynamic evaluation of patients with Moyamoya Disease

Early Post-operative CT-Angiography Imaging After EC-IC Bypass Surgery in Moyamoya Patients

Longitudinal Reproducibility of CO<sub>2</sub>-Triggered BOLD MRI for the Hemodynamic Evaluation of Adult Patients with Moyamoya Angiopathy

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