4D ASL-based MR angiography for visualization of distal arteries and leptomeningeal collateral vessels in moyamoya disease: a comparison of techniques

Abstract

• The 4D-PACK enables good visualization of distal cerebral arteries in moyamoya disease. • The 4D-PACK enables direct visualization of leptomeningeal collateral vessels in moyamoya disease. • Vessel visualization by 4D-PACK can be useful in assessing cerebral hemodynamics.

Super-selective ASL and 4D ASL-based MR Angiography in a Patient with Moyamoya Disease

“…To the authors’ knowledge, the acquired 4D ASL-based MRA, referred to as 4D-PACK, has been used by only two preceding investigations [ 7 , 8 ]; yet, in these two publications, no super-selective acquisitions were performed. One comparative study in Japanese patients with moyamoya disease investigated vessel visualization by the technique in relation to inflow-enhanced multi-phase angiography and DSA, pointing at significantly improved visualization of cerebral arteries and leptomeningeal collaterals for non-selective 4D-PACK [ 7 ]. High arterial signal in time-resolved manner can be obtained even at late time points because the sequence is based on pseudocontinuous ASL instead of pulsed ASL, and scanning is accelerated using the keyhole and view-sharing techniques [ 7 , 8 ].…”

“…2 Pseudocontinuous arterial spin labeling (ASL) showed mostly normal cerebral blood flow (a; in ml/100 g/min), super-selective ASL showed reduced but detectable supply of the left middle cerebral artery territory by the left-sided internal carotid artery (ICA; b) and complete supply of the left anterior cerebral artery territory by the contralateral ICA (two representative axial slices; c) background suppression, EPI factor 29, scan time: 4 min 48 s). Furthermore, super-selective ASL (according to Helle et al [6]; similar parameters as for pseudocontinuous ASL with 1800 ms post-label delay, scan time: 4 min 3 s) and 4D MRA based on super-selective ASL with contrastenhanced timing-robust angiography (CENTRA) keyhole and view-sharing technique (4D-PACK according to Togao et al [7]; 3D GRE readout, 7 time points at 100, 200, 500, 800, 1200, 1600 and 2000 ms, turbo factor 60, TR/TE/ alpha = 4982 ms/1.7 ms/11°, 1 × 1.3 × 1.6 mm 3 spatial resolution, scan time: 5 min 10 s) were separately applied for the left and right ICA. Labeling positions of super-selective acquisitions were successfully set fully automated based on TOF-MRA of the neck arteries (1.5 × 1.5 × 2 mm 3 spatial resolution, acquired within 45 s with Compressed SENSE) by an additional software tool integrated in the scanner software.…”

“…[ 6 ]; similar parameters as for pseudocontinuous ASL with 1800 ms post-label delay, scan time: 4 min 3 s) and 4D MRA based on super-selective ASL with contrast-enhanced timing-robust angiography (CENTRA) keyhole and view-sharing technique (4D-PACK according to Togao et al. [ 7 ]; 3D GRE readout, 7 time points at 100, 200, 500, 800, 1200, 1600 and 2000 ms, turbo factor 60, TR/TE/alpha = 4982 ms/1.7 ms/11°, 1 × 1.3 × 1.6 mm 3 spatial resolution, scan time: 5 min 10 s) were separately applied for the left and right ICA. Labeling positions of super-selective acquisitions were successfully set fully automated based on TOF-MRA of the neck arteries (1.5 × 1.5 × 2 mm 3 spatial resolution, acquired within 45 s with Compressed SENSE) by an additional software tool integrated in the scanner software.…”

Evaluation of Hemodynamic Change by Indocyanine Green-FLOW 800 Videoangiography Mapping: Prediction of Hyperperfusion Syndrome in Patients with Moyamoya Disease

“…From this, it could be inferred that neurologic deficits are more likely to occur as the local hemodynamic change becomes larger. The evaluation of hemodynamic changes in MMD from previous studies [11][12][13] has mainly focused on the hemisphere and regional cerebral perfusion changes by means of CT perfusion and multimodal MRI. These kinds of evaluations can assess the change of blood flow quantitively and predict the occurrence of HPS.…”

Contemporary and emerging magnetic resonance imaging methods for evaluation of moyamoya disease

“…42 Another technique, 4D pseudocontinuous arterial spin labeling (ASL), can demonstrate fill from leptomeningeal collaterals. 66 Overall, these luminal techniques can demonstrate the areas of stenosis or occlusion of the basal arteries, collateral vasculature, and ECA-MCA bypass graft status, and can identify associated aneurysms which may occur in either the basal arteries or peripheral arteries such as moyamoya vessels. 51 Therefore, the modified Suzuki stage can potentially be established with these MRA luminal techniques without the need for formal catheter angiography.…”