Arterial spin labelling MRI for assessment of cerebral perfusion in children with moyamoya disease: comparison with dynamic susceptibility contrast MRI

Abstract

INTRODUCTION:This study seeks to evaluate the diagnostic accuracy of cerebral perfusion imaging with arterial spin labelling (ASL) MR imaging in children with moyamoya disease compared to dynamic susceptibility contrast (DSC) imaging. METHODS: Ten children (7 females; age, 9.2 ± 5.4 years) with moyamoya disease underwent cerebral perfusion imaging with ASL and DSC on a 3-T MRI scanner in the same session. Cerebral perfusion images were acquired with ASL (pulsed continuous 3D ASL sequence, 32 axial slices, TR = 5.5 s, TE = 25 ms, FOV = 24 cm, matrix = 128 × 128) and DSC (gradient echo EPI sequence, 35 volumes of 28 axial slices, TR = 2,000 ms, TE = 36 ms, FOV = 24 cm, matrix = 96 × 96, 0.2 ml/kg Gd-DOTA). Cerebral blood flow maps were generated. ASL and DSC images were qualitatively assessed regarding perfusion of left and right ACA, MCA, and PCA territories by two independent readers using a 3-point-Likert scale and quantitative relative cerebral blood flow (rCBF) was calculated. Correlation between ASL and DSC for qualitative and quantitative assessment and the accuracy of ASL for the detection of reduced perfusion per territory with DSC serving as the standard of reference were calculated. RESULTS: With a good interreader agreement ( = 0.62) qualitative perfusion assessment with ASL and DSC showed a strong and significant correlation ( = 0.77; p < 0.001), as did quantitative rCBF (r = 0.79; p < 0.001). ASL showed a sensitivity, specificity and accuracy of 94 %, 93 %, and 93 % for the detection of reduced perfusion per territory. CONCLUSION: In children with moyamoya disease, unenhanced ASL enables the detection of reduced perfusion per vascular territory with a good accuracy compared to contrast-enhanced DSC. Methods: 10 children (7 females, age: 9.2±5.4years) with moyamoya disease underwent cerebral perfusion imaging with ASL and DSC on a 3T MRI scanner in the same session.Cerebral perfusion images were acquired with ASL (pulsed continuous 3D ASL sequence, 32 axial slices, TR=5.5s, TE=25ms, FOV=24cm, matrix=128x128) and DSC (gradient echo EPI sequence, 35 volumes of 28 axial slices, TR=2000ms, TE=36ms, FOV=24cm, matrix=96x96, 0.2ml/kg Gd-DOTA). Cerebral blood flow maps were generated. ASL and DSC images were qualitatively assessed regarding perfusion of left and right ACA, MCA and PCA territories by two independent readers using a 3-point-Likert scale and quantitative relative cerebral blood flow (rCBF) was calculated. Correlation between ASL and DSC for qualitative and quantitative assessment and the accuracy of ASL for the detection of reduced perfusion per territory with DSC serving as the standard of reference were calculated.Results: With a good interreader agreement (k=0.62) qualitative perfusion assessment with ASL and DSC showed a strong and significant correlation (ρ = 0.77; p<0.001), as did quantitative rCBF (r=0.79; p<0.001). ASL showed a sensitivity, specificity and accuracy of 94%, 93% and 93% for the detection of reduced perfusion per territory. Conclusion:In children with moyamoya dis...

Correlation of Asymmetry Indices Measured by Arterial Spin-Labeling MR Imaging and SPECT in Patients with Crossed Cerebellar Diaschisis

“…In addition, several previous studies reported that measured CBF values were similar between ASL and SPECT and between ASL and DSC MR imaging in patients with Moyamoya disease or carotid stenosis. 24,37,38 According to these results, the sensitivity of ASL might be greater than that of SPECT for assessing cerebral perfusion during follow-up in patients with CCD and correlating the findings with the clinical course. Therefore, additional study using ASL is necessary to investigate the serial changes in CCD and their clinical importance.…”

Quantitative Cerebral Perfusion Imaging in Children and Young Adults with Moyamoya Disease: Comparison of Arterial Spin-Labeling-MRI and H2[15O]-PET

“…20 In a recent study with the use of DSC as the standard of reference in children with Moyamoya disease, it could be demonstrated that ASL-based measurements of CBF showed a similarly strong and significant correlation with DSC-based perfusion (r ϭ 0.79, P Ͻ .001), enabling the detection of impaired perfusion per cerebral vascular territory with a high diagnostic accuracy. 9 In a direct comparison of ASL and H 2 [ 15 O]-PET, one study found similar cortical perfusion values with no significant …”

“…9,12,13 To investigate the effects of variations in blood T1 across the patient group, the blood T1 was calculated for n ϭ 11 patients from venous hematocrit levels according to the equation T1 ϭ 1/(0.83 Hct ϩ 0.28).…”

A qualitative comparison of arterial spin labelling and dynamic susceptibility contrast MRI in 52 children with a range of neurological conditions

“…Examples where ASL has found application in the paediatric population include patients with temporal lobe epilepsy, 6 acute ischaemic stroke, 7 brain tumours, 8 sickle cell disease, 9-11 neurotuberculosis, 12 focal cortical dysplasia, 13,14 arteriovenous malformations, 15 traumatic brain injury 16 and moyamoya disease. 17 There have been several studies performed that compare perfusion measurements obtained from ASL with those from DSC, [18][19][20][21][22][23] particularly in stroke and brain tumour populations, but few have been performed in a paediatric population. 17 The purpose of this study was to make a qualitative comparison between CBF images produced by traditional DSC MRI and those produced using ASL MRI in a group of paediatric patients imaged as part of the routine investigation of a variety of neurological conditions.…”