Quantitative Cerebrovascular Reserve Measured by Acetazolamide-Challenged Dynamic CT Perfusion in Ischemic Adult Moyamoya Disease: Initial Experience with Angiographic Correlation

Kang, Kaijiang; Kim, H.S.; Kim, S.Y.

doi:10.3174/ajnr.a1129

Cited by 53 publications

(38 citation statements)

References 16 publications

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“…However, these methods are associated with a limited availability and considerable radiation doses, which are of concern especially in a pediatric population potentially undergoing serial examinations. The more readily available option of CT perfusion imaging [23] is similarly limited in its use in children due to the radiation burden associated with the method. As a modality not associated with ionizing radiation, MRI has emerged as a valuable method for cerebral perfusion imaging in the assessment of children with moyamoya disease.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2013

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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...

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Section: Discussionmentioning

confidence: 99%

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

et al. 2013

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“…This is because the blood supply through collateral pathways can compensate for the reduced CBF, even with advancement of the disease. 1,18 However, CVR tends to diminish as MMD progresses. 18 We also found that the CBNS was related to impaired CVR, though not to cerebral perfusion.…”

Section: Discussionmentioning

confidence: 99%

Clinical Significance of the Champagne Bottle Neck Sign in the Extracranial Carotid Arteries of Patients with Moyamoya Disease

Yasuda¹,

Arakawa²,

Shimogawa

et al. 2016

AJNR Am J Neuroradiol

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“…Inability to compensate in times of stress can induce ischemia. In patients with stenotic lesions, baseline CTP maps are not useful in predicting cerebrovascular reserve; however, changes in CBF 60,62 and MTT 61 after acetazolamide challenge correlate with hemodynamic reserve (Fig 13). Acetazolamide is a potent carbonic anhydrase inhibitor causing short-term cerebral arteriole vasodilation except within territories that are already maximally dilated due to autoregulatory reflex vasodilation.…”

Section: Assessing Cerebrovascular Reservementioning

confidence: 99%

“…Collateral circulation plays an important role in the case of chronic stenoses. 60 Autoregulatory reflex vasodilation tends to be more important in cases of acute stenoses. 61 These mechanisms provide physiologic reserve to compensate during times of stress.…”

Section: Assessing Cerebrovascular Reservementioning

confidence: 99%

Evaluation of CT Perfusion in the Setting of Cerebral Ischemia: Patterns and Pitfalls

Lui¹,

Tang²,

Allmendinger³

et al. 2010

AJNR Am J Neuroradiol

116

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SUMMARY: CTP has a growing role in evaluating stroke. It can be performed immediately following NCCT and has advantages of accessibility and speed. Differentiation of salvageable ischemic penumbra from unsalvageable core infarct may help identify patients most likely to benefit from thrombectomy or thrombolysis. Still, CTP interpretation can be complex. We review normal and ischemic perfusion patterns followed by an illustrative series of technical/diagnostic challenges of CTP interpretation in the setting of acute stroke syndromes.ABBREVIATIONS: ACA ϭ anterior cerebral artery; AIF ϭ arterial input function; ASPECTS ϭ Alberta Stroke Program Early CT Score; CBF ϭ cerebral blood flow; CBV ϭ cerebral blood volume; CTA ϭ CT angiography; CTP ϭ CT perfusion; DWI ϭ diffusion-weighted imaging; ICA ϭ internal carotid artery; MCA ϭ middle cerebral artery; MTT ϭ mean transit time; NCCT ϭ noncontrast CT; PET ϭ positron-emission tomography; SPECT ϭ single-photon emission CT; TTP ϭ time to peak; VOF ϭ venous output function

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Quantitative Cerebrovascular Reserve Measured by Acetazolamide-Challenged Dynamic CT Perfusion in Ischemic Adult Moyamoya Disease: Initial Experience with Angiographic Correlation

Cited by 53 publications

References 16 publications

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

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

Clinical Significance of the Champagne Bottle Neck Sign in the Extracranial Carotid Arteries of Patients with Moyamoya Disease

Evaluation of CT Perfusion in the Setting of Cerebral Ischemia: Patterns and Pitfalls

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