Quantitative cerebral perfusion imaging in children and young adults with Moyamoya disease: comparison of arterial spin-labeling-MRI and H(2)[(15)O]-PET

AJNR Am J Neuroradiol. 2014 May;35(5):1022-8. doi: 10.3174/ajnr.A3799. Epub 2013 Dec 12.

Abstract

Background and purpose: Cerebral perfusion assessment is important in the preoperative evaluation and postoperative follow-up of patients with Moyamoya disease. The objective of this study was to evaluate the correlation of quantitative CBF measurements performed with arterial spin-labeling-MR imaging and H2[(15)O]-PET in children and young adults with Moyamoya disease.

Materials and methods: Thirteen children and young adults (8 female patients; age, 9.7 ± 7.1 years; range, 1-23 years) with Moyamoya disease underwent cerebral perfusion imaging with H2[(15)O]-PET (Discovery STE PET/CT, 3D Fourier rebinning filtered back-projection, 128 × 128 × 47 matrix, 2.34 × 2.34 × 3.27 mm(3) voxel spacing) and arterial spin-labeling (3T scanner, 3D pulsed continuous arterial spin-labeling sequence, 32 axial sections, TR = 5.5 seconds, TE = 25 ms, FOV = 24 cm, 128 × 128 matrix, 1.875 × 1.875 × 5 mm(3) voxel spacing) within less than 2 weeks of each other. Perfusion of left and right anterior cerebral artery, MCA, and posterior cerebral artery territories was qualitatively assessed for arterial spin-labeling-MR imaging and H2[(15)O]-PET by 2 independent readers by use of a 3-point-Likert scale. Quantitative correlation of relative CBF with cerebellar normalization between arterial spin-labeling-MR imaging and H2[(15)O]-PET was evaluated in a volume-based approach for each vascular territory after 3D image coregistration.

Results: Interreader agreement was good (κ = 0.67-0.69), and strong and significant correlations were found between arterial spin-labeling-MR imaging and H2[(15)O]-PET for both qualitative perfusion scoring (ρ = 0.77; P < .001) and quantitative perfusion assessment of relative CBF with cerebellar normalization (r = 0.67, P < .001).

Conclusions: In children and young adults with Moyamoya disease, quantitative evaluation of CBF is possible with the use of arterial spin-labeling-MR imaging without ionizing radiation or contrast injection with a good correlation to H2[(15)O]-PET after cerebellar normalization.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Blood Flow Velocity
  • Cerebral Angiography / methods
  • Cerebral Arteries / diagnostic imaging
  • Cerebral Arteries / pathology
  • Cerebral Arteries / physiopathology*
  • Cerebrovascular Circulation*
  • Child, Preschool
  • Female
  • Humans
  • Infant
  • Magnetic Resonance Angiography / methods*
  • Male
  • Moyamoya Disease / diagnosis*
  • Moyamoya Disease / physiopathology*
  • Observer Variation
  • Oxygen Radioisotopes
  • Positron-Emission Tomography / methods*
  • Radiopharmaceuticals
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Spin Labels
  • Water
  • Young Adult

Substances

  • Oxygen Radioisotopes
  • Radiopharmaceuticals
  • Spin Labels
  • Water