Noninvasive Evaluation of CBF and Perfusion Delay of Moyamoya Disease Using Arterial Spin-Labeling MRI with Multiple Postlabeling Delays: Comparison with 15 O-Gas PET and DSC-MRI

• Published in: American journal of neuroradiology : AJNR Vol. 38; no. 4; pp. 696 - 702
• Main Authors: Hara, S, Tanaka, Y, Ueda, Y, Hayashi, S, Inaji, M, Ishiwata, K, Ishii, K, Maehara, T, Nariai, T
• Format: Journal Article
• Language: English
• Published: United States 01.04.2017
• Subjects: Adult; Cerebrovascular Circulation - physiology; Female; Humans; Magnetic Resonance Imaging - methods; Male; Middle Aged; Moyamoya Disease - diagnostic imaging; Moyamoya Disease - physiopathology; Neuroimaging - methods; Positron-Emission Tomography - methods; Spin Labels
• ISSN: 0195-6108; 1936-959X
• DOI: 10.3174/ajnr.A5068

Arterial spin-labeling MR imaging with multiple postlabeling delays has a potential to evaluate various hemodynamic parameters. To clarify whether arterial spin-labeling MR imaging can identify CBF and perfusion delay in patients with Moyamoya disease, we compared arterial spin-labeling, DSC, and O-gas PET in terms of their ability to identify these parameters. Eighteen patients with Moyamoya disease (5 men, 13 women; ages, 21-55 years) were retrospectively analyzed. CBF values of pulsed continuous arterial spin-labeling using 2 postlabeling delays (short arterial spin-labeling, 1525 ms; delayed arterial spin-labeling, 2525 ms) were compared with CBF values measured by O-gas PET. All plots were divided into 2 groups by the cutoff of time-based parameters (the time of the maximum observed concentration, TTP, MTT, delay of MTT to cerebellum, and disease severity [symptomatic or not]). The ratio of 2 arterial spin-labeling CBFs (delayed arterial spin-labeling CBF to short arterial spin-labeling CBF) was compared with time-based parameters: time of the maximum observed concentration, TTP, and MTT. The short arterial spin-labeling-CBF values were significantly correlated with the PET-CBF values ( = 0.63; = .01). However, the short arterial spin-labeling-CBF value dropped in the regions with severe perfusion delay. The delayed arterial spin-labeling CBF overestimated PET-CBF regardless of the degree of perfusion delay. Delayed arterial spin-labeling CBF/short arterial spin-labeling CBF was well correlated with the time of the maximum observed concentration, TTP, and MTT (ρ = 0.71, 0.64, and 0.47, respectively). Arterial spin-labeling using 2 postlabeling delays may detect PET-measured true CBF and perfusion delay in patients with Moyamoya disease. Provided its theoretic basis and limitations are considered, noninvasive arterial spin-labeling could be a useful alternative for evaluating the hemodynamics of Moyamoya disease.