CO₂BOLD assessment of moyamoya syndrome: Validation with single photon emission computed tomography and positron emission tomography imaging

Abstract

AIMTo compare the assessment of cerebrovascular reserve (CVR) using CO2BOLD magnetic resonance imaging (MRI) vs positron emission tomography (PET) and single photon emission computed tomography (SPECT) as reference standard.METHODSTen consecutive patients (8 women, mean age of 41 ± 26 years) with moyamoya syndrome underwent 14 pre-surgical evaluations for external-internal carotid artery bypass surgery. CVR was assessed using CO2BOLD and PET (4)/SPECT (11) with a maximum interval of 36 d, and evaluated by two experienced neuroradiologists.RESULTSThe inter-rater agreement was 0.81 for SPECT (excellent), 0.43 for PET (fair) and 0.7 for CO2BOLD (good). In 9/14 cases, there was a correspondence between CO2BOLD and PET/SPECT. In 4/14 cases, CVR was over-estimated in CO2BOLD, while in 1/14 case, CVR was underestimated in CO2BOLD. The sensitivity of CO2BOLD was 86% and a specificity of 43%.CONCLUSIONCO2BOLD can be used for pre-surgical assessment of CVR in patients with moyamoya syndrome and combines the advantages of absent irradiation, high availability of MRI and assessment of brain parenchyma, cerebral vessels and surrogate CVR in one stop.

Hypercapnic BOLD MRI compared to H215O PET/CT for the hemodynamic evaluation of patients with Moyamoya Disease

“…CO 2 -triggered BOLD MRI has developed significantly since its first descriptions and has the potential to become a routine tool for the evaluation of the cerebrovascular reactivity in the future (Liu et al, 2017; Shiino et al, 2003; Sam et al, 2015; Pellaton et al, 2016; Mikulis et al, 2005; Mazerolle et al, 2018; Mandell et al, 2008; Heyn et al, 2010; van Niftrik et al, 2016; Fierstra et al, 2013; Donahue et al, 2014; Bright and Murphy, 2013; Kastrup et al, 2001). The studies performed to date have focused on the image-acquisition techniques and their optimization as well as aim at critically comparing it with other imaging modalities.…”

“…Throughout the last decades new approaches have been pursued to overcome some of these drawbacks. More advanced imaging attempts used MR-based arterial spin labeling (ASL), CO 2 -triggered blood‑oxygen-level-dependent (BOLD) and even resting-state functional MRI techniques, which could be used without any intravenous contrast agent injections (Liu et al, 2017; Shiino et al, 2003; Sam et al, 2015; Pellaton et al, 2016; Mikulis et al, 2005; Mazerolle et al, 2018; Mandell et al, 2008; Heyn et al, 2010; van Niftrik et al, 2016; Fierstra et al, 2013; Donahue et al, 2014; Bright and Murphy, 2013; Fierstra et al, 2018). A contemporary consensus statement of different imaging methods for diagnosis and evaluation of cerebrovascular disease was recently published by Donahue et al (2018) Of these, CO 2 -triggered BOLD MRI seems to be one of the most promising tools for evaluation of cerebral hemodynamics.…”

Further Implications of Off-Label Use of Acetazolamide in the Management of Moyamoya Disease in Japan

“…Alternative approaches to acetazolamide for CVR are currently being evaluated, including breath holding and carbon dioxide inhalation. In addition, blood oxygenation level-dependent MR imaging has been frequently used as a surrogate CVR marker (10,11). These approaches can be hard to implement and require patient compliance levels not necessary for acetazolamide studies.…”

Longitudinal Reproducibility of CO₂-Triggered BOLD MRI for the Hemodynamic Evaluation of Adult Patients with Moyamoya Angiopathy

“…The so-called cerebrovascular reactivity (CVR) can be triggered by exogenous changes of the CO 2 concentration with a breathing mask, or endogenously by breathing pauses, commonly called breathhold [9,12]. CO 2 BOLD MRI has been validated for different stimuli, in comparison with PET and SPECT, before and after cerebral revascularization and for different MR field strengths [9,[12][13][14][15][16]. To our knowledge, longitudinal early and long-term follow-up examinations have not been evaluated in terms of their reliability in monitoring untreated, hemodynamically affected, and not-affected vascular territories in moyamoya patients.…”