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

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 H 2 [15 O]-PET in children and young adults with Moyamoya disease.

Comparison of simultaneous arterial spin labeling MRI and 15O-H2O PET measurements of regional cerebral blood flow in rest and altered perfusion states

“…Positron emission tomography (PET) with 15 O-labelled water ( 15 O-H 2 O) for measurement of regional cerebral blood flow (rCBF) is a well-established technique and often considered the reference method for absolute quantitative physiological measurements. 1 In over 30 years of research, 15 O-H 2 O PET has proven its usefulness in physiologic experiments and for clinical investigational purposes. 2,3 It is, however, a costly, technically demanding and invasive technique, only accessible in highly specialized centers.…”

“…[8][9][10][11][12][13][14][15][16][17] The quantitative correlation varies substantially and appears to decrease with the time interval between sequential PET and MRI scan sessions as described in a recent systematic revision analyzing the existing literature comparing the two techniques. 18 The introduction of commercial hybrid PET/MRI scanners has enabled simultaneous 15 O-H 2 O PET and ASL MRI measurements under identical conditions, thereby abolishing key sources of physiological variability in the comparison during rest and acutely altered physiological states. However, in our experience, even after implementing and testing a sufficiently robust ASL sequence and post-processing pipeline, the added complexity of simultaneity and the physical constrains of the PET/MRI scanner environment itself may inhibit effective use of this advantage.…”

“…However, in our experience, even after implementing and testing a sufficiently robust ASL sequence and post-processing pipeline, the added complexity of simultaneity and the physical constrains of the PET/MRI scanner environment itself may inhibit effective use of this advantage. 19,20 Thus, previous studies comparing simultaneously acquired ASL MRI and 15 O-H 2 O PET have been published up to date are scarce. Zhang et al 8 compared resting CBF in healthy individuals using rCBF maps obtained by ASL scaled by global CBF measured by phase contrast mapping (PCM) MRI in a prototype hybrid scanner.…”

Cerebral Blood Flow Improvement after Indirect Revascularization for Pediatric Moyamoya Disease: A Statistical Analysis of Arterial Spin-Labeling MRI

“…4 Recently, to avoid radiation exposure, arterial spin-labeling (ASL) MR imaging has been successfully developed to quantify CBF alterations in different stroke conditions, including MM. 5,6 This MR imaging has the advantage of being noninvasive because it uses water protons as an endogenous tracer to measure CBF, rather than intravenous injection of a contrast agent, which may be a concern in the pediatric population. Because children under-going an operation for MM need repeated quantification of their CBF before and after surgery, ASL MR imaging may be of particular interest, and statistical approaches, as described with statistical parametric analysis (SPM) of ASL MR imaging in cognitive series, may allow intraindividual and group analysis of CBF comparisons before and after the operation.…”

BOLD‐fMRI with median nerve electrical stimulation predict hemodynamic improvement after revascularization in patients with moyamoya disease

“…Positron emission tomography (PET) and MR perfusion‐weighted imaging (MR‐PWI) are the most extensively used methods for assessing the cerebral hemodynamics . However, use of radionuclides and its high cost limit the clinical use of PET . For MMD, the delay arrival of the bolus of contrast agent will make the quantification of MR‐PWI data misleading .…”