Tae Jin Yun MD, Presenter: Nothing to Disclose

Jin Chul Paeng, Abstract Co-Author: Nothing to Disclose

Chul-Ho Sohn MD, Abstract Co-Author: Nothing to Disclose

Beom Su Kim MD, Abstract Co-Author: Nothing to Disclose

Seung Hong Choi MD, PhD, Abstract Co-Author: Nothing to Disclose

Ji-hoon Kim MD, Abstract Co-Author: Nothing to Disclose

We aimed to assess the ability of arterial spin labeling (ASL) to identify an impaired cerebrovascular reactivity (CVR) relative to single photon emission computed tomography (SPECT) in patients with moyamoya disease (MMD).

The institutional review board of our hospital approved this prospective study and written informed consent was obtained from all patients. We conducted a prospective study to determine the ability of ASL to identify CVR relative to SPECT in 78 subjects with MMD. Among these patients, 31 patients performed unilateral direct arterial anastomosis, and in these patients, follow up ASL perfusion MR and SPECT were performed additionally (for ASL, 1 weeks, 3 months, and 6 months after operation; for SPECT, 6 months after operation). Volumes of interests based on internal carotid artery territories were applied to the cerebral blood flow maps from the basal stress ASL and SPECT. And, the concordance between the CVR indexes (CVRIs) from ASL and SPECT was assessed using Bland-Altman analysis, and the area under the receiver-operating characteristic curve (AUC) was used to evaluate diagnostic accuracy of ASL relative to that of SPECT using various CVRI cutoff points. 

The CVRI from ASL had a negative bias as compared to the CVRI from SPECT (systemic bias, -3.5%). In addition, the differences between the CVRI from ASL and SPECT tended to be larger when the CVRI is more impaired. The analysis of the diagnostic accuracy of ASL for detecting the impaired CVR revealed an AUC of 0.81 with a sensitivity of 81%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 12%. ASL performed in 6 months after anastomosis showed significant increase in CVRI than that performed preoperatively as well as SPECT (for ASL, -2.7 ± 7.3 and -11.2 ± 9.3, P < 0.001; for SPECT, -3.7 ± 2.9 and -6.2 ± 5.2, P = 0.013, respectively).

ASL can identify impaired CVR with excellent performance in patients with MMD and has the potential to serve as a non-invasive imaging tool for determining CVR in patients with cerebrovascular disease.

1. ASL can identify impaired CVR with excellent performance in patients with MMD 2. ASL has the potential to serve as a non-invasive imaging tool for determining CVR in patients with cerebrovascular disease.

Yun, T, Paeng, J, Sohn, C, Kim, B, Choi, S, Kim, J, Identification of an Impaired Cerebrovascular Reactivity by Use of Arterial Spin Labeling in Patients with Moyamoya Disease.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14017646.html