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Taira N, Hara S, Namba A, Tanaka Y, Maehara T. Spatial coefficient of variation of arterial spin labeling magnetic resonance imaging can predict decreased cerebrovascular reactivity measured by acetazolamide challenge single-photon emission tomography. Neuroradiology 2024; 66:1693-1703. [PMID: 39042167 DOI: 10.1007/s00234-024-03431-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 07/09/2024] [Indexed: 07/24/2024]
Abstract
PURPOSE The aim of this study was to investigate whether the spatial coefficient of variation of arterial spin labeling (ASL-CoV) acquired in clinical settings can be used to estimate decreased cerebrovascular reactivity (CVR) measured with single-photon emission computed tomography (SPECT) and acetazolamide challenge in patients with atherosclerotic stenosis of intra- or extracranial arteries. METHODS We evaluated the data of 27 atherosclerotic stenosis patients who underwent pseudocontinuous ASL and SPECT. After spatial normalization, regional values were measured using the distributed middle cerebral artery territorial atlas of each patient. We performed comparisons, correlations, and receiver operating characteristic (ROC) curve analyses between ASL-cerebral blood blow (CBF), ASL-CoV, SPECT-CBF and SPECT-CVR. RESULTS Although the ASL-CBF values were positively correlated with SPECT-CBF values (r = 0.48, 95% confidence interval (CI) = 0.28-0.64), no significant difference in ASL-CBF values was detected between regions with and without decreased CVR. However, regions with decreased CVR had significantly greater ASL-CoV values than regions without decreased CVR. SPECT-CVR was negatively correlated with ASL-CoV (ρ = -0.29, 95% CI = -0.49 - -0.06). The area under the ROC curve of ASL-CoV in predicting decreased CVR (0.66, 95% CI = 0.51-0.81) was greater than that of ASL-CBF (0.51, 95% CI = 0.34-0.68). An ASL-CoV threshold value of 42% achieved a high specificity of 0.93 (sensitivity = 0.42, positive predictive value = 0.77, and negative predictive value = 0.75). CONCLUSION ASL-CoV acquired by single postlabeling delay without an acetazolamide challenge may aid in the identification of patients with decreased CVR on SPECT.
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Affiliation(s)
- Naoki Taira
- Department of Neurosurgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Shoko Hara
- Department of Neurosurgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
| | - Aya Namba
- Department of Neurosurgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Yoji Tanaka
- Department of Neurosurgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Taketoshi Maehara
- Department of Neurosurgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
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Soler-Rico M, Di Santo M, Vaz G, Joris V, Fomekong E, Guillaume S, Van Boven M, Raftopoulos C. How to reduce the complication rate of multiple burr holes surgery in moyamoya angiopathy. Acta Neurochir (Wien) 2023; 165:3613-3622. [PMID: 37993630 DOI: 10.1007/s00701-023-05876-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/16/2023] [Indexed: 11/24/2023]
Abstract
PURPOSE This study is aimed at analyzing clinical outcome, absence of stroke recurrence, revascularization, and complications and long-term follow-up in the surgical treatment of moyamoya angiopathy (MMA) using the multiple burr holes (MBH) technique with dura opening and arachnoid preservation as a single procedure. To the best of our knowledge, this is the first to describe an MBH technique with arachnoid preservation. METHOD We retrospectively reviewed all patients operated from June 2001 to March 2021, for a symptomatic and progressive MMA operated with opening of the dura but arachnoid preservation. Clinical examinations were obtained in all patients, and radiological monitoring was performed by cerebral 3D-magnetic resonance angiography (MRA) with perfusion or single-photon emission computed tomography (SPECT) with acetazolamide. RESULTS In total, 21 consecutive patients (6 children and 15 adults) were included with a mean age of 7.4 years in the pediatric group and 36.9 years in the adult group. Initial presentation was permanent ischemic stroke in 15 cases, transient ischemic attack (TIA) in 5 cases, and cerebral hemorrhage in one case. The MBH with dura opening and arachnoid preservation was performed bilaterally in 9 cases (43%) and unilaterally in 12 cases (57%). One patient died due to intraoperative bilateral ischemic stroke. Of the 20 other patients, 30% demonstrated clinical stability and 70% showed partial or complete recovery. Although one patient experienced a perioperative stroke, we did not observe any pseudomeningocele or postoperative ischemic stroke (IS) recurrence in all surviving cases during the average follow-up period of 55.5 months (range: 1-195). These outcomes emphasize the importance of preoperative monitoring to ensure the effectiveness and safety of the intervention. Postoperative angiography studies showed revascularization in 96.3% of treated hemispheres (100% in the adult group vs 80% in the pediatric group). CONCLUSIONS Our results on this small cohort suggest that the MBH technique with opening of the dura and arachnoids preservation can prevent recurrent strokes and reduce the risk of pseudomeningocele.
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Affiliation(s)
- M Soler-Rico
- Neurosurgery Department, St-Luc Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - M Di Santo
- Neurosurgery Department, St-Luc Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - G Vaz
- Neurosurgery Department, St-Luc Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - V Joris
- Neurosurgery Department, St-Luc Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - E Fomekong
- Neurosurgery Department, St-Luc Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - S Guillaume
- Medical Imaging Department, St-Luc Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - M Van Boven
- Anesthesiology Department, St-Luc Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - C Raftopoulos
- Neurosurgery Department, St-Luc Hospital, Université Catholique de Louvain, Brussels, Belgium.
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Guo Z, Yan Z, Qu F, Cheng D, Wang C, Feng Y. The value of indocyanine green-FLOW800 in microvasculature for predicting cerebral hyperperfusion syndrome in moyamoya disease patients. Sci Rep 2023; 13:18352. [PMID: 37884669 PMCID: PMC10603131 DOI: 10.1038/s41598-023-45676-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/23/2023] [Indexed: 10/28/2023] Open
Abstract
Among the notable complications of direct hemodynamic reconstruction for moyamoya disease (MMD) is cerebral hyperperfusion syndrome (CHS). In this study, we evaluated hemodynamic changes in small regional microvasculature (SRMV) around the anastomosis site by using indocyanine green (ICG)-FLOW800 video angiography and verified that it better predicted the onset of CHS. Intraoperative ICG-FLOW800 analysis was performed on 31 patients (36 cerebral hemispheres) with MMD who underwent superficial temporal artery-middle cerebral artery (MCA) bypass grafting at our institution. The regions of interest were established in the SRMV and thicker MCA around the anastomosis. Calculations were made for half-peak to time (TTP1/2), cerebral blood volume (CBV), and cerebral blood flow (CBF). According to the presence or absence of CHS after surgery, CHS and non-CHS groups of patients were separated. The results showed that ΔCBV and ΔCBF were substantially greater in SRMV than in MCA (p < 0.001). Compared with the non-CHS group, ΔCBF and ΔCBV of SRMV and MCA were considerably greater in the CHS group (p < 0.001). ΔCBF and ΔCBV on the ROC curve for both SRMV and MCA had high sensitivity and specificity (SRMV: ΔCBF, AUC = 0.8586; ΔCBV, AUC = 0.8158. MCA: ΔCBF, AUC = 0.7993; ΔCBV, AUC = 0.8684). ICG-FLOW800 video angiography verified the differential hemodynamic changes in the peri-anastomotic MCA and SRMV before and after bypass surgery in patients with MMD.
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Affiliation(s)
- Zhongxiang Guo
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Jiangsu Road No. 16, Qingdao, 266003, Shandong Province, China
| | - Zhaohui Yan
- Department of Neurosurgery, Haiyang People's Hospital, Haiyang Road No. 37, Haiyang, 265199, Shandong Province, China
| | - Fan Qu
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Jiangsu Road No. 16, Qingdao, 266003, Shandong Province, China
| | - Dekui Cheng
- Department of Neurosurgery, Liaocheng People's Hospital, Dongchang West Road No. 67, Liaocheng, 25200, Shandong Province, China
| | - Chao Wang
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Jiangsu Road No. 16, Qingdao, 266003, Shandong Province, China
| | - Yugong Feng
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Jiangsu Road No. 16, Qingdao, 266003, Shandong Province, China.
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Svedung Wettervik T, Fahlström M, Wikström J, Enblad P, Lewén A. Editorial: Moyamoya disease - natural history and therapeutic challenges. Front Neurol 2023; 14:1270197. [PMID: 37731851 PMCID: PMC10509009 DOI: 10.3389/fneur.2023.1270197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/24/2023] [Indexed: 09/22/2023] Open
Affiliation(s)
| | - Markus Fahlström
- Department of Surgical Sciences, Section of Neuroradiology, Uppsala University, Uppsala, Sweden
| | - Johan Wikström
- Department of Surgical Sciences, Section of Neuroradiology, Uppsala University, Uppsala, Sweden
| | - Per Enblad
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Anders Lewén
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
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Lewén A, Fahlström M, Borota L, Larsson EM, Wikström J, Enblad P. ASL-MRI-guided evaluation of multiple burr hole revascularization surgery in Moyamoya disease. Acta Neurochir (Wien) 2023; 165:2057-2069. [PMID: 37326844 PMCID: PMC10409847 DOI: 10.1007/s00701-023-05641-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 04/25/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE Moyamoya (MM) disease is characterized by progressive intracranial arterial stenosis. Patients commonly need revascularization surgery to optimize cerebral blood flow (CBF). Estimation of CBF and cerebrovascular reserve (CVR) is therefore necessary before and after surgery. However, assessment of CBF before and after indirect revascularization surgery with the multiple burr hole (MBH) technique in MM has not been studied extensively. In this study, we describe our initial experience using arterial spin labeling magnetic resonance perfusion imaging (ASL-MRI) for CBF and CVR assessment before and after indirect MBH revascularization surgery in MM patients. METHODS Eleven MM patients (initial age 6-50 years, 1 male/10 female) with 19 affected hemispheres were included. A total of 35 ASL-MRI examinations were performed using a 3D-pCASL acquisition before and after i.v. acetazolamide challenge (1000 mg in adults and 10 mg/kg in children). Twelve MBH procedures were performed in seven patients. The first follow-up ASL-MRI was performed 7-21 (mean 12) months after surgery. RESULTS Before surgery, CBF was 46 ± 16 (mean ± SD) ml/100 g/min and CVR after acetazolamide challenge was 38.5 ± 9.9 (mean ± SD)% in the most affected territory (middle cerebral artery). In cases in which surgery was not performed, CVR was 56 ± 12 (mean ± SD)% in affected hemispheres. After MBH surgery, there was a relative change in CVR compared to baseline (preop) of + 23.5 ± 23.3% (mean ± SD). There were no new ischemic events. CONCLUSION Using ASL-MRI we followed changes in CBF and CVR in patients with MM. The technique was encouraging for assessments before and after revascularization surgery.
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Affiliation(s)
- Anders Lewén
- Department of Medical Sciences, Neurosurgery, Uppsala University, Uppsala University Hospital, SE 751 85, Uppsala, Sweden.
| | - Markus Fahlström
- Department of Surgical Sciences, Neuroradiology, Uppsala University, Uppsala, Sweden
| | - Ljubisa Borota
- Department of Surgical Sciences, Neuroradiology, Uppsala University, Uppsala, Sweden
| | - Elna-Marie Larsson
- Department of Surgical Sciences, Neuroradiology, Uppsala University, Uppsala, Sweden
| | - Johan Wikström
- Department of Surgical Sciences, Neuroradiology, Uppsala University, Uppsala, Sweden
| | - Per Enblad
- Department of Medical Sciences, Neurosurgery, Uppsala University, Uppsala University Hospital, SE 751 85, Uppsala, Sweden
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Zha X, Liang Z, Zheng L, Xu Y. Association of Cerebral Hemodynamics and Cognitive Function in Adult Patients with Moyamoya Disease: A Three-Dimensional Pseudo-Continuous Arterial Spin Labeling Study. World Neurosurg 2023; 175:e447-e454. [PMID: 37024086 DOI: 10.1016/j.wneu.2023.03.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVE Cognitive dysfunction is a serious complication of moyamoya disease (MMD) in adults, and reduced cerebral blood flow (CBF) might be the potential cause. We aimed to explore the correlation between cerebral hemodynamics and cognitive function in adults with MMD by using three-dimensional pseudo-continuous arterial spin labeling (3D-pCASL). METHODS A total of 24 MMD patients with a history of cerebral infarction, 25 asymptomatic MMD patients, and 25 healthy controls were prospectively enrolled in this study. All participants were performed 3D-pCASL, and cognitive function was evaluated with the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment Scale (MoCA), and the Trail Making Test Part A (TMTA). The correlation between cerebral hemodynamics and cognitive function was explored in the region of interest-based analysis. RESULTS Compared with healthy controls, both CBF and cognition decreased in adult MMD. In the infarction group, the MMSE and MoCA scores correlated with CBF of the right anterior cerebral artery (P = 0.037 and 0.010, respectively) and the left middle cerebral artery (MCA) cortical territories (P = 0.002 and 0.001, respectively), and the TMTA time-consuming has a negative correlation with CBF of the right and left MCA cortical territories (P = 0.044 and 0.010, respectively); in the asymptomatic group, the MMSE and MoCA scores correlated with CBF of the left MCA cortical territory (P = 0.032 and 0.029, respectively). CONCLUSIONS The 3D-pCASL can find the hypoperfusion area of CBF in adults with MMD, and hypoperfusion in specific brain regions may cause cognitive dysfunction even in asymptomatic patients.
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Affiliation(s)
- Xiangyue Zha
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Zhiyu Liang
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Liyun Zheng
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Yikai Xu
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China.
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Bini G, Bailey KM, Voyvodic JT, Chiavaccini L, Munana KR, Keenihan EK. Effects of alfaxalone, propofol and isoflurane on cerebral blood flow and cerebrovascular reactivity to carbon dioxide in dogs: A pilot study. Vet J 2023; 291:105939. [PMID: 36509393 DOI: 10.1016/j.tvjl.2022.105939] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022]
Abstract
Propofol total intravenous anesthesia is a common choice to anesthetize patients with increased intracranial pressure, reducing cerebral blood flow while maintaining cerebrovascular reactivity to CO2. Propofol and alfaxalone are commonly used for total intravenous anesthesia in dogs, but the effects of alfaxalone on cerebral blood flow and cerebrovascular reactivity to CO2 are unknown. Our hypothesis was that alfaxalone would not be significantly different to propofol, while isoflurane would increase cerebral blood flow and decrease cerebrovascular reactivity to CO2. Six healthy hound dogs were evaluated in this randomized crossover trial. Dogs were anesthetized with 7.5 mg/kg propofol, 3 mg/kg alfaxalone or 8 % sevoflurane, mechanically ventilated and maintained with propofol (400 µg/kg/min), alfaxalone (150 µg/kg/min) or 1.7 % end-tidal isoflurane, respectively, with one week washout between treatments. Cerebral blood flow and cerebrovascular reactivity to CO2 during hypercapnic and hypocapnic challenges were measured using arterial spin labelling and blood oxygen level-dependent magnetic resonance imaging sequences, respectively. Median (interquartile range, IQR) normocapnic cerebral blood flow was significantly lower (P = 0.016) with alfaxalone compared to isoflurane, in the whole brain 15.39 mL/min/100 g (14.90-19.90 mL/min/100 g) vs. 34.10 mL/min/100 g (33.35-43.17 mL/min/100 g), the grey matter 14.57 mL/min/100 g (13.66-18.72 mL/min/100 g) vs. 32.37 mL/min/100 g (31.03-42.99 mL/min/100 g), the caudal brain 15.47 mL/min/100 g (13.37-21.45 mL/min/100 g) vs. 36.85 mL/min/100 g (32.50-47.18 mL/min/100 g) and the temporal lobe grey matter 18.80 mL/min/100 g (15.89-20.84 mL/min/100 g) vs. 43.32 (36.07-43.58 mL/min/100 g). Median (IQR) hypocapnic cerebrovascular reactivity to CO2 was significantly higher (P = 0.016) for alfaxalone compared to isoflurane 8.85 %S/mm Hg (6.92-10.44 %S/mm Hg) vs. 3.90 %S/mm Hg (3.80-4.33 %S/mm Hg). Alfaxalone maintained lower cerebral blood flow and higher hypocapnic cerebrovascular reactivity to CO2 than isoflurane.
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Affiliation(s)
- G Bini
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, 601 Vernon Tharp St., Columbus, OH 43210, USA.
| | - K M Bailey
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27607 USA
| | - J T Voyvodic
- Brain Imaging and Analysis Center, Radiology Department, Duke University, 40 Duke Medicine Circle, Durham, NC 27710, USA
| | - L Chiavaccini
- Department of Comparative, Diagnostic & Population Medicine, College of Veterinary Medicine, University of Florida, 2015 SW 16th Ave, Gainesville, FL 32608, USA
| | - K R Munana
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27607, USA
| | - E K Keenihan
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27607 USA
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Yu Z, Bai X, Zhang Y, Zhang G, Qiu C, Chen L, Li S, He S, Ma J, Zhao J. Baseline Hemodynamic Impairment and Revascularization Outcome in Newly Diagnosed Adult Moyamoya Disease Determined by Pseudocontinuous Arterial Spin Labeling. World Neurosurg 2022; 165:e494-e504. [PMID: 35750142 DOI: 10.1016/j.wneu.2022.06.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The study aimed to investigate the hemodynamic features and independent predictors of neoangiogenesis after revascularization in moyamoya disease (MMD) by pseudocontinuous arterial spin labeling magnetic resonance imaging (pCASL MRI). METHODS Thirty-nine MMD patients were categorized into infarction group, hemorrhagic group, and atypical group. All patients underwent combined bypass surgery and pCASL MRI with postlabeling delays (PLD) of 1525 ms and 2525 ms. Absolute CBFMCA (cerebral blood flow in middle cerebral artery territory), relative CBFMCA (CBFMCA 2525 ms/CBFMCA 1525 ms), and spatial coefficient of variation of MCA (CoVMCA) were analyzed. Relationships between CBFMCA and the following clinical parameters were assessed: Suzuki stage, modified Rankin scale (mRS), cerebrovascular accident lesion score, and deep medullary veins score. Potential predictors for favorable neoangiogenesis and hemodynamic changes were explored as well. RESULTS Preoperative CBFMCA differed among MMD patients with variable clinical presentations, Matsushima stages, modified Rankin Scale scores, CVA scores, and deep medullary vein scores. After bypass surgery, mean CBFMCA increased significantly in the infarction group (P = 0.027) and decreased in the hemorrhagic group (P = 0.043), while spatial CoVMCA was observed to decline in all groups. Higher preoperative relative CBFMCA and spatial CoVMCA were independent predictors for robust neoangiogenesis after bypass. The cutoff value of 0.330 of spatial CoVMCA at long PLD yielded the best sensitivity at 82.1% and specificity at 81.8%. Furthermore, both preoperative relative CBFMCA and spatial CoVMCA showed mild positive correlations with ΔmRS in MMD patients. CONCLUSIONS pCASL-MRI with multiple PLDs could reflect preoperative hemodynamic impairment and predict the neoangiogenesis after combined bypass surgery in moyamoya patients.
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Affiliation(s)
- Zhiqiang Yu
- Nanjing Comprehensive Stroke Center, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Xingcheng Bai
- Nanjing Comprehensive Stroke Center, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Yanping Zhang
- Nanjing Comprehensive Stroke Center, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Guangxu Zhang
- Nanjing Comprehensive Stroke Center, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Chen Qiu
- Nanjing Comprehensive Stroke Center, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Lijiu Chen
- Nanjing Comprehensive Stroke Center, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Shun Li
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Shengxue He
- Nanjing Comprehensive Stroke Center, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Jun Ma
- Nanjing Comprehensive Stroke Center, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Jinbing Zhao
- Nanjing Comprehensive Stroke Center, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.
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Wang Q. Editorial for "Reliability and Sensitivity to Longitudinal CBF Changes in Steno-Occlusive Diseases: ASL versus 123 I-IMP-SPECT". J Magn Reson Imaging 2022; 55:1733-1734. [PMID: 34874088 DOI: 10.1002/jmri.28022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 11/29/2021] [Indexed: 12/31/2022] Open
Affiliation(s)
- Qianfeng Wang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
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Zhao J, Yu Z, Zhang Y, Qiu C, Zhang G, Chen L, He S, Ma J. Caveolin-1 Promoted Collateral Vessel Formation in Patients With Moyamoya Disease. Front Neurol 2022; 13:796339. [PMID: 35557625 PMCID: PMC9086974 DOI: 10.3389/fneur.2022.796339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 03/24/2022] [Indexed: 11/18/2022] Open
Abstract
Background Caveolin-1 (Cav-1) plays pivotal roles in the endothelial function and angiogenesis postischemia. Moyamoya disease (MMD) is characterized by progressive artery stenosis with unknown etiology. We aim to determine whether serum Cav-1 levels of patients with MMD were associated with collateral vessel formation after bypass surgery. Methods We studied serum Cav-1 levels of 130 patients with MMD (16 with RNF213 p.R4810K mutation and 114 without RNF213 p.R4810K mutation), 15 patients with acute stroke, and 33 healthy controls. Cerebral perfusion and collateral circulation were evaluated preoperation and at 6 months after operation using pseudocontinuous arterial spin labeling MRI (pCASL-MRI) and digital subtraction angiography (DSA), respectively. Endothelial expression of Cav-1 was verified in the superficial temporal artery (STA) wall of patients with MMD by immunofluorescence double staining. We also investigated whether overexpression of Cav-1 affects cell migration and tube formation using human microvascular endothelial cells (HMECs). Results The serum Cav-1 level of patients with MMD intermediated between the stroke group and healthy controls and it was enhanced after the bypass surgery (681.87 ± 311.63 vs. 832.91 ± 464.41 pg/ml, p = 0.049). By 6 months after bypass surgery, patients with MMD with better collateral compensation manifested higher postoperative/preoperative Cav-1 ratio (rCav-1) than bad compensation patients. Consistently, cerebral blood flow (CBF) determined by pCASL-MRI (nCBFMCA ratio) was positively in line with rCav-1 ratio (r = 0.8615, p < 0.0001). Cav-1 was expressed in the endothelial cells of the STA vessels of patients with MMD. Overexpression of Cav-1 by plasmid transfection in HMECs promoted tube formation and cell migration. Conclusion This study indicated that Cav-1 may be a potential driver to promote angiogenesis and collateral formation after bypass surgery in patients with MMD, providing a better understanding of MMD pathophysiology and potential non-surgical targets of MMD.
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Affiliation(s)
- Jinbing Zhao
- Nanjing Comprehensive Stroke Center, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Zhiqiang Yu
- Nanjing Comprehensive Stroke Center, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Yanping Zhang
- Nanjing Comprehensive Stroke Center, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Cheng Qiu
- Nanjing Comprehensive Stroke Center, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Guangxu Zhang
- Nanjing Comprehensive Stroke Center, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Lijiu Chen
- Nanjing Comprehensive Stroke Center, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Shengxue He
- Nanjing Comprehensive Stroke Center, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Jun Ma
- Nanjing Comprehensive Stroke Center, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
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Ueda Y, Tanaka Y, Hara S, Inaji M, Ishii K, Maehara T, Nariai T. Differences in cerebral blood flow measurement using arterial spin labeling MRI between patients with moyamoya disease and patients with arteriosclerotic cerebrovascular disease. Acta Radiol 2022; 64:311-319. [PMID: 35037475 DOI: 10.1177/02841851211069245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND It is unclear whether the accuracy of arterial spin labeling (ASL) magnetic resonance imaging (MRI) is the same between moyamoya disease (MMD), which is known to have markedly elevated cerebral blood volume (CBV), and atherosclerotic intracranial arterial stenosis (AS), which has relatively less elevated CBV. PURPOSE To investigate how the differences in hemodynamics affect measurement of ASL-cerebral blood flow (CBF) using ASL for patients with MMD and AS. MATERIAL AND METHODS Fourteen MMD and ten AS patients were evaluated with ASL-MRI, magnetic resonance angiography (MRA), and 15O-gas positron emission computed tomography (PET). The regional CBF values of ASL using two post-labeling delays (PLDs; 1525 ms and 2525 ms) were compared with the PET-derived CBF, CBV, and mean transit time (MTT). Corresponding anterior circulation results were evaluated by flow territory map-based analysis. RESULTS The correlation between the ASL-CBF values (2525 ms) and PET-CBF declined in the MMD group (r = 0.28; P < 0.01), while the AS group showed good correlation (r = 0.77; P < 0.01). In the MMD group, the ASL-CBF values (2525 ms) overestimated the PET-CBF values as the regional CBV values increased (r = 0.35; P < 0.01). When the regions of interest were divided into two subgroups according to the degree of arterial stenosis by MRA, the correlation coefficient between the ASL-CBF (2525 ms) and PET-CBF values improved (mild stenosis: r = 0.36; P = 0.06; severe stenosis: r = 0.51; P < 0.01). CONCLUSION The accuracy of CBF measurements using ASL-MRI differed between patients with MMD and AS. The prominent increase of CBV and the degree of arterial stenosis may have affected the accuracy of ASL-CBF in patients with MMD.
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Affiliation(s)
- Yasuhiro Ueda
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoji Tanaka
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shoko Hara
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
- Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Motoki Inaji
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
- Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Kenji Ishii
- Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Taketoshi Maehara
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tadashi Nariai
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
- Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
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12
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Lang SS, Tucker AM, Schreiber C, Storm PB, Liu H, Li Y, Ichord R, Beslow LA, Sedora-Roman NI, Cox M, Nasser H, Vossough A, Fisher MJ, Kilbaugh TJ, Huh JW. Arterial spin labeling as an ancillary assessment to postoperative conventional angiogram in pediatric moyamoya disease. J Neurosurg Pediatr 2022; 29:40-47. [PMID: 34598159 DOI: 10.3171/2021.7.peds21302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 07/06/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Digital subtraction angiography (DSA) is commonly performed after pial synangiosis surgery for pediatric moyamoya disease to assess the degree of neovascularization. However, angiography is invasive, and the risk of ionizing radiation is a concern in children. In this study, the authors aimed to identify whether arterial spin labeling (ASL) can predict postoperative angiogram grading. In addition, they sought to determine whether patients who underwent ASL imaging without DSA had similar postoperative outcomes when compared with patients who received ASL imaging and postoperative DSA. METHODS The medical records of pediatric patients who underwent pial synangiosis for moyamoya disease at a quaternary children's hospital were reviewed during a 10-year period. ASL-only and ASL+DSA cohorts were analyzed. The frequency of preoperative and postoperative symptoms was analyzed within each cohort. Three neuroradiologists assigned a visual ASL grade for each patient indicating the change from the preoperative to postoperative ASL perfusion sequences. A postoperative neovascularization grade was also assigned for patients who underwent DSA. RESULTS Overall, 21 hemispheres of 14 patients with ASL only and 14 hemispheres of 8 patients with ASL+DSA were analyzed. The groups had similar rates of MRI evidence of acute or chronic stroke preoperatively (61.9% in the ASL-only group and 64.3% in the ASL+DSA group). In the entire cohort, transient ischemic attack (TIA) (p = 0.027), TIA composite (TIA or unexplained neurological symptoms; p = 0.0006), chronic headaches (p = 0.035), aphasia (p = 0.019), and weakness (p = 0.001) all had decreased frequency after intervention. The authors found a positive association between revascularization observed on DSA and the visual ASL grading (p = 0.048). The visual ASL grades in patients with an angiogram indicating robust neovascularization demonstrated improved perfusion when compared with the ASL grades of patients with a poor neovascularization. CONCLUSIONS Noninvasive ASL perfusion imaging had an association with postoperative DSA neoangiogenesis following pial synangiosis surgery in children. There were no significant postoperative stroke differences between the ASL-only and ASL+DSA cohorts. Both cohorts demonstrated significant improvement in preoperative symptoms after surgery. Further study in larger cohorts is necessary to determine whether the results of this study are validated in order to circumvent the invasive catheter angiogram.
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Affiliation(s)
- Shih-Shan Lang
- 1Division of Neurosurgery, Children's Hospital of Philadelphia, Department of Neurosurgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia.,2Center for Data Driven Discovery in Biomedicine, Children's Hospital of Philadelphia, Philadelphia
| | - Alexander M Tucker
- 1Division of Neurosurgery, Children's Hospital of Philadelphia, Department of Neurosurgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia.,2Center for Data Driven Discovery in Biomedicine, Children's Hospital of Philadelphia, Philadelphia
| | - Craig Schreiber
- 3Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia
| | - Phillip B Storm
- 1Division of Neurosurgery, Children's Hospital of Philadelphia, Department of Neurosurgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia.,2Center for Data Driven Discovery in Biomedicine, Children's Hospital of Philadelphia, Philadelphia
| | - Hongyan Liu
- 4Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Perelman School of Medicine, Philadelphia
| | - Yimei Li
- 4Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Perelman School of Medicine, Philadelphia.,5Division of Oncology, Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at University of Pennsylvania, Philadelphia
| | - Rebecca Ichord
- 6Division of Neurology, Children's Hospital of Philadelphia, Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia
| | - Lauren A Beslow
- 6Division of Neurology, Children's Hospital of Philadelphia, Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia
| | - Neda I Sedora-Roman
- 7Department of Radiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia; and
| | - Mougnyan Cox
- 7Department of Radiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia; and
| | - Hussein Nasser
- 7Department of Radiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia; and
| | - Arastoo Vossough
- 7Department of Radiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia; and
| | - Michael J Fisher
- 5Division of Oncology, Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at University of Pennsylvania, Philadelphia
| | - Todd J Kilbaugh
- 8Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jimmy W Huh
- 8Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
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13
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Imaging methods for surgical revascularization in patients with moyamoya disease: an updated review. Neurosurg Rev 2021; 45:343-356. [PMID: 34417671 PMCID: PMC8827314 DOI: 10.1007/s10143-021-01596-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 06/20/2021] [Accepted: 06/24/2021] [Indexed: 02/08/2023]
Abstract
Neuroimaging is crucial in moyamoya disease (MMD) for neurosurgeons, during pre-surgical planning and intraoperative navigation not only to maximize the success rate of surgery, but also to minimize postsurgical neurological deficits in patients. This is a review of recent literatures which updates the clinical use of imaging methods in the morphological and hemodynamic assessment of surgical revascularization in patients with MMD. We aimed to assist surgeons in assessing the status of moyamoya vessels, selecting bypass arteries, and monitoring postoperative cerebral perfusion through the latest imaging technology.
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14
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Fahlström M, Wikström J, Borota L, Enblad P, Lewén A. Variable Temporal Cerebral Blood Flow Response to Acetazolamide in Moyamoya Patients Measured Using Arterial Spin Labeling. Front Neurol 2021; 12:615017. [PMID: 34168605 PMCID: PMC8217767 DOI: 10.3389/fneur.2021.615017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 05/07/2021] [Indexed: 11/13/2022] Open
Abstract
Cerebrovascular reserve capacity (CVR), an important predictor of ischaemic events and a prognostic factor for patients with moyamoya disease (MMD), can be assessed by measuring cerebral blood flow (CBF) before and after administration of acetazolamide (ACZ). Often, a single CBF measurement is performed between 5 and 20 min after ACZ injection. Assessment of the temporal response of the vasodilation secondary to ACZ administration using several repeated CBF measurements has not been studied extensively. Furthermore, the high standard deviations of the group-averaged CVRs reported in the current literature indicate a patient-specific dispersion of CVR values over a wide range. This study aimed to assess the temporal response of the CBF and derived CVR during ACZ challenge using arterial spin labeling in patients with MMD. Eleven patients with MMD were included before or after revascularisation surgery. CBF maps were acquired using pseudo-continuous arterial spin labeling before and 5, 15, and 25 min after an intravenous ACZ injection. A vascular territory template was spatially normalized to patient-specific space, including the bilateral anterior, middle, and posterior cerebral arteries. CBF increased significantly post-ACZ injection in all vascular territories and at all time points. Group-averaged CBF and CVR values remained constant throughout the ACZ challenge in most patients. The maximum increase in CBF occurred most frequently at 5 min post-ACZ injection. However, peaks at 15 or 25 min were also present in some patients. In 68% of the affected vascular territories, the maximum increase in CBF did not occur at 15 min. In individual cases, the difference in CVR between different time points was between 1 and 30% points (mean difference 8% points). In conclusion, there is a substantial variation in CVR between different time points after the ACZ challenge in patients with MMD. Thus, there is a risk that the use of a single post-ACZ measurement time point overestimates disease progression, which could have wide implications for decision-making regarding revascularisation surgery and the interpretation of the outcome thereof. Further studies with larger sample sizes using multiple CBF measurements post-ACZ injection in patients with MMD are encouraged.
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Affiliation(s)
- Markus Fahlström
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - Johan Wikström
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - Ljubisa Borota
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - Per Enblad
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Anders Lewén
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden
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15
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Lee SB, Lee S, Cho YJ, Choi YH, Cheon JE, Kim WS. Monitoring Cerebral Perfusion Changes Using Arterial Spin-Labeling Perfusion MRI after Indirect Revascularization in Children with Moyamoya Disease. Korean J Radiol 2021; 22:1537-1546. [PMID: 34132076 PMCID: PMC8390823 DOI: 10.3348/kjr.2020.1464] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/19/2021] [Accepted: 03/12/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the role of arterial spin-labeling (ASL) perfusion MRI in identifying cerebral perfusion changes after indirect revascularization in children with moyamoya disease. MATERIALS AND METHODS We included pre- and postoperative perfusion MRI data of 30 children with moyamoya disease (13 boys and 17 girls; mean age ± standard deviation, 6.3 ± 3.0 years) who underwent indirect revascularization between June 2016 and August 2017. Relative cerebral blood flow (rCBF) and qualitative perfusion scores for arterial transit time (ATT) effects were evaluated in the middle cerebral artery (MCA) territory on ASL perfusion MRI. The rCBF and relative time-to-peak (rTTP) values were also measured using dynamic susceptibility contrast (DSC) perfusion MRI. Each perfusion change on ASL and DSC perfusion MRI was analyzed using the paired t test. We analyzed the correlation between perfusion changes on ASL and DSC images using Spearman's correlation coefficient. RESULTS The ASL rCBF values improved at both the ganglionic and supraganglionic levels of the MCA territory after surgery (p = 0.040 and p = 0.003, respectively). The ATT perfusion scores also improved at both levels (p < 0.001 and p < 0.001, respectively). The rCBF and rTTP values on DSC MRI showed significant improvement at both levels of the MCA territory of the operated side (all p < 0.05). There was no significant correlation between the improvements in rCBF values on the two perfusion images (r = 0.195, p = 0.303); however, there was a correlation between the change in perfusion scores on ASL and rTTP on DSC MRI (r = 0.701, p < 0.001). CONCLUSION Recognizing the effects of ATT on ASL perfusion MRI may help monitor cerebral perfusion changes and complement quantitative rCBF assessment using ASL perfusion MRI in patients with moyamoya disease after indirect revascularization.
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Affiliation(s)
- Seul Bi Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Seunghyun Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
| | - Yeon Jin Cho
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Young Hun Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Eun Cheon
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Woo Sun Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
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16
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Setta K, Matsuda T, Sasaki M, Chiba T, Fujiwara S, Kobayashi M, Yoshida K, Kubo Y, Suzuki M, Yoshioka K, Ogasawara K. Diagnostic Accuracy of Screening Arterial Spin-Labeling MRI Using Hadamard Encoding for the Detection of Reduced CBF in Adult Patients with Ischemic Moyamoya Disease. AJNR Am J Neuroradiol 2021; 42:1403-1409. [PMID: 34016589 DOI: 10.3174/ajnr.a7167] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/11/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Adult patients with ischemic Moyamoya disease are advised to undergo selective revascularization surgery based on cerebral hemodynamics. The purpose of this study was to determine the diagnostic accuracy of arterial spin-labeling MR imaging using Hadamard-encoded multiple postlabeling delays for the detection of reduced CBF in such patients. MATERIALS AND METHODS Thirty-seven patients underwent brain perfusion SPECT and pseudocontinuous arterial spin-labeling MR imaging using standard postlabeling delay (1525 ms) and Hadamard-encoded multiple postlabeling delays. For Hadamard-encoded multiple postlabeling delays, based on data obtained from the 7 sub-boluses with combinations of different labeling durations and postlabeling delays, CBF corrected by the arterial transit time was calculated on a voxel-by-voxel basis. Using a 3D stereotaxic template, we automatically placed ROIs in the ipsilateral cerebellar hemisphere and 5 MCA territories in the symptomatic cerebral hemisphere; then, the ratio of the MCA to cerebellar ROI was calculated. RESULTS The area under the receiver operating characteristic curve for detecting reduced SPECT-CBF ratios (<0.686) was significantly greater for the Hadamard-encoded multiple postlabeling delays-CBF ratios (0.885) than for the standard postlabeling delay-CBF ratios (0.786) (P = .001). The sensitivity and negative predictive value for the Hadamard-encoded multiple postlabeling delays-CBF ratios were 100% (95% confidence interval, 100%-100%) and significantly higher than the sensitivity (95% CI, 44%-80%) and negative predictive value (95% CI, 88%-97%) for the standard postlabeling delay-CBF ratio, respectively. CONCLUSIONS ASL MR imaging using Hadamard-encoded multiple postlabeling delays may be applicable as a screening tool because it can detect reduced CBF on brain perfusion SPECT with 100% sensitivity and a 100% negative predictive value in adult patients with ischemic Moyamoya disease.
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Affiliation(s)
- K Setta
- From the Department of Neurosurgery (K.S., T.C., S.F., M.K., K. Yoshida, Y. Kubo, K.O.), Institute for Biomedical Sciences, Iwate Medical University School of Medicine, Yahaba-cho, Japan
| | - T Matsuda
- Division of Ultrahigh Field MRI, Institute for Biomedical Sciences (T.M., M. Sasaki), Iwate Medical University School of Medicine, Yahaba-cho, Japan
| | - M Sasaki
- Department of Radiology (M. Suzuki, K. Yoshioka) Institute for Biomedical Sciences (TM, MS), Iwate Medical University School of Medicine, Yahaba-cho, Japan.,Division of Ultrahigh Field MRI, Institute for Biomedical Sciences (T.M., M. Sasaki), Iwate Medical University School of Medicine, Yahaba-cho, Japan
| | - T Chiba
- From the Department of Neurosurgery (K.S., T.C., S.F., M.K., K. Yoshida, Y. Kubo, K.O.), Institute for Biomedical Sciences, Iwate Medical University School of Medicine, Yahaba-cho, Japan
| | - S Fujiwara
- From the Department of Neurosurgery (K.S., T.C., S.F., M.K., K. Yoshida, Y. Kubo, K.O.), Institute for Biomedical Sciences, Iwate Medical University School of Medicine, Yahaba-cho, Japan
| | - M Kobayashi
- From the Department of Neurosurgery (K.S., T.C., S.F., M.K., K. Yoshida, Y. Kubo, K.O.), Institute for Biomedical Sciences, Iwate Medical University School of Medicine, Yahaba-cho, Japan
| | - K Yoshida
- From the Department of Neurosurgery (K.S., T.C., S.F., M.K., K. Yoshida, Y. Kubo, K.O.), Institute for Biomedical Sciences, Iwate Medical University School of Medicine, Yahaba-cho, Japan.,Department of Radiology (M. Suzuki, K. Yoshioka) Institute for Biomedical Sciences (TM, MS), Iwate Medical University School of Medicine, Yahaba-cho, Japan
| | - Y Kubo
- From the Department of Neurosurgery (K.S., T.C., S.F., M.K., K. Yoshida, Y. Kubo, K.O.), Institute for Biomedical Sciences, Iwate Medical University School of Medicine, Yahaba-cho, Japan
| | | | - K Yoshioka
- From the Department of Neurosurgery (K.S., T.C., S.F., M.K., K. Yoshida, Y. Kubo, K.O.), Institute for Biomedical Sciences, Iwate Medical University School of Medicine, Yahaba-cho, Japan.,Department of Radiology (M. Suzuki, K. Yoshioka) Institute for Biomedical Sciences (TM, MS), Iwate Medical University School of Medicine, Yahaba-cho, Japan
| | - K Ogasawara
- From the Department of Neurosurgery (K.S., T.C., S.F., M.K., K. Yoshida, Y. Kubo, K.O.), Institute for Biomedical Sciences, Iwate Medical University School of Medicine, Yahaba-cho, Japan
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17
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He S, Liu Z, Wei Y, Duan R, Xu Z, Zhang C, Yuan L, Li T, Ma N, Lou X, Liu X, Wang R. Impairments in brain perfusion, executive control network, topological characteristics, and neurocognition in adult patients with asymptomatic Moyamoya disease. BMC Neurosci 2021; 22:35. [PMID: 33980154 PMCID: PMC8117595 DOI: 10.1186/s12868-021-00638-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 04/19/2021] [Indexed: 12/21/2022] Open
Abstract
Background Asymptomatic Moyamoya disease (MMD) impairs hemodynamic and cognitive function. The relationship between these changes, cerebral blood flow (CBF), and network connectivity remains largely unknown. The aim of this study was to increase understanding of the relationship between CBF, functional networks, and neurocognition in adults with asymptomatic MMD. We compared CBF and functional status in 26 patients with MMD and 20 healthy controls using arterial spin labeling and resting state functional magnetic resonance imaging sequences. At the same time, a detailed cognitive test was performed in 15 patients with no cerebral or lumen infarction who were selected by magnetic resonance imaging-T2 FLAIR screening. Results Compared to the controls, the patients showed varying degrees of decline in their computational ability (simple subtraction, p = 0.009; complex subtraction, p = 0.006) and short-term memory (p = 0.042). The asymptomatic MMD group also showed decreased CBF in the left anterior central and left inferior frontal gyri of the island flap with multiple node abnormalities in the brain network and reduced network connectivity. There was a significant association of these changes with cognitive decline in the MMD group. Conclusions In patients with asymptomatic MMD, disturbance of CBF and impaired brain network connections may be important causes of cognitive decline and appear before clinical symptoms. Clinical trial registration-URL: http://www.chictr.org.cn Unique identifier: ChiCTR1900023610 Supplementary Information The online version contains supplementary material available at 10.1186/s12868-021-00638-z.
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Affiliation(s)
- Shihao He
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China
| | - Ziqi Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China
| | - Yanchang Wei
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China
| | - Ran Duan
- Department of Neurosurgery, Peking University International Hospital, Beijing, 102206, China
| | - Zongsheng Xu
- Department of Neurosurgery, Peking University International Hospital, Beijing, 102206, China
| | - Cai Zhang
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/Mc Govern Institute for Brain Research, Beijing Normal University, Beijing, 100875, China
| | - Li Yuan
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/Mc Govern Institute for Brain Research, Beijing Normal University, Beijing, 100875, China
| | - Tian Li
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/Mc Govern Institute for Brain Research, Beijing Normal University, Beijing, 100875, China
| | - Ning Ma
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China
| | - Xin Lou
- Department of Radiology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Xiaoyuan Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China.
| | - Rong Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China. .,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100069, China. .,Department of Neurosurgery, Peking University International Hospital, Beijing, 102206, China.
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18
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Zhuang C, Poublanc J, Mcketton L, Venkatraghavan L, Sobczyk O, Duffin J, Crawley AP, Fisher JA, Wu R, Mikulis DJ. The value of a shorter-delay arterial spin labeling protocol for detecting cerebrovascular impairment. Quant Imaging Med Surg 2021; 11:608-619. [PMID: 33532261 DOI: 10.21037/qims-20-148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background The aim of this study was to determine the relationship between blood oxygen level dependent (BOLD) cerebrovascular reactivity (CVR) and cerebral blood flow (CBF) obtained from arterial spin labeling (ASL) using different post labeling delays (PLD). Methods Forty-two patients with steno-occlusive diseases and impaired CVR were divided into two groups, one scanned with a 1.5-second (1.5-s) and the other with a 2.5-second (2.5-s) PLD ASL protocol. For all patients, a region of interest (ROI) was drawn around the CVR impairment. This affected ROI was then left-right flipped across the brain midline to obtain the control ROI. For both groups, the difference in grey matter CVR between affected and control ROI was first tested to confirm significance. The average grey matter CBF of affected and control ROIs were then compared. The same analysis method was used to compare affected and control hemispheres. Results In both groups of 1.5-s and 2.5-s PLD, CVR values in the affected ROI (-0.049±0.055 and -0.042±0.074%/mmHg, respectively) were significantly lower compared to that in the control ROI (0.152±0.054 and 0.152±0.053%/mmHg, respectively, P<0.0001). In the group with the 1.5-s PLD, CBF in the affected ROI (37.62±11.37 mL/100 g/min) was significantly lower compared to CBF in the control ROI (44.13±11.58 mL/100 g/min, P<0.05). However, in the group with the 2.5-s PLD, no significant differences could be seen between CBF in the affected ROI (40.50±14.82 mL/100 g/min) and CBF in the control ROI (39.68±12.49 mL/100 g/min, P=0.73). In the hemisphere-based analysis, CBF was significantly lower in the affected side than in the control side for the group with the 1.5-s PLD (P<0.05) when CVR was impaired (P<0.0001), but not for the group with the 2.5-s PLD (P=0.49). Conclusions In conclusion, our study reveals and highlights the value of a shorter-PLD ASL protocol, which is able to reflect CVR impairment. At the same time, we offer a better understanding of the relationship between BOLD CVR and CBF obtained from ASL.
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Affiliation(s)
- Caiyu Zhuang
- Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada.,Department of Medical Imaging, the First Affiliated Hospital, Medical College of Shantou University, Shantou, China
| | - Julien Poublanc
- Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Larissa Mcketton
- Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | | | - Olivia Sobczyk
- Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - James Duffin
- Department of Anaesthesia, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Department of Physiology, University Health Network, Toronto, Canada
| | - Adrian P Crawley
- Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Joseph A Fisher
- Department of Anaesthesia, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Department of Physiology, University Health Network, Toronto, Canada
| | - Renhua Wu
- Department of Medical Imaging, the Second Affiliated Hospital, Medical College of Shantou University, Shantou, China
| | - David J Mikulis
- Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
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19
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Wang J, Pan LJ, Zhou B, Zu JY, Zhao YX, Li Y, Zhu WQ, Li L, Xu JR, Chen ZA. Crossed cerebellar diaschisis after stroke detected noninvasively by arterial spin-labeling MR imaging. BMC Neurosci 2020; 21:46. [PMID: 33218307 PMCID: PMC7678313 DOI: 10.1186/s12868-020-00595-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 10/09/2020] [Indexed: 12/20/2022] Open
Abstract
Background As a noninvasive perfusion-weighted MRI technique, arterial spin-labeling (ASL) was becoming increasingly used to evaluate cerebral hemodynamics in many studies. The relation between ASL-MRI and crossed cerebellar diaschisis (CCD) was rarely discussed. In this study, the aim of our study was to assess the performance of ASL-MRI in the detection of crossed cerebellar diaschisis after stroke in compared with single-photon emission CT (SPECT). Results 17 of 51(33.3%) patients revealed CCD phenomenon by the SPECT method. In CCD-positive group, CBFASL of ipsilateral cerebellar were significantly increased compared with contralateral cerebellar (p < 0.0001) while no significant differences (p = 0.063, > 0.001) in the CCD-negative group. Positive correlation was detected between admission National institute of health stroke scale (NIHSS) and asymmetry index of SPECT (AISPECT) (r = 0.351, p = 0.011), AIASL (r = 0.372, p = 0.007); infract volume and AISPECT (r = 0.443, p = 0.001), AIASL (r = 0.426, p = 0.002). Significant correlation was also found between cerebral blood flow of SPECT (CBFSPECT) and CBFASL, AISPECT and AIASL (r = 0.204, p = 0.04; r = 0.467, p = 0.001, respectively). Furthermore, the area under the receiver operating characteristic (ROC) curve value of AIASL was 0.829. Conclusions CBF derived from ASL-MRI could be valuable for assessment of CCD in supratentorial stroke patients. Additionally, CCD was significantly associated with larger ischemic volume and higher initial NIHSS score.
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Affiliation(s)
- Juan Wang
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Rd, Shanghai, 200127, China.,Department of Radiology, Renji Hospital South Campus, School of Medicine, Shanghai Jiao Tong University, 2000 Jiangyue Rd, Shanghai, 201112, China
| | - Li-Jun Pan
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Rd, Shanghai, 200127, China
| | - Bin Zhou
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Rd, Shanghai, 200127, China.,Department of Radiology, Renji Hospital South Campus, School of Medicine, Shanghai Jiao Tong University, 2000 Jiangyue Rd, Shanghai, 201112, China
| | - Jin-Yan Zu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Rd, Shanghai, 200127, China.,Department of Radiology, Renji Hospital South Campus, School of Medicine, Shanghai Jiao Tong University, 2000 Jiangyue Rd, Shanghai, 201112, China
| | - Yi-Xu Zhao
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Rd, Shanghai, 200127, China
| | - Yang Li
- Department of Radiology, Renji Hospital South Campus, School of Medicine, Shanghai Jiao Tong University, 2000 Jiangyue Rd, Shanghai, 201112, China
| | - Wan-Qiu Zhu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Rd, Shanghai, 200127, China
| | - Lei Li
- Department of Radiology, Renji Hospital South Campus, School of Medicine, Shanghai Jiao Tong University, 2000 Jiangyue Rd, Shanghai, 201112, China
| | - Jian-Rong Xu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Rd, Shanghai, 200127, China
| | - Zeng-Ai Chen
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Rd, Shanghai, 200127, China. .,Department of Radiology, Renji Hospital South Campus, School of Medicine, Shanghai Jiao Tong University, 2000 Jiangyue Rd, Shanghai, 201112, China.
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20
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Ya J, Zhou D, Ding J, Rajah GB, Wu Y, Yang X, Hou Y, Jin K, Pan L, Wu Y, Du J, Ding Y, Ji X, Yang Q, Meng R. Arterial spin labeling-MR may be an alternative to SPECT for evaluating cerebral perfusion in patients with unilateral middle cerebral artery stenosis. Neurol Res 2020; 42:621-629. [PMID: 32657247 DOI: 10.1080/01616412.2020.1782080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Cerebral blood flow (CBF) mapping of single-photon emission tomography (SPECT) is considered a gold standard for evaluating cerebral perfusion. However, invasiveness, high costs and strict technical requirements can limit its clinical use. We aimed to evaluate the concordance of CBF maps obtained from SPECT and pseudo-continuous arterial spin labeling magnetic resonance (PCASL-MR) imaging for evaluating cerebral perfusion. METHODS PCASL-MR/SPECT-CBF maps were obtained from 16 eligible patients with unilateral middle cerebral artery stenosis (MCAS). Three slices (basal ganglia, semi-oval center and cerebellum) on both PCASL-MR and SPECT maps were divided into different regions of interest (ROIs) according to the ASPECT criterion, arterial territories, and cerebral hemispheres, respectively. The concordance of the two types of CBF maps and the specificity and sensitivity of PCASL-MR imaging on predicting regional hypoperfusion were calculated. RESULTS A total of 448 ROIs were divided according to the ASPECT criterion, 192 ROIs partitioned in accordance with arterial territories, and 96 ROIs delineated based on cerebral hemispheres were analyzed. PCASL-MR imaging exhibited 83.78% to 100% sensitivity, 90.19% to 95.83% specificity for detection of hypoperfusion. Qualitative analyses revealed a strong concordance between PCASL-MR and SPECT on reflecting regional cerebral hypoperfusion (Kappa coefficient = 0.662-0.920, p < 0.01). Semi-quantitative analysis by ΔCBF revealed moderate consistency (Spearman correlation coefficient = 0.610-0.571). CONCLUSIONS Our findings suggest that PCASL-MR may be a promising non-invasive, inexpensive alternative to SPECT for evaluating cerebral perfusion accurately in patients with symptomatic MCAS.
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Affiliation(s)
- Jingyuan Ya
- Department of Neurology, Xuanwu Hospital, Capital Medical University , Beijing, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders , Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University , Beijing, China.,National Clinical Research Center for Geriatric Diseases , Beijing, China
| | - Da Zhou
- Department of Neurology, Xuanwu Hospital, Capital Medical University , Beijing, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders , Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University , Beijing, China.,National Clinical Research Center for Geriatric Diseases , Beijing, China
| | - Jiayue Ding
- Department of Neurology, Xuanwu Hospital, Capital Medical University , Beijing, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders , Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University , Beijing, China.,National Clinical Research Center for Geriatric Diseases , Beijing, China
| | - Gary B Rajah
- Department of Neurosurgery, Wayne State University School of Medicine , Detroit, Michigan, USA.,Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo , Buffalo, NY, USA.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health , Buffalo, NY, USA
| | - Ye Wu
- Department of Radiology, Xuanwu Hospital, Capital Medical University , Beijing, China
| | - Xiaoxu Yang
- Department of Radiology, Xuanwu Hospital, Capital Medical University , Beijing, China
| | - Yaqin Hou
- Department of Radiology, Xuanwu Hospital, Capital Medical University , Beijing, China
| | - Kexin Jin
- Department of Neurology, Xuanwu Hospital, Capital Medical University , Beijing, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders , Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University , Beijing, China
| | - Liqun Pan
- Department of Neurology, Xuanwu Hospital, Capital Medical University , Beijing, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders , Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University , Beijing, China.,National Clinical Research Center for Geriatric Diseases , Beijing, China
| | - Yu Wu
- Department of Radiology, Xuanwu Hospital, Capital Medical University , Beijing, China
| | - Jingwen Du
- Department of Radiology, Xuanwu Hospital, Capital Medical University , Beijing, China
| | - Yuchuan Ding
- Advanced Center of Stroke, Beijing Institute for Brain Disorders , Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University , Beijing, China.,Department of Neurosurgery, Wayne State University School of Medicine , Detroit, Michigan, USA
| | - Xunming Ji
- Advanced Center of Stroke, Beijing Institute for Brain Disorders , Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University , Beijing, China.,National Clinical Research Center for Geriatric Diseases , Beijing, China.,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University , Beijing, China
| | - Qi Yang
- Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University , Beijing, China.,Department of Radiology, Xuanwu Hospital, Capital Medical University , Beijing, China.,Department of Radiology, Chaoyang Hospital , China
| | - Ran Meng
- Department of Neurology, Xuanwu Hospital, Capital Medical University , Beijing, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders , Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University , Beijing, China.,National Clinical Research Center for Geriatric Diseases , Beijing, China
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21
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Arterial transit artifacts observed by arterial spin labeling in Moyamoya disease. J Stroke Cerebrovasc Dis 2020; 29:105058. [PMID: 32807463 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105058] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/01/2020] [Accepted: 06/12/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Arterial spin labeling (ASL) is a magnetic resonance imaging (MRI) technique used to assess cerebral perfusion. When tissue perfusion is impaired, such as in Moyamoya disease, a hyperintense band called the arterial transit artifact (ATA) may occur, which interferes with accurate measurements on ASL-MRI. In this study, we evaluated the correlation of ATAs with magnetic resonance angiography (MRA) and single-photon emission computed tomography (SPECT) imaging results in Moyamoya disease. The aim of our study was to elucidate the pathophysiology of ATAs and risk factors for high ATA scores. MATERIALS AND METHODS This retrospective study included 28 patients (56 hemispheres) with Moyamoya disease treated at our institution. MRI, MRA, ASL perfusion, and N-isopropyl-[123I] b-iodoamphetamine (123I-IMP) SPECT were performed. In order to semi-quantitatively evaluate the degree of ATA, the ATA scores were measured according to the number of hyperintense signal bands in the cerebral cortex. The relationship between the ATA scores and clinical and radiological factors were analyzed. RESULTS Regional cerebral blood flow (rCBF) determined with ASL weakly correlated with that determined by 123I-IMP SPECT (ρ=0.31, p=0.027). There was no significant association between the ATA scores and rCBF values determined with 123I-IMP SPECT (p=0.872, 0.745, 0.743 at PLD1000 (post-labeling delay), 1500, and 2000, respectively). However, there was a significant correlation between ATA scores and MRA scores (ρ=0.427 p=0.001; ρ=0.612 p=0.001; ρ=0.563 p=0.001 at PLD1000, 1500, and 2000, respectively). An analysis of patient background characteristics revealed a significantly higher incidence of high ATA scores in female patients, patients with high MRA scores, and patients with a distinguishable ivy sign. A multivariate analysis confirmed that female sex, high MRA score, and presence of an ivy sign were risk factors for high ATA scores. CONCLUSION ATA scores were moderately correlated with MRA scores, and presence of an ivy sign was the most predictive factor for high ATA scores. A high ATA score determined using ASL in a patient with Moyamoya disease might suggest an advanced disease stage and a reduction in cerebrovascular reserve capacity.
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22
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Fahlström M, Lewén A, Enblad P, Larsson EM, Wikström J. High Intravascular Signal Arterial Transit Time Artifacts Have Negligible Effects on Cerebral Blood Flow and Cerebrovascular Reserve Capacity Measurement Using Single Postlabel Delay Arterial Spin-Labeling in Patients with Moyamoya Disease. AJNR Am J Neuroradiol 2020; 41:430-436. [PMID: 32115416 DOI: 10.3174/ajnr.a6411] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 12/24/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Arterial spin-labeling-derived CBF values may be affected by arterial transit time artefacts. Thus, our aim was to assess to what extent arterial spin-labeling-derived CBF and cerebrovascular reserve capacity values in major vascular regions are overestimated due to the arterial transit time artifacts in patients with Moyamoya disease. MATERIALS AND METHODS Eight patients with Moyamoya disease were included before or after revascularization surgery. CBF maps were acquired using a 3D pseudocontinuous arterial spin-labeling sequence, before and 5, 15, and 25 minutes after an IV acetazolamide injection and were registered to each patient's 3D-T1-weighted images. Vascular regions were defined by spatial normalization to a Montreal Neurological Institute-based vascular regional template. The arterial transit time artifacts were defined as voxels with high signal intensity corresponding to the right tail of the histogram for a given vascular region, with the cutoff selected by visual inspection. Arterial transit time artifact maps were created and applied as masks to exclude arterial transit time artifacts on CBF maps, to create corrected CBF maps. The cerebrovascular reserve capacity was calculated as CBF after acetazolamide injection relative to CBF at baseline for corrected and uncorrected CBF values, respectively. RESULTS A total of 16 examinations were analyzed. Arterial transit time artifacts were present mostly in the MCA, whereas the posterior cerebral artery was generally unaffected. The largest differences between corrected and uncorrected CBF and cerebrovascular reserve capacity values, reported as patient group average ratio and percentage point difference, respectively, were 0.978 (95% CI, 0.968-0.988) and 1.8 percentage points (95% CI, 0.3-3.2 percentage points). Both were found in the left MCA, 15 and 5 minutes post-acetazolamide injection, respectively. CONCLUSIONS Arterial transit time artifacts have negligible overestimation effects on calculated vascular region-based CBF and cerebrovascular reserve capacity values derived from single-delay 3D pseudocontinuous arterial spin-labeling.
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Affiliation(s)
- M Fahlström
- From the Departments of Surgical Sciences (M.F., E.-M.L., J.W.) and Neuroscience (A.L., P.E.), Uppsala University, Uppsala, Sweden.
| | - A Lewén
- From the Departments of Surgical Sciences (M.F., E.-M.L., J.W.) and Neuroscience (A.L., P.E.), Uppsala University, Uppsala, Sweden
| | - P Enblad
- From the Departments of Surgical Sciences (M.F., E.-M.L., J.W.) and Neuroscience (A.L., P.E.), Uppsala University, Uppsala, Sweden
| | - E-M Larsson
- From the Departments of Surgical Sciences (M.F., E.-M.L., J.W.) and Neuroscience (A.L., P.E.), Uppsala University, Uppsala, Sweden
| | - J Wikström
- From the Departments of Surgical Sciences (M.F., E.-M.L., J.W.) and Neuroscience (A.L., P.E.), Uppsala University, Uppsala, Sweden
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23
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Wong TH, Shagera QA, Ryoo HG, Ha S, Lee DS. Basal and Acetazolamide Brain Perfusion SPECT in Internal Carotid Artery Stenosis. Nucl Med Mol Imaging 2020; 54:9-27. [PMID: 32206127 PMCID: PMC7062956 DOI: 10.1007/s13139-019-00633-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/19/2019] [Accepted: 12/26/2019] [Indexed: 10/25/2022] Open
Abstract
Internal carotid artery (ICA) stenosis including Moyamoya disease needs revascularization when hemodynamic insufficiency is validated. Vascular reserve impairment was the key to find the indication for endarterectomy/bypass surgery in the atherosclerotic ICA stenosis and to determine the indication, treatment effect, and prognosis in Moyamoya diseases. Vascular reserve was quantitatively assessed by 1-day split-dose I-123 IMP basal/acetazolamide SPECT in Japan or by Tc-99m HMPAO SPECT in other countries using qualitative or semi-quantitative method. We summarized the development of 1-day basal/ acetazolamide brain perfusion SPECT for ICA stenosis, both quantitative and qualitative methods, and their methodological issues regarding (1) acquisition protocol; (2) qualitative assessment, either visual or deep learning-based; (3) clinical use for atherosclerotic ICA steno-occlusive diseases and mostly Moyamoya diseases; and (4) their impact on the choice of treatment options. Trials to use CT perfusion or perfusion MRI using contrast materials or arterial spin labeling were briefly discussed in their endeavor to use basal studies alone to replace acetazolamide-challenge SPECT. Theoretical and practical issues imply that basal perfusion evaluation, no matter how much sophisticated, will not disclose vascular reserve. Acetazolamide rarely causes serious adverse reactions but included fatality, and now, we need to monitor patients closely in acetazolamide-challenge studies.
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Affiliation(s)
- Teck Huat Wong
- Department of Nuclear Medicine, Seoul National University College of Medicine, 28 Yongon-Dong, Jongno-Gu, Seoul, 110-744 South Korea
- Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Seoul, South Korea
| | - Qaid Ahmed Shagera
- Department of Nuclear Medicine, Seoul National University College of Medicine, 28 Yongon-Dong, Jongno-Gu, Seoul, 110-744 South Korea
- Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Seoul, South Korea
| | - Hyun Gee Ryoo
- Department of Nuclear Medicine, Seoul National University College of Medicine, 28 Yongon-Dong, Jongno-Gu, Seoul, 110-744 South Korea
- Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Seoul, South Korea
| | - Seunggyun Ha
- Division of Nuclear Medicine Department of Radiology, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Dong Soo Lee
- Department of Nuclear Medicine, Seoul National University College of Medicine, 28 Yongon-Dong, Jongno-Gu, Seoul, 110-744 South Korea
- Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Seoul, South Korea
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24
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Ya J, Zhou D, Ding J, Ding Y, Ji X, Yang Q, Meng R. High-resolution combined arterial spin labeling MR for identifying cerebral arterial stenosis induced by moyamoya disease or atherosclerosis. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:87. [PMID: 32175380 DOI: 10.21037/atm.2019.12.140] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Distinguishing moyamoya disease (MMD) from intracranial atherosclerotic stenosis (IAS) is critical for its treatment and outcome evaluation. This study aimed to use the combined sequences of high-resolution magnetic resonance imaging (HRMRI) and arterial spin labeling MR (ASL-MR) to identify the two entities accurately. Methods This prospective study enrolled 58 patients with middle cerebral artery (MCA) steno-occlusion identified by digital subtraction angiography (DSA), including 27 cases of MMD and 31 cases of IAS. All patients underwent MRA, HRMRI and ASL-MR prior to DSA. Two radiologists blinded to DSA results analyzed the MR images. The inner and outer diameters of the target arteries, the wall thickness of the stenotic segment, and the perfusion status in the territories of the target arteries [cerebral blood flow (CBF), cerebral blood volume (CBV) and arterial transit time (ATT)] were measured quantitatively. The differences between MMD and IAS regarding the aspects of HRMRI and Pseudo-continuous ASLMR (PCASL-MR) maps were analyzed based on both visual characteristics and data information. Results Regarding the HRMRI images, MMD tended to have homogeneous and concentric vessel-wall thickening as well as collaterals adjacent to the stenotic vessels; while IAS showed eccentric and heterogeneous vessel-wall thickening. For the CBF maps of PCASL-MR, abnormal hyper-perfused spots embedded inside the hypo-perfused regions were observed in MMD instead of IAS. Quantitative analysis revealed that MMD displayed smaller inner and outer diameters, and smaller maximum wall thickness, higher average value of CBF, CBV and ATT, and higher maximum value of CBF and CBV, when compared to IAS (all P<0.01). The average wall thickness and the maximum value of ATT showed no significant difference between MMD and IAS (P>0.01). Conclusions HRMRI combined with PCASL-MR may help distinguish MMD and IAS induced cerebral arterial stenosis and cerebral perfusion disorder accurately and non-invasively.
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Affiliation(s)
- Jingyuan Ya
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing 100069, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Da Zhou
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing 100069, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Jiayue Ding
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing 100069, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Yuchuan Ding
- Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.,Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Xunming Ji
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing 100069, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Qi Yang
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing 100069, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.,Department of Neuroimaging, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Ran Meng
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing 100069, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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25
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Hara S, Tanaka Y, Ueda Y, Abe D, Hayashi S, Inaji M, Maehara T, Ishii K, Nariai T. Detection of hemodynamic impairment on 15O gas PET using visual assessment of arterial spin-labeling MR imaging in patients with moyamoya disease. J Clin Neurosci 2019; 72:258-263. [PMID: 31843438 DOI: 10.1016/j.jocn.2019.11.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 12/25/2018] [Accepted: 11/19/2019] [Indexed: 12/24/2022]
Abstract
It is unclear whether the visual assessment of noninvasive arterial spin labeling magnetic resonance imaging (ASL) can identify instances of hemodynamic compromise including an elevated oxygen extraction fraction (OEF) measured by 15O-gas positron emission tomography (PET). Here we evaluated the relationship between a four-point visual assessment system referred to as 'ASL scores' using ASL with two postlabeling delays (PLDs; 1525 ms and 2525 ms) and some quantitative hemodynamic parameters measured by PET. We retrospectively evaluated the cases of 18 Japanese patients with moyamoya disease who underwent ASL and PET. We compared the patients' regional ASL scores on two ASL images to the regional values of PET parameters, and we observed a significant trend in accord with the presumed clinical severity among all PET parameters and ASL scores (p < .003). The ASL score of the long PLD (2525 ms) showed the highest specificity (98.5%) for elevated OEF. Our results suggest that hemodynamic impairment (including elevated OEF) in patients with moyamoya disease may be grossly assessed by a visual assessment of noninvasive ASL images, which can be easily obtained in clinical settings.
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Affiliation(s)
- Shoko Hara
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoji Tanaka
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Yasuhiro Ueda
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Daisu Abe
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shihori Hayashi
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan; Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Motoki Inaji
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan; Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Taketoshi Maehara
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kenji Ishii
- Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Tadashi Nariai
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan; Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
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26
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Li J, Liu X, Zhang D, Zhang Y, Wang R, Yuan J, Zhao J. Cognitive Performance Profile in Pediatric Moyamoya Disease Patients and Its Relationship With Regional Cerebral Blood Perfusion. Front Neurol 2019; 10:1308. [PMID: 31920931 PMCID: PMC6920207 DOI: 10.3389/fneur.2019.01308] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 11/26/2019] [Indexed: 11/13/2022] Open
Abstract
Object: Moyamoya disease affects the cognitive function of pediatric patients, and compromised cerebral blood flow might be the potential cause. We aimed to explore the specific correlation between cognitive impairment and regional perfusion status in pediatric moyamoya disease patients. Methods: We prospectively enrolled consecutive pediatric moyamoya disease patients admitted to Beijing Tiantan Hospital from July 2017 to March 2019. Arterial spin-labeling magnetic resonance and the Wechsler Intelligence Scale for Children (the 4th edition) were performed on all participants. The cognitive performance of patients was analyzed, and its correlation to cerebral perfusion status was also investigated in the region of interest-based analysis. Results: A total of 21 patients met the inclusion criteria (mean aged 11.14 ± 2.82, male: female = 11:10). Six patients (28.6%) showed no cognitive deficits in any index score, while 15 (71.4%) showed cognitive deficits with differing severity. Nine (42.9%) patients showed overall cognitive impairment, and all cognitive index scores except for Verbal Comprehension Index were significantly lower than the mean scores of normative data with corresponding age. Perceptual Reasoning Index (p = 0.019) were statistically lower in patients with radiologically confirmed cerebral infarction. Suzuki stage of the left hemisphere negatively correlated to Full-scale Intelligence Quotient (r = −0.452, p = 0.039). Region of Interest analysis showed that cerebral blood flow of the left temporal lobe independently associated with the Processing Speed Index (β = 0.535, p = 0.041). Conclusion: Pediatric moyamoya disease patients exhibited different levels of cognitive impairment. Cerebral infarction is related to poorer perceptual reasoning ability. Cerebral blood flow in the left temporal lobe positively correlates with processing speed.
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Affiliation(s)
- Jiaxi Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Xingju Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Dong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Yan Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Rong Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Jing Yuan
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
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Lou J, Liu Z, Xu B, Wang YK, Liu CJ, Liu M, Liu XD. Evaluation of 99mTC-ECD SPECT/CT brain Imaging with NeuroGam analysis in Moyamoya disease after surgical revascularization. Medicine (Baltimore) 2019; 98:e16525. [PMID: 31725599 PMCID: PMC6867761 DOI: 10.1097/md.0000000000016525] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To evaluate the clinical value of NeuroGam software in assessing the brain foci perfusion changes by TC-ECD single photon emission computed tomography/computed tomography (SPECT/CT) brain imaging in patients with Moyamoya Disease (MMD).Seventy-two patients with MMD who underwent superficial temporal artery-middle cerebral artery (STA-MCA) bypass combined with encephalo-duro-myo-synangiosis (EDMS) surgical revascularization were included. Baseline and follow-up TC-ECD SPECT/CT brain scans were performed on all patients at least twice before and after operation. Pre- and post-SPECT dicom images were reoriented into Talairach space using NeuroGam Software package. Additional visual analysis was performed. Differences mean pixel value between pre- and post- operation brain perfusion were assessed with paired t test and McNemar test.Significant differences in the number of hypoperfusion foci were found between visual assessment and NeuroGam aided assessment. More hypoperfusion foci were found by NeuroGam software aided assessment in the frontal, parietal, temporal, occipital lobe, thalamus, basal ganglia and cerebellum before and after surgery (P < .0001). According to NeuroGam software assessment, the perfusion of frontal, parietal, temporal lobe, anterior and middle cerebral regions on the operative side significantly improved before and after surgery (t = -3.734, t = -3.935, t = -5.099, t = -4.006, t = -5.170, all P < .001). However, no significant differences were found in the occipital lobe (t = -1.962, P = .054), thalamus (t = 1.362, P = .177), basal ganglia (t = -2.394, P = .019), and cerebellum (t = 1.383, P = .171) before and after surgery.The NeuroGam software provides a quantitative approach for monitoring surgical effect of MMD in a variable time (3-12 months after surgery). It could discover the perfusion changes that are neglected in conventional visual assessment.
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Affiliation(s)
- Jingjing Lou
- Department of Nuclear Medicine of Huashan Hospital, Fudan University
- Universal Medical Imaging Diagnostic Center
| | - Zhuang Liu
- Department of Nuclear Medicine of Huashan Hospital, Fudan University
| | - Bin Xu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuan-Kai Wang
- Department of Nuclear Medicine of Huashan Hospital, Fudan University
| | - Cong-Jin Liu
- Department of Nuclear Medicine of Huashan Hospital, Fudan University
| | - Miao Liu
- Department of Nuclear Medicine of Huashan Hospital, Fudan University
| | - Xing-Dang Liu
- Department of Nuclear Medicine of Huashan Hospital, Fudan University
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Lu J, Zhao Y, Ma L, Chen Y, Li M, Ye X, Wang R, Chen X, Zhao Y. Multimodal neuronavigation-guided precision bypass in adult ischaemic patients with moyamoya disease: study protocol for a randomised controlled trial. BMJ Open 2019; 9:e025566. [PMID: 30898819 PMCID: PMC6475208 DOI: 10.1136/bmjopen-2018-025566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Revascularisation surgery is an important treatment of moyamoya disease (MMD). Several general methods of revascularisation had been used: direct, indirect and combined techniques. However, there had been no reports about the criteria of recipient arteries selection in bypass surgery for MMD. Surgeons usually choose the recipient arteries by their own experiences. Their choices of the recipient arteries are various and may contribute the different outcome of patients. The purpose is to identify utility and efficacy of precision bypass guided by multimodal neuronavigation of MMD in a prospective randomised controlled trial. METHOD AND ANALYSIS This study is a prospective randomised controlled clinical trial. This study will enrol a total of 100 eligible patients. These eligible patients will be randomised to the empirical bypass group and the multimodal neuronavigation-guided precision bypass group in a 1:1 ratio. Patient baseline characteristics and MMD characteristics will be described. In the multimodal neuronavigation-guided group, the blood velocity and blood flow of the recipient arteries will be identified. Surgical complications and outcomes at pretreatment, post-treatment, at discharge and at 3 month, 6 month, 12 month and end of trial will be analysed with CT perfusion, MRI, digital subtraction angiography, modified Rankin Scale, National Institute of Health Stroke Scale and modified Barthel Scale. This trial will determine whether multimodal neuronavigation-guided precision bypass is superior to empirical bypass in patients with MMD and identify the safety and efficacy of multimodal neuronavigation-guided precision bypass. ETHICS AND DISSEMINATION The study protocol and written informed consent were reviewed and approved by the Clinical Research Ethics Committee of Peking University International Hospital. Study findings will be disseminated in the printed media. The study started in August, 2018 and expected to be completed in December, 2020. TRIAL REGISTRATION NUMBER NCT03516851; Pre-results.
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Affiliation(s)
- Junlin Lu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yahui Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Li Ma
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yu Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Mingtao Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xun Ye
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, PekingUniversity International Hospital, Beijing, China
| | - Rong Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, PekingUniversity International Hospital, Beijing, China
| | - Xiaolin Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, PekingUniversity International Hospital, Beijing, China
| | - Yuanli Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, PekingUniversity International Hospital, Beijing, China
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Kronenburg A, Bulder MMM, Bokkers RPH, Hartkamp NS, Hendrikse J, Vonken EJ, Kappelle LJ, van der Zwan A, Klijn CJM, Braun KPJ. Cerebrovascular Reactivity Measured with ASL Perfusion MRI, Ivy Sign, and Regional Tissue Vascularization in Moyamoya. World Neurosurg 2019; 125:e639-e650. [PMID: 30716498 DOI: 10.1016/j.wneu.2019.01.140] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 01/13/2019] [Accepted: 01/14/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Arterial spin labeling (ASL) perfusion magnetic resonance imaging (MRI) may be used to determine brain regions at risk for ischemia in patients with moyamoya vasculopathy and to identify patients who may benefit from surgical revascularization. We aimed to investigate whether 1) the severity of moyamoya is related to the presence of leptomeningeal collaterals and cerebrovascular reactivity (CVR), 2) the presence of collaterals and ivy sign reflects disturbed CVR, and 3) arterial transit artefacts (ATAs) and ivy sign reflect the presence of collaterals. METHODS We determined severity of moyamoya on digital subtraction angiography (DSA) according to the modified Suzuki classification in 20 brain regions and scored regional tissue revascularization using a 4-point scale. Regional CVR and ATAs were assessed on ASL perfusion MRI, ivy sign on fluid attenuation inversion recovery MRI. RESULTS In 11 patients (median age 36 years; 91% female), we studied 203 regions. ATAs were associated with the presence of collaterals on DSA (P < 0.01). Of all regions with clearly visible collateral vessels on DSA, however, only 24% had ATAs. Ivy sign was not related to the presence or absence of collaterals nor to CVR. In 10% of regions with good vascularization on DSA, CVR was poor or showed steal. CONCLUSIONS ATAs were associated with the presence of collaterals on DSA. Although DSA vascularization scores correlated with CVR, 10% of regions with good vascularization on DSA had absent CVR or steal on ASL-MRI. DSA and ivy sign did not provide adequate information on the hemodynamic status of brain tissue in patients with moyamoya vasculopathy.
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Affiliation(s)
- Annick Kronenburg
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, Utrecht, the Netherlands.
| | - Marcel M M Bulder
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, Utrecht, the Netherlands; Department of Neurology, Bravis Hospital, Bergen op Zoom, the Netherlands
| | - Reinoud P H Bokkers
- Department of Radiology, UMC Utrecht, Utrecht, the Netherlands; Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | | | | | - L Jaap Kappelle
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, Utrecht, the Netherlands
| | - Albert van der Zwan
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, Utrecht, the Netherlands
| | - Catharina J M Klijn
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, Utrecht, the Netherlands; Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Center for Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Kees P J Braun
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, Utrecht, the Netherlands
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Dlamini N, Muthusami P, Amlie-Lefond C. Childhood Moyamoya: Looking Back to the Future. Pediatr Neurol 2019; 91:11-19. [PMID: 30424960 DOI: 10.1016/j.pediatrneurol.2018.10.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 10/04/2018] [Accepted: 10/14/2018] [Indexed: 11/26/2022]
Abstract
Moyamoya is a chronic, progressive steno-occlusive arteriopathy that typically affects the anterior circulation arteries of the circle of Willis. A network of deep thalamoperforating and lenticulostriate collaterals develop to by-pass the occlusion giving rise to the characteristic angiographic "puff of smoke" appearance. Moyamoya confers a lifelong risk of stroke and neurological demise, with peak age of presentation in childhood ranging between five and 10 years. Moyamoya disease refers to patients who do not have a comorbid condition, whereas moyamoya syndrome refers to patients in whom moyamoya occurs in association with an acquired or inherited disorder such as sickle cell disease, neurofibromatosis type-1 or trisomy 21. The incidence of moyamoya disease and moyamoya syndrome demonstrates geographic and ethnic variation, with a predominance of moyamoya disease in East-Asian populations. Antiplatelet therapy and surgical revascularization procedures are the mainstay of management, as there are no available treatments to slow the progression of the arteriopathy. Future research is required to address the major gaps that remain in our understanding of the pathologic basis, optimal timing for surgery, and determinants of outcome in this high-stroke risk condition of childhood.
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Affiliation(s)
- Nomazulu Dlamini
- Department of Neurology, The Hospital for Sick Children, Toronto, Canada.
| | - Prakash Muthusami
- Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada
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Zhang J, Xia C, Liu Y, Qian W, Peng W, Liu K, Li L, Zhao F, Li Z. Comparative study of MR mTI-ASL and DSC-PWI in evaluating cerebral hemodynamics of patients with Moyamoya disease. Medicine (Baltimore) 2018; 97:e12768. [PMID: 30313089 PMCID: PMC6203517 DOI: 10.1097/md.0000000000012768] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The aim of this study was to explore the correlation between multi-inversion time arterial spin labeling (mTI-ASL) and dynamic susceptibility contrast-enhanced perfusion weighted imaging (DSC-PWI) in assessment of hemodynamics of patients with Moyamoya disease (MMD).In this study, 24 MMD patients and 21 healthy subjects were enrolled between June 2017 and December 2017. The images of mTI-ASL and DSC-PWI in the week before revascularization surgery were retrospectively analyzed. The parameters of cerebral blood flow (CBF), time to peak (TTP), and bolus arrival time (BAT) were measured in regions of interest (ROIs) of lateral middle cerebral artery (MCA) territories, basal ganglia (BG), and cerebellum, and relative perfusion parameters (rCBF-ASL, rBAT-ASL, rCBF-DSC, and rTTP-DSC) were calculated by dividing by cerebellum value. One-way analysis of variance and Student-Newman-Keuls tests were performed to compare rCBF-ASL and rCBF-DSC in the MMD group and the control group. Unpaired t test was used to compare rBAT-ASL and rTTP-DSC in the MMD group and the control group. And we assessed the correlation between rCBF-ASL and rCBF-DSC and between rBAT-ASL and rTTP-DSC using Pearson correlation analysis.All the relative parameters were significantly different between the MMD group and the control group (all P<.05). Meanwhile, there was significant difference between rCBF-ASL and rCBF-DSC (P<.05), and there was strong correlation between rCBF-ASL and rCBF-DSC (r = 0.839, P<.001), and moderate correlation between rBAT-ASL and rTTP-DSC (r = 0.519, P<.001).Both mTI-ASL and DSC-PWI could be used to assess perfusion state in MMD patients before revascularization surgery effectively. As a noninvasive imaging technique, mTI-ASL could provide perfusion parameters without contrast medium injection, and the results were quite correlative with DSC-PWI.
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Affiliation(s)
| | | | - Yi Liu
- Department of Neurosurgery, Sichuan University West China Hospital, Chengdu City, China
| | - Weiqiang Qian
- Department of Neurosurgery, Sichuan University West China Hospital, Chengdu City, China
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Moyamoya disease in pregnancy: a systematic review. Acta Neurochir (Wien) 2018; 160:1711-1719. [PMID: 29915888 DOI: 10.1007/s00701-018-3597-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 06/11/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Moyamoya disease (MMD) management during pregnancy poses a challenge to health care providers, and recommendations are outdated, vague, and controversial. We conducted a systematic review to investigate and present the available evidence. METHOD We searched five online databases and bibliographies of relevant published original studies to identify case reports, case series, cohort studies, and reviews reporting on patients diagnosed with MMD before, during, or shortly after pregnancy. We report and analyze the respective data. RESULTS Fifty-four relevant articles were identified. In the group of patients with MMD diagnosed prior to pregnancy, 68.7% had previously undergone bypass surgery, 64.5% delivered via cesarean section, 95.2% of mothers had good outcomes, and no bad fetal outcomes were reported. In patients first diagnosed with MMD due to a cerebrovascular accident during pregnancy, the mean gestational age on symptom onset was 28.7 weeks and 69.5% presented with cerebral hemorrhage. In this group, 57.2% received neurosurgical operative management, and 80% underwent cesarean section with 13.6% maternal mortality and 23.5% fetal demise. In patients diagnosed with MMD immediately postpartum, 46.6% suffered a cerebrovascular event within 3 days of delivery, 78.3% of which were ischemic. Only 15.3% underwent surgical hematoma evacuation and one patient (9%) expired. CONCLUSIONS MMD may coincide with pregnancy, but there is paucity of high-quality data. It appears that MMD is not a contraindication to pregnancy, if blood pressure and ventilation are properly managed. There is no clear evidence that bypass surgery before pregnancy or cesarean mode of delivery improve outcomes.
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Lee S, Yun TJ, Yoo RE, Yoon BW, Kang KM, Choi SH, Kim JH, Kim JE, Sohn CH, Han MH. Monitoring Cerebral Perfusion Changes after Revascularization in Patients with Moyamoya Disease by Using Arterial Spin-labeling MR Imaging. Radiology 2018; 288:565-572. [PMID: 29714677 DOI: 10.1148/radiol.2018170509] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To determine whether arterial spin-labeling (ASL) magnetic resonance (MR) imaging could be used to identify changes in cerebral blood flow (CBF), collateral blood flow, and anastomosis site patency after revascularization in patients with moyamoya disease. Materials and Methods This retrospective study was conducted in 145 patients with moyamoya disease who underwent middle cerebral artery (MCA)-superficial temporal artery anastomosis. Preoperative, early postoperative, and late postoperative ASL and digital subtraction angiography images were analyzed. In the MCA territory, absolute CBF (hereafter, CBFMCA) and normalized CBF values adjusted to nonanastomosis side (hereafter, nCBFMCA) and to cerebellum (hereafter, nCBFCbll) were calculated. Collateral grading in the MCA territory was assessed according to Alberta Stroke Program Early CT Score methodology, and anastomosis site patency were also assessed. Changes in CBF were compared by using one-way analysis of variance with Bonferroni correction for multiple comparisons. Intermodality agreement was determined by κ statistics. Results Significant increases in CBFMCA, nCBFMCA, and nCBFCbll were found after revascularization (preoperative and postoperative values of CBFMCA, 35.2 mL/100 g per minute ± 7.8 [mean ± standard deviation] and 51.5 mL/100 g per minute ± 12.0; nCBFMCA, 0.73 mL/100 g per minute ± 0.14 and 1.01 mL/100 g per minute ± 0.18; nCBFCbll, 0.74 mL/100 g per minute ± 0.12 and 1.12 mL/100 g per minute ± 0.16; all P < .001). Agreements for collateral grading and anastomosis patency between ASL MR imaging and digital subtraction angiography were moderate to good, with weighted κ values of 0.77 (95% confidence interval: 0.73, 0.81) and 0.57 (95% confidence interval: 0.37, 0.76), respectively. Conclusion ASL MR imaging can be used to identify perfusion changes in patients with moyamoya disease after revascularization as a noninvasive monitoring tool.
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Affiliation(s)
- Seunghyun Lee
- From the Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (S.L., T.J.Y., R.E.Y., K.M.K., S.H.C., J.H.K., C.H.S., M.H.H.); Department of Radiology (S.L., T.J.Y., R.E.Y., K.M.K., S.H.C., J.H.K., C.H.S., M.H.H.), Clinical Research Center for Stroke, Clinical Research Institute (B.W.Y.), Department of Neurology (B.W.Y.), and Department of Neurosurgery (J.E.K.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 03080, Republic of Korea
| | - Tae Jin Yun
- From the Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (S.L., T.J.Y., R.E.Y., K.M.K., S.H.C., J.H.K., C.H.S., M.H.H.); Department of Radiology (S.L., T.J.Y., R.E.Y., K.M.K., S.H.C., J.H.K., C.H.S., M.H.H.), Clinical Research Center for Stroke, Clinical Research Institute (B.W.Y.), Department of Neurology (B.W.Y.), and Department of Neurosurgery (J.E.K.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 03080, Republic of Korea
| | - Roh-Eul Yoo
- From the Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (S.L., T.J.Y., R.E.Y., K.M.K., S.H.C., J.H.K., C.H.S., M.H.H.); Department of Radiology (S.L., T.J.Y., R.E.Y., K.M.K., S.H.C., J.H.K., C.H.S., M.H.H.), Clinical Research Center for Stroke, Clinical Research Institute (B.W.Y.), Department of Neurology (B.W.Y.), and Department of Neurosurgery (J.E.K.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 03080, Republic of Korea
| | - Byung-Woo Yoon
- From the Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (S.L., T.J.Y., R.E.Y., K.M.K., S.H.C., J.H.K., C.H.S., M.H.H.); Department of Radiology (S.L., T.J.Y., R.E.Y., K.M.K., S.H.C., J.H.K., C.H.S., M.H.H.), Clinical Research Center for Stroke, Clinical Research Institute (B.W.Y.), Department of Neurology (B.W.Y.), and Department of Neurosurgery (J.E.K.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 03080, Republic of Korea
| | - Koung Mi Kang
- From the Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (S.L., T.J.Y., R.E.Y., K.M.K., S.H.C., J.H.K., C.H.S., M.H.H.); Department of Radiology (S.L., T.J.Y., R.E.Y., K.M.K., S.H.C., J.H.K., C.H.S., M.H.H.), Clinical Research Center for Stroke, Clinical Research Institute (B.W.Y.), Department of Neurology (B.W.Y.), and Department of Neurosurgery (J.E.K.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 03080, Republic of Korea
| | - Seung Hong Choi
- From the Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (S.L., T.J.Y., R.E.Y., K.M.K., S.H.C., J.H.K., C.H.S., M.H.H.); Department of Radiology (S.L., T.J.Y., R.E.Y., K.M.K., S.H.C., J.H.K., C.H.S., M.H.H.), Clinical Research Center for Stroke, Clinical Research Institute (B.W.Y.), Department of Neurology (B.W.Y.), and Department of Neurosurgery (J.E.K.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 03080, Republic of Korea
| | - Ji-Hoon Kim
- From the Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (S.L., T.J.Y., R.E.Y., K.M.K., S.H.C., J.H.K., C.H.S., M.H.H.); Department of Radiology (S.L., T.J.Y., R.E.Y., K.M.K., S.H.C., J.H.K., C.H.S., M.H.H.), Clinical Research Center for Stroke, Clinical Research Institute (B.W.Y.), Department of Neurology (B.W.Y.), and Department of Neurosurgery (J.E.K.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 03080, Republic of Korea
| | - Jeong Eun Kim
- From the Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (S.L., T.J.Y., R.E.Y., K.M.K., S.H.C., J.H.K., C.H.S., M.H.H.); Department of Radiology (S.L., T.J.Y., R.E.Y., K.M.K., S.H.C., J.H.K., C.H.S., M.H.H.), Clinical Research Center for Stroke, Clinical Research Institute (B.W.Y.), Department of Neurology (B.W.Y.), and Department of Neurosurgery (J.E.K.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 03080, Republic of Korea
| | - Chul-Ho Sohn
- From the Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (S.L., T.J.Y., R.E.Y., K.M.K., S.H.C., J.H.K., C.H.S., M.H.H.); Department of Radiology (S.L., T.J.Y., R.E.Y., K.M.K., S.H.C., J.H.K., C.H.S., M.H.H.), Clinical Research Center for Stroke, Clinical Research Institute (B.W.Y.), Department of Neurology (B.W.Y.), and Department of Neurosurgery (J.E.K.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 03080, Republic of Korea
| | - Moon Hee Han
- From the Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (S.L., T.J.Y., R.E.Y., K.M.K., S.H.C., J.H.K., C.H.S., M.H.H.); Department of Radiology (S.L., T.J.Y., R.E.Y., K.M.K., S.H.C., J.H.K., C.H.S., M.H.H.), Clinical Research Center for Stroke, Clinical Research Institute (B.W.Y.), Department of Neurology (B.W.Y.), and Department of Neurosurgery (J.E.K.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 03080, Republic of Korea
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Hervé D, Kossorotoff M, Bresson D, Blauwblomme T, Carneiro M, Touze E, Proust F, Desguerre I, Alamowitch S, Bleton JP, Borsali A, Brissaud E, Brunelle F, Calviere L, Chevignard M, Geffroy-Greco G, Faesch S, Habert MO, De Larocque H, Meyer P, Reyes S, Thines L, Tournier-Lasserve E, Chabriat H. French clinical practice guidelines for Moyamoya angiopathy. Rev Neurol (Paris) 2018. [PMID: 29519672 DOI: 10.1016/j.neurol.2017.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Jezzard P, Chappell MA, Okell TW. Arterial spin labeling for the measurement of cerebral perfusion and angiography. J Cereb Blood Flow Metab 2018; 38:603-626. [PMID: 29168667 PMCID: PMC5888859 DOI: 10.1177/0271678x17743240] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Arterial spin labeling (ASL) is an MRI technique that was first proposed a quarter of a century ago. It offers the prospect of non-invasive quantitative measurement of cerebral perfusion, making it potentially very useful for research and clinical studies, particularly where multiple longitudinal measurements are required. However, it has suffered from a number of challenges, including a relatively low signal-to-noise ratio, and a confusing number of sequence variants, thus hindering its clinical uptake. Recently, however, there has been a consensus adoption of an accepted acquisition and analysis framework for ASL, and thus a better penetration onto clinical MRI scanners. Here, we review the basic concepts in ASL and describe the current state-of-the-art acquisition and analysis approaches, and the versatility of the method to perform both quantitative cerebral perfusion measurement, along with quantitative cerebral angiographic measurement.
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Affiliation(s)
- Peter Jezzard
- 1 Wellcome Centre for Integrative Neuroimaging, FMRIB Division, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - Thomas W Okell
- 1 Wellcome Centre for Integrative Neuroimaging, FMRIB Division, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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TOMINAGA T, SUZUKI N, MIYAMOTO S, KOIZUMI A, KURODA S, TAKAHASHI JC, FUJIMURA M, HOUKIN K. Recommendations for the Management of Moyamoya Disease: A Statement from Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) [2nd Edition]. ACTA ACUST UNITED AC 2018. [DOI: 10.2335/scs.46.1] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Teiji TOMINAGA
- On behalf of the Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) Research on Intractable Diseases of the Ministry of Health, Labour and Welfare
| | - Norihiro SUZUKI
- On behalf of the Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) Research on Intractable Diseases of the Ministry of Health, Labour and Welfare
| | - Susumu MIYAMOTO
- On behalf of the Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) Research on Intractable Diseases of the Ministry of Health, Labour and Welfare
| | - Akio KOIZUMI
- On behalf of the Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) Research on Intractable Diseases of the Ministry of Health, Labour and Welfare
| | - Satoshi KURODA
- On behalf of the Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) Research on Intractable Diseases of the Ministry of Health, Labour and Welfare
| | - Jun C. TAKAHASHI
- On behalf of the Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) Research on Intractable Diseases of the Ministry of Health, Labour and Welfare
| | - Miki FUJIMURA
- On behalf of the Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) Research on Intractable Diseases of the Ministry of Health, Labour and Welfare
| | - Kiyohiro HOUKIN
- On behalf of the Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) Research on Intractable Diseases of the Ministry of Health, Labour and Welfare
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Fan AP, Guo J, Khalighi MM, Gulaka PK, Shen B, Park JH, Gandhi H, Holley D, Rutledge O, Singh P, Haywood T, Steinberg GK, Chin FT, Zaharchuk G. Long-Delay Arterial Spin Labeling Provides More Accurate Cerebral Blood Flow Measurements in Moyamoya Patients: A Simultaneous Positron Emission Tomography/MRI Study. Stroke 2017; 48:2441-2449. [PMID: 28765286 DOI: 10.1161/strokeaha.117.017773] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 06/05/2017] [Accepted: 06/21/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE Arterial spin labeling (ASL) MRI is a promising, noninvasive technique to image cerebral blood flow (CBF) but is difficult to use in cerebrovascular patients with abnormal, long arterial transit times through collateral pathways. To be clinically adopted, ASL must first be optimized and validated against a reference standard in these challenging patient cases. METHODS We compared standard-delay ASL (post-label delay=2.025 seconds), multidelay ASL (post-label delay=0.7-3.0 seconds), and long-label long-delay ASL acquisitions (post-label delay=4.0 seconds) against simultaneous [15O]-positron emission tomography (PET) CBF maps in 15 Moyamoya patients on a hybrid PET/MRI scanner. Dynamic susceptibility contrast was performed in each patient to identify areas of mild, moderate, and severe time-to-maximum (Tmax) delays. Relative CBF measurements by each ASL scan in 20 cortical regions were compared with the PET reference standard, and correlations were calculated for areas with moderate and severe Tmax delays. RESULTS Standard-delay ASL underestimated relative CBF by 20% in areas of severe Tmax delays, particularly in anterior and middle territories commonly affected by Moyamoya disease (P<0.001). Arterial transit times correction by multidelay acquisitions led to improved consistency with PET, but still underestimated CBF in the presence of long transit delays (P=0.02). Long-label long-delay ASL scans showed the strongest correlation relative to PET, and there was no difference in mean relative CBF between the modalities, even in areas of severe delays. CONCLUSIONS Post-label delay times of ≥4 seconds are needed and may be combined with multidelay strategies for robust ASL assessment of CBF in Moyamoya disease.
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Affiliation(s)
- Audrey P Fan
- From the Departments of Radiology (A.P.F., J.G., P.K.G., B.S., J.H.P., H.G., D.H., O.R., P.S., T.H., F.T.C., G.Z.) and Neurosurgery (G.K.S.), Stanford University, CA; and Global Applied Science Lab, GE Healthcare, Menlo Park, CA (M.M.K.).
| | - Jia Guo
- From the Departments of Radiology (A.P.F., J.G., P.K.G., B.S., J.H.P., H.G., D.H., O.R., P.S., T.H., F.T.C., G.Z.) and Neurosurgery (G.K.S.), Stanford University, CA; and Global Applied Science Lab, GE Healthcare, Menlo Park, CA (M.M.K.)
| | - Mohammad M Khalighi
- From the Departments of Radiology (A.P.F., J.G., P.K.G., B.S., J.H.P., H.G., D.H., O.R., P.S., T.H., F.T.C., G.Z.) and Neurosurgery (G.K.S.), Stanford University, CA; and Global Applied Science Lab, GE Healthcare, Menlo Park, CA (M.M.K.)
| | - Praveen K Gulaka
- From the Departments of Radiology (A.P.F., J.G., P.K.G., B.S., J.H.P., H.G., D.H., O.R., P.S., T.H., F.T.C., G.Z.) and Neurosurgery (G.K.S.), Stanford University, CA; and Global Applied Science Lab, GE Healthcare, Menlo Park, CA (M.M.K.)
| | - Bin Shen
- From the Departments of Radiology (A.P.F., J.G., P.K.G., B.S., J.H.P., H.G., D.H., O.R., P.S., T.H., F.T.C., G.Z.) and Neurosurgery (G.K.S.), Stanford University, CA; and Global Applied Science Lab, GE Healthcare, Menlo Park, CA (M.M.K.)
| | - Jun Hyung Park
- From the Departments of Radiology (A.P.F., J.G., P.K.G., B.S., J.H.P., H.G., D.H., O.R., P.S., T.H., F.T.C., G.Z.) and Neurosurgery (G.K.S.), Stanford University, CA; and Global Applied Science Lab, GE Healthcare, Menlo Park, CA (M.M.K.)
| | - Harsh Gandhi
- From the Departments of Radiology (A.P.F., J.G., P.K.G., B.S., J.H.P., H.G., D.H., O.R., P.S., T.H., F.T.C., G.Z.) and Neurosurgery (G.K.S.), Stanford University, CA; and Global Applied Science Lab, GE Healthcare, Menlo Park, CA (M.M.K.)
| | - Dawn Holley
- From the Departments of Radiology (A.P.F., J.G., P.K.G., B.S., J.H.P., H.G., D.H., O.R., P.S., T.H., F.T.C., G.Z.) and Neurosurgery (G.K.S.), Stanford University, CA; and Global Applied Science Lab, GE Healthcare, Menlo Park, CA (M.M.K.)
| | - Omar Rutledge
- From the Departments of Radiology (A.P.F., J.G., P.K.G., B.S., J.H.P., H.G., D.H., O.R., P.S., T.H., F.T.C., G.Z.) and Neurosurgery (G.K.S.), Stanford University, CA; and Global Applied Science Lab, GE Healthcare, Menlo Park, CA (M.M.K.)
| | - Prachi Singh
- From the Departments of Radiology (A.P.F., J.G., P.K.G., B.S., J.H.P., H.G., D.H., O.R., P.S., T.H., F.T.C., G.Z.) and Neurosurgery (G.K.S.), Stanford University, CA; and Global Applied Science Lab, GE Healthcare, Menlo Park, CA (M.M.K.)
| | - Tom Haywood
- From the Departments of Radiology (A.P.F., J.G., P.K.G., B.S., J.H.P., H.G., D.H., O.R., P.S., T.H., F.T.C., G.Z.) and Neurosurgery (G.K.S.), Stanford University, CA; and Global Applied Science Lab, GE Healthcare, Menlo Park, CA (M.M.K.)
| | - Gary K Steinberg
- From the Departments of Radiology (A.P.F., J.G., P.K.G., B.S., J.H.P., H.G., D.H., O.R., P.S., T.H., F.T.C., G.Z.) and Neurosurgery (G.K.S.), Stanford University, CA; and Global Applied Science Lab, GE Healthcare, Menlo Park, CA (M.M.K.)
| | - Frederick T Chin
- From the Departments of Radiology (A.P.F., J.G., P.K.G., B.S., J.H.P., H.G., D.H., O.R., P.S., T.H., F.T.C., G.Z.) and Neurosurgery (G.K.S.), Stanford University, CA; and Global Applied Science Lab, GE Healthcare, Menlo Park, CA (M.M.K.)
| | - Greg Zaharchuk
- From the Departments of Radiology (A.P.F., J.G., P.K.G., B.S., J.H.P., H.G., D.H., O.R., P.S., T.H., F.T.C., G.Z.) and Neurosurgery (G.K.S.), Stanford University, CA; and Global Applied Science Lab, GE Healthcare, Menlo Park, CA (M.M.K.)
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Clinical assessment of cerebral hemodynamics in Moyamoya disease via multiple inversion time arterial spin labeling and dynamic susceptibility contrast-magnetic resonance imaging: A comparative study. J Neuroradiol 2017; 44:273-280. [DOI: 10.1016/j.neurad.2016.12.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 08/24/2016] [Accepted: 12/21/2016] [Indexed: 11/24/2022]
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Utility of Arterial Spin Labeling MRI in Pediatric Neuroimaging: A Pictorial Essay. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0232-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Haller S, Zaharchuk G, Thomas DL, Lovblad KO, Barkhof F, Golay X. Arterial Spin Labeling Perfusion of the Brain: Emerging Clinical Applications. Radiology 2017; 281:337-356. [PMID: 27755938 DOI: 10.1148/radiol.2016150789] [Citation(s) in RCA: 333] [Impact Index Per Article: 47.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Arterial spin labeling (ASL) is a magnetic resonance (MR) imaging technique used to assess cerebral blood flow noninvasively by magnetically labeling inflowing blood. In this article, the main labeling techniques, notably pulsed and pseudocontinuous ASL, as well as emerging clinical applications will be reviewed. In dementia, the pattern of hypoperfusion on ASL images closely matches the established patterns of hypometabolism on fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) images due to the close coupling of perfusion and metabolism in the brain. This suggests that ASL might be considered as an alternative for FDG, reserving PET to be used for the molecular disease-specific amyloid and tau tracers. In stroke, ASL can be used to assess perfusion alterations both in the acute and the chronic phase. In arteriovenous malformations and dural arteriovenous fistulas, ASL is very sensitive to detect even small degrees of shunting. In epilepsy, ASL can be used to assess the epileptogenic focus, both in peri- and interictal period. In neoplasms, ASL is of particular interest in cases in which gadolinium-based perfusion is contraindicated (eg, allergy, renal impairment) and holds promise in differentiating tumor progression from benign causes of enhancement. Finally, various neurologic and psychiatric diseases including mild traumatic brain injury or posttraumatic stress disorder display alterations on ASL images in the absence of visualized structural changes. In the final part, current limitations and future developments of ASL techniques to improve clinical applicability, such as multiple inversion time ASL sequences to assess alterations of transit time, reproducibility and quantification of cerebral blood flow, and to measure cerebrovascular reserve, will be reviewed. © RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Sven Haller
- From Affidea Centre Diagnostique Radiologique de Carouge, Clos de la Fonderie 1, 1227 Carouge, Switzerland (S.H.); Dept of Surgical Sciences, Div of Radiology, Uppsala Univ, Sweden (S.H.); Dept of Neuroradiology, Univ Hosp Freiburg, Germany (S.H.); Faculty of Medicine Univ of Geneva, Switzerland (S.H.); Dept of Radiology, Stanford Univ, Stanford, Calif (G.Z.); Univ College London, Inst of Neurology, London, England (D.L.T., X.G.); Dept of Diagnostic and Interventional Neuroradiology, Geneva Univ Hosps,Switzerland (K.O.L.); Dept of Radiology & Nuclear Medicine and PET Research, VU Univ Medical Ctr, Amsterdam, the Netherlands (F.B.); and Insts of Neurology and Healthcare Engineering, Univ College London, England (F.B.)
| | - Greg Zaharchuk
- From Affidea Centre Diagnostique Radiologique de Carouge, Clos de la Fonderie 1, 1227 Carouge, Switzerland (S.H.); Dept of Surgical Sciences, Div of Radiology, Uppsala Univ, Sweden (S.H.); Dept of Neuroradiology, Univ Hosp Freiburg, Germany (S.H.); Faculty of Medicine Univ of Geneva, Switzerland (S.H.); Dept of Radiology, Stanford Univ, Stanford, Calif (G.Z.); Univ College London, Inst of Neurology, London, England (D.L.T., X.G.); Dept of Diagnostic and Interventional Neuroradiology, Geneva Univ Hosps,Switzerland (K.O.L.); Dept of Radiology & Nuclear Medicine and PET Research, VU Univ Medical Ctr, Amsterdam, the Netherlands (F.B.); and Insts of Neurology and Healthcare Engineering, Univ College London, England (F.B.)
| | - David L Thomas
- From Affidea Centre Diagnostique Radiologique de Carouge, Clos de la Fonderie 1, 1227 Carouge, Switzerland (S.H.); Dept of Surgical Sciences, Div of Radiology, Uppsala Univ, Sweden (S.H.); Dept of Neuroradiology, Univ Hosp Freiburg, Germany (S.H.); Faculty of Medicine Univ of Geneva, Switzerland (S.H.); Dept of Radiology, Stanford Univ, Stanford, Calif (G.Z.); Univ College London, Inst of Neurology, London, England (D.L.T., X.G.); Dept of Diagnostic and Interventional Neuroradiology, Geneva Univ Hosps,Switzerland (K.O.L.); Dept of Radiology & Nuclear Medicine and PET Research, VU Univ Medical Ctr, Amsterdam, the Netherlands (F.B.); and Insts of Neurology and Healthcare Engineering, Univ College London, England (F.B.)
| | - Karl-Olof Lovblad
- From Affidea Centre Diagnostique Radiologique de Carouge, Clos de la Fonderie 1, 1227 Carouge, Switzerland (S.H.); Dept of Surgical Sciences, Div of Radiology, Uppsala Univ, Sweden (S.H.); Dept of Neuroradiology, Univ Hosp Freiburg, Germany (S.H.); Faculty of Medicine Univ of Geneva, Switzerland (S.H.); Dept of Radiology, Stanford Univ, Stanford, Calif (G.Z.); Univ College London, Inst of Neurology, London, England (D.L.T., X.G.); Dept of Diagnostic and Interventional Neuroradiology, Geneva Univ Hosps,Switzerland (K.O.L.); Dept of Radiology & Nuclear Medicine and PET Research, VU Univ Medical Ctr, Amsterdam, the Netherlands (F.B.); and Insts of Neurology and Healthcare Engineering, Univ College London, England (F.B.)
| | - Frederik Barkhof
- From Affidea Centre Diagnostique Radiologique de Carouge, Clos de la Fonderie 1, 1227 Carouge, Switzerland (S.H.); Dept of Surgical Sciences, Div of Radiology, Uppsala Univ, Sweden (S.H.); Dept of Neuroradiology, Univ Hosp Freiburg, Germany (S.H.); Faculty of Medicine Univ of Geneva, Switzerland (S.H.); Dept of Radiology, Stanford Univ, Stanford, Calif (G.Z.); Univ College London, Inst of Neurology, London, England (D.L.T., X.G.); Dept of Diagnostic and Interventional Neuroradiology, Geneva Univ Hosps,Switzerland (K.O.L.); Dept of Radiology & Nuclear Medicine and PET Research, VU Univ Medical Ctr, Amsterdam, the Netherlands (F.B.); and Insts of Neurology and Healthcare Engineering, Univ College London, England (F.B.)
| | - Xavier Golay
- From Affidea Centre Diagnostique Radiologique de Carouge, Clos de la Fonderie 1, 1227 Carouge, Switzerland (S.H.); Dept of Surgical Sciences, Div of Radiology, Uppsala Univ, Sweden (S.H.); Dept of Neuroradiology, Univ Hosp Freiburg, Germany (S.H.); Faculty of Medicine Univ of Geneva, Switzerland (S.H.); Dept of Radiology, Stanford Univ, Stanford, Calif (G.Z.); Univ College London, Inst of Neurology, London, England (D.L.T., X.G.); Dept of Diagnostic and Interventional Neuroradiology, Geneva Univ Hosps,Switzerland (K.O.L.); Dept of Radiology & Nuclear Medicine and PET Research, VU Univ Medical Ctr, Amsterdam, the Netherlands (F.B.); and Insts of Neurology and Healthcare Engineering, Univ College London, England (F.B.)
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Frontocingulate cerebral blood flow and cerebrovascular reactivity associated with antidepressant response in late-life depression. J Affect Disord 2017; 215:103-110. [PMID: 28324779 PMCID: PMC5472992 DOI: 10.1016/j.jad.2017.03.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 03/08/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Vascular pathology is common in late-life depression (LLD) and may contribute to alterations in cerebral blood flow (CBF) and cerebrovascular reactivity (CVR). In turn, such hemodynamic deficits may adversely affect brain function and clinical course. The goal of this study was to examine whether altered cerebral hemodynamics in depressed elders predicted antidepressant response. METHODS 21 depressed elders completed cranial 3T MRI, including a pseudo-continuous Arterial Spin Labeling (pcASL) acquisition on both room air and during a hypercapnia challenge. Participants then completed 12 weeks of open-label sertraline. Statistical analyses examined the relationship between regional normalized CBF and CVR values and change in Montgomery-Asberg Depression Rating Scale (MADRS) and tested for differences based on remission status. RESULTS 10 participants remitted and 11 did not. After controlling for age and baseline MADRS, greater change in MADRS with treatment was associated with lower pre-treatment normalized CBF in the caudal anterior cingulate cortex (cACC) and lateral orbitofrontal cortex (OFC), as well as lower CVR with hypercapnia in the caudal medial frontal gyrus (cMFG). After controlling for age and baseline MADRS score, remitters exhibited lower CBF in the cACC and lower CVR in the cMFG. LIMITATIONS Our sample was small, did not include a placebo arm, and we examined only specific regions of interest. CONCLUSIONS Our findings suggest that increased perfusion of the OFC and the ACC is associated with a poor antidepressant response. They do not support that vascular pathology as measured by CBF and CVR negatively affects acute treatment outcomes.
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Hara S, Tanaka Y, Ueda Y, Hayashi S, Inaji M, Ishiwata K, Ishii K, Maehara T, Nariai T. Noninvasive Evaluation of CBF and Perfusion Delay of Moyamoya Disease Using Arterial Spin-Labeling MRI with Multiple Postlabeling Delays: Comparison with 15O-Gas PET and DSC-MRI. AJNR Am J Neuroradiol 2017; 38:696-702. [PMID: 28209582 DOI: 10.3174/ajnr.a5068] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 11/09/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE 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 15O-gas PET in terms of their ability to identify these parameters. MATERIALS AND METHODS 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 15O-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. RESULTS The short arterial spin-labeling-CBF values were significantly correlated with the PET-CBF values (r = 0.63; P = .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). CONCLUSIONS 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.
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Affiliation(s)
- S Hara
- From the Department of Neurosurgery (S.H., Y.T., Y.U., S.H., M.I., T.M., T.N.), Tokyo Medical and Dental University, Tokyo, Japan
| | - Y Tanaka
- From the Department of Neurosurgery (S.H., Y.T., Y.U., S.H., M.I., T.M., T.N.), Tokyo Medical and Dental University, Tokyo, Japan
| | - Y Ueda
- From the Department of Neurosurgery (S.H., Y.T., Y.U., S.H., M.I., T.M., T.N.), Tokyo Medical and Dental University, Tokyo, Japan
| | - S Hayashi
- From the Department of Neurosurgery (S.H., Y.T., Y.U., S.H., M.I., T.M., T.N.), Tokyo Medical and Dental University, Tokyo, Japan
| | - M Inaji
- From the Department of Neurosurgery (S.H., Y.T., Y.U., S.H., M.I., T.M., T.N.), Tokyo Medical and Dental University, Tokyo, Japan
- Research Team for Neuroimaging (M.I., K. Ishiwata, K. Ishii, T.N.), Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - K Ishiwata
- Research Team for Neuroimaging (M.I., K. Ishiwata, K. Ishii, T.N.), Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - K Ishii
- Research Team for Neuroimaging (M.I., K. Ishiwata, K. Ishii, T.N.), Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - T Maehara
- From the Department of Neurosurgery (S.H., Y.T., Y.U., S.H., M.I., T.M., T.N.), Tokyo Medical and Dental University, Tokyo, Japan
| | - T Nariai
- From the Department of Neurosurgery (S.H., Y.T., Y.U., S.H., M.I., T.M., T.N.), Tokyo Medical and Dental University, Tokyo, Japan
- Research Team for Neuroimaging (M.I., K. Ishiwata, K. Ishii, T.N.), Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
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Ni WW, Christen T, Rosenberg J, Zun Z, Moseley ME, Zaharchuk G. Imaging of cerebrovascular reserve and oxygenation in Moyamoya disease. J Cereb Blood Flow Metab 2017; 37:1213-1222. [PMID: 27207169 PMCID: PMC5453445 DOI: 10.1177/0271678x16651088] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study aimed to determine whether measurements of cerebrovascular reserve and oxygenation, assessed with spin relaxation rate R2', yield similar information about pathology in pre-operative Moyamoya disease patients, and to assess whether R2' is a better measure of oxygenation than other proposed markers, such as R2* and R2. Twenty-five pre-operative Moyamoya disease patients were scanned at 3.0T with acetazolamide challenge. Cerebral blood flow mapping with multi-delay arterial spin labeling, and R2*, R2, and R2' mapping with Gradient-Echo Sampling of Free Induction Decay and Echo were performed. No baseline cerebral blood flow difference was found between angiographically abnormal and normal regions (49 ± 12 vs. 48 ± 11 mL/100 g/min, p = 0.44). However, baseline R2' differed between these regions (3.2 ± 0.7 vs. 2.9 ± 0.6 s-1, p < 0.001), indicating reduced oxygenation in abnormal regions. Cerebrovascular reserve was lower in angiographically abnormal regions (21 ± 38 vs. 41 ± 26%, p = 0.001). All regions showed trend toward significantly improved oxygenation post-acetazolamide. Regions with poorer cerebrovascular reserve had lower baseline oxygenation (Kendall's τ = -0.24, p = 0.003). A number of angiographically abnormal regions demonstrated preserved cerebrovascular reserve, likely due to the presence of collaterals. Finally, of the concurrently measured relaxation rates, R2' was superior for oxygenation assessment.
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Affiliation(s)
- Wendy W Ni
- 1 Department of Radiology, Stanford University, Stanford, CA, USA.,2 Department of Electrical Engineering, Stanford University, Stanford, CA, USA
| | - Thomas Christen
- 1 Department of Radiology, Stanford University, Stanford, CA, USA
| | | | - Zungho Zun
- 3 Division of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC, USA.,4 Department of Pediatrics, George Washington University, Washington, DC, USA
| | | | - Greg Zaharchuk
- 1 Department of Radiology, Stanford University, Stanford, CA, USA
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Shimogawa T, Morioka T, Sayama T, Haga S, Akiyama T, Murao K, Kanazawa Y, Furuta Y, Sakata A, Arakawa S. Signal changes on magnetic resonance perfusion images with arterial spin labeling after carotid endarterectomy. Surg Neurol Int 2016; 7:S1031-S1040. [PMID: 28144479 PMCID: PMC5234294 DOI: 10.4103/2152-7806.196322] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 06/23/2016] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Cerebral hyperperfusion after carotid endarterectomy (CEA) is defined as an increase in ipsilateral cerebral blood flow (CBF). Practically, however, prompt and precise assessment of cerebral hyperperfusion is difficult because of limitations in the methodology of CBF measurement during the perioperative period. Arterial spin labeling (ASL) is a completely noninvasive and repeatable magnetic resonance perfusion imaging technique that uses magnetically-labelled blood water as an endogenous tracer. To clarify the usefulness of ASL in the management of cerebral hyperperfusion, we investigated signal changes by ASL with a single 1.5-s post-labeling delay on visual inspection. METHODS Thirty-two consecutive patients who underwent CEA were enrolled in this retrospective study. RESULTS On postoperative day 1, 22 (68.8%) and 4 (12.5%) patients exhibited increased ASL signals bilaterally (Group A) and on the operated side (Group B), respectively. Follow-up ASL showed improvement in these findings. Six (18.8%) patients showed no change (Group C). There was no apparent correlation between ASL signals on postoperative day 1 and the preoperative hemodynamic state, including the cerebrovascular reserve (P = 0.2062). Three (9.4%) patients developed cerebral hyperperfusion syndrome (two in Group A and one in Group B). Coincidence in the localization of increased ASL signals and electroencephalographic abnormalities was noted in these patients. CONCLUSION Visual analysis of ASL with a single post-labeling delay overestimates CBF and cannot identify patients at risk of cerebral hyperperfusion syndrome probably because of the strong effect of the shortened arterial transit time immediately after CEA. However, ASL may be used as for screening.
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Affiliation(s)
- Takafumi Shimogawa
- Department of Neurosurgery, Kyushu Rosai Hospital, Kitakyushu, Japan
- Department of Neurosurgery, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Takato Morioka
- Department of Neurosurgery, Kyushu Rosai Hospital, Kitakyushu, Japan
- Department of Neurosurgery, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Tetsuro Sayama
- Department of Neurosurgery, Kyushu Rosai Hospital, Kitakyushu, Japan
| | - Sei Haga
- Department of Neurosurgery, Kyushu Rosai Hospital, Kitakyushu, Japan
| | - Tomoaki Akiyama
- Department of Neurosurgery, Kyushu Rosai Hospital, Kitakyushu, Japan
| | - Kei Murao
- Department of Cerebrovascular Disease, Kyushu Rosai Hospital, Kitakyushu, Japan
| | - Yuka Kanazawa
- Department of Cerebrovascular Disease, Kyushu Rosai Hospital, Kitakyushu, Japan
| | - Yoshihiko Furuta
- Department of Cerebrovascular Disease, Kyushu Rosai Hospital, Kitakyushu, Japan
| | - Ayumi Sakata
- Department of Clinical Chemistry and Laboratory Medicine, Kyusyu University Hospital, Fukuoka, Japan
| | - Shuji Arakawa
- Department of Cerebrovascular Disease, Kyushu Rosai Hospital, Kitakyushu, Japan
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Pellaton A, Bijlenga P, Bouchez L, Cuvinciuc V, Barnaure I, Garibotto V, Lövblad KO, Haller S. CO 2BOLD assessment of moyamoya syndrome: Validation with single photon emission computed tomography and positron emission tomography imaging. World J Radiol 2016; 8:887-894. [PMID: 27928470 PMCID: PMC5120248 DOI: 10.4329/wjr.v8.i11.887] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 08/25/2016] [Accepted: 09/22/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To 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.
METHODS Ten 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.
RESULTS The 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%.
CONCLUSION CO2BOLD 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.
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Ravi H, Liu P, Peng SL, Liu H, Lu H. Simultaneous multi-slice (SMS) acquisition enhances the sensitivity of hemodynamic mapping using gas challenges. NMR IN BIOMEDICINE 2016; 29:1511-1518. [PMID: 27598821 PMCID: PMC5123823 DOI: 10.1002/nbm.3600] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/29/2016] [Accepted: 07/18/2016] [Indexed: 06/06/2023]
Abstract
Hemodynamic mapping using gas inhalation has received increasing interest in recent years. Cerebrovascular reactivity (CVR), which reflects the ability of the brain vasculature to dilate in response to a vasoactive stimulus, can be measured by CO2 inhalation with continuous acquisition of blood oxygen level-dependent (BOLD) magnetic resonance images. Cerebral blood volume (CBV) can be measured by O2 inhalation. These hemodynamic mapping methods are appealing because of their absence of gadolinium contrast agent, their ability to assess both baseline perfusion and vascular reserve, and their utility in calibrating the functional magnetic resonance imaging (fMRI) signal. However, like other functional and physiological indices, a major drawback of these measurements is their poor sensitivity and reliability. Simultaneous multi-slice echo planar imaging (SMS EPI) is a fast imaging technology that allows the excitation and acquisition of multiple two-dimensional slices simultaneously, and has been shown to enhance the sensitivity of several MRI applications. To our knowledge, the benefit of SMS in gas inhalation imaging has not been investigated. In this work, we compared the sensitivity of CO2 and O2 inhalation data collected using SMS factor 2 (SMS2) and SMS factor 3 (SMS3) with those collected using conventional EPI (SMS1). We showed that the sensitivity of SMS scans was significantly (p = 0.01) higher than that of conventional EPI, although no difference was found between SMS2 and SMS3 (p = 0.3). On a voxel-wise level, approximately 20-30% of voxels in the brain showed a significant enhancement in sensitivity when using SMS compared with conventional EPI, with other voxels showing an increase, but not reaching statistical significance. When using SMS, the scan duration can be reduced by half, whilst maintaining the sensitivity of conventional EPI. The availability of a sensitive acquisition technique can further enhance the potential of gas inhalation MRI in clinical applications.
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Affiliation(s)
- Harshan Ravi
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
- Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA
| | - Peiying Liu
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
- Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Shin-Lei Peng
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
- Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan
| | - Hanli Liu
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA
| | - Hanzhang Lu
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA.
- Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX, USA.
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Blauwblomme T, Lemaitre H, Naggara O, Calmon R, Kossorotoff M, Bourgeois M, Mathon B, Puget S, Zerah M, Brunelle F, Sainte-Rose C, Boddaert N. Cerebral Blood Flow Improvement after Indirect Revascularization for Pediatric Moyamoya Disease: A Statistical Analysis of Arterial Spin-Labeling MRI. AJNR Am J Neuroradiol 2016; 37:706-12. [PMID: 26585258 DOI: 10.3174/ajnr.a4592] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 08/20/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The severity of Moyamoya disease is generally scaled with conventional angiography and nuclear medicine. Arterial spin-labeling MR imaging is now acknowledged for the noninvasive quantification of cerebral blood flow. This study aimed to analyze CBF modifications with statistical parametric mapping of arterial spin-labeling MR imaging in children undergoing an operation for Moyamoya disease. MATERIALS AND METHODS We included 15 children treated by indirect cerebral revascularization with multiple burr-holes between 2011 and 2013. Arterial spin-labeling MR imaging and T1 sequences were then analyzed under SPM8, according to the general linear model, before and after the operation (3 and 12 months). Voxel-based analysis was performed at the group level, comparing all diseased hemispheres with all normal hemispheres and, at the individual level, comparing each patient with a control group. RESULTS Group analysis showed statistically significant preoperative hypoperfusion in the MCA territory in the Moyamoya hemispheres and a significant increase of cerebral perfusion in the same territory after revascularization (P < .05 family-wise error-corrected). Before the operation, individual analysis showed significant hypoperfusion for each patient co-localized with the angiographic defect on DSA. All except 1 patient had improvement of CBF after revascularization, correlated with their clinical status. CONCLUSIONS SPM analysis of arterial spin-labeling MR imaging offers a noninvasive evaluation of preoperative cerebral hemodynamic impairment and an objective assessment of postoperative improvement in children with Moyamoya disease.
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Affiliation(s)
- T Blauwblomme
- From the Université René Descartes (T.B., O.N., R.C., B.M., S.P., M.Z., F.B., C.S.-R., N.B.), PRES Sorbonne Paris Cité, Paris, France APHP, Departments of Pediatric Neurosurgery (T.B., M.B., S.P., M.Z., C.S.-R.) French Institute of Health and Medical Research U1000 (T.B., H.L., R.C., N.B.), Institut Imagine, University Paris-Sud 11 and University Paris Descartes, Paris, France
| | - H Lemaitre
- French Institute of Health and Medical Research U1000 (T.B., H.L., R.C., N.B.), Institut Imagine, University Paris-Sud 11 and University Paris Descartes, Paris, France
| | - O Naggara
- From the Université René Descartes (T.B., O.N., R.C., B.M., S.P., M.Z., F.B., C.S.-R., N.B.), PRES Sorbonne Paris Cité, Paris, France Neuroradiology (O.N., R.C., F.B., N.B.), Hospital Necker, Paris, France Department of Neuroradiology (O.N.), French Institute of Health and Medical Research U894, Hospital Sainte-Anne, Paris, France
| | - R Calmon
- From the Université René Descartes (T.B., O.N., R.C., B.M., S.P., M.Z., F.B., C.S.-R., N.B.), PRES Sorbonne Paris Cité, Paris, France Neuroradiology (O.N., R.C., F.B., N.B.), Hospital Necker, Paris, France French Institute of Health and Medical Research U1000 (T.B., H.L., R.C., N.B.), Institut Imagine, University Paris-Sud 11 and University Paris Descartes, Paris, France
| | - M Kossorotoff
- APHP, Department of Pediatric Neurology (M.K.), French Center for Pediatric Stroke, Hospital Necker, Paris, France
| | - M Bourgeois
- APHP, Departments of Pediatric Neurosurgery (T.B., M.B., S.P., M.Z., C.S.-R.)
| | - B Mathon
- From the Université René Descartes (T.B., O.N., R.C., B.M., S.P., M.Z., F.B., C.S.-R., N.B.), PRES Sorbonne Paris Cité, Paris, France
| | - S Puget
- APHP, Departments of Pediatric Neurosurgery (T.B., M.B., S.P., M.Z., C.S.-R.)
| | - M Zerah
- From the Université René Descartes (T.B., O.N., R.C., B.M., S.P., M.Z., F.B., C.S.-R., N.B.), PRES Sorbonne Paris Cité, Paris, France APHP, Departments of Pediatric Neurosurgery (T.B., M.B., S.P., M.Z., C.S.-R.)
| | - F Brunelle
- From the Université René Descartes (T.B., O.N., R.C., B.M., S.P., M.Z., F.B., C.S.-R., N.B.), PRES Sorbonne Paris Cité, Paris, France Neuroradiology (O.N., R.C., F.B., N.B.), Hospital Necker, Paris, France
| | - C Sainte-Rose
- From the Université René Descartes (T.B., O.N., R.C., B.M., S.P., M.Z., F.B., C.S.-R., N.B.), PRES Sorbonne Paris Cité, Paris, France APHP, Departments of Pediatric Neurosurgery (T.B., M.B., S.P., M.Z., C.S.-R.)
| | - N Boddaert
- From the Université René Descartes (T.B., O.N., R.C., B.M., S.P., M.Z., F.B., C.S.-R., N.B.), PRES Sorbonne Paris Cité, Paris, France Neuroradiology (O.N., R.C., F.B., N.B.), Hospital Necker, Paris, France French Institute of Health and Medical Research U1000 (T.B., H.L., R.C., N.B.), Institut Imagine, University Paris-Sud 11 and University Paris Descartes, Paris, France UMR 1163 (N.B.), Institut Imagine, Paris, France
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Noguchi T, Yakushiji Y, Nishihara M, Togao O, Yamashita K, Kikuchi K, Matsuo M, Azama S, Irie H. Arterial Spin-labeling in Central Nervous System Infection. Magn Reson Med Sci 2016; 15:386-394. [PMID: 27001393 PMCID: PMC5608113 DOI: 10.2463/mrms.mp.2015-0140] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: To investigate the characteristics of arterial spin-labeling magnetic resonance imaging (ASL-MRI) in central nervous system (CNS) infection. Methods: Thirty-two patients with CNS infections underwent a pulsed ASL-MRI. The findings on ASL-MRI were retrospectively assessed for the pathogens as well as each of the following four pathology classified based on conventional MRI findings: non-purulent parenchymal involvement, meningeal involvement, abscess formation, and ventricular involvement. Results: Among the 17 patients with non-purulent parenchymal involvement, ASL-MRI revealed high perfusion in 8 patients (47%) and low perfusion 1 patient (6%). Especially, four of five patients (80%) with definite or suspected herpes simplex virus (HSV) infection showed high perfusion on ASL-MRI. Seventeen of 22 patients (77%) with meningeal involvement showed high perfusion along the cerebral sulci irrespective of the pathogens. Meanwhile, 4 of 16 lesions (25%) with abscess formation showed low perfusion and one of six patients (17%) with ventricular involvement had high perfusion. Conclusions: The characteristics of ASL-MRI in CNS infections were clearly delineated. ASL-MRI could be helpful for monitoring the brain function in CNS infections noninvasively.
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Affiliation(s)
- Tomoyuki Noguchi
- Department of Radiology, National Center for Global Health and Medicine
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Hamano E, Kataoka H, Morita N, Maruyama D, Satow T, Iihara K, Takahashi JC. Clinical implications of the cortical hyperintensity belt sign in fluid-attenuated inversion recovery images after bypass surgery for moyamoya disease. J Neurosurg 2016; 126:1-7. [PMID: 26894456 DOI: 10.3171/2015.10.jns151022] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Transient neurological symptoms are frequently observed during the early postoperative period after direct bypass surgery for moyamoya disease. Abnormal signal changes in the cerebral cortex can be seen in postoperative MR images. The purpose of this study was to reveal the radiological features of the "cortical hyperintensity belt (CHB) sign" in postoperative FLAIR images and to verify its relationship to transient neurological events (TNEs) and regional cerebral blood flow (rCBF). METHODS A total of 141 hemispheres in 107 consecutive patients with moyamoya disease who had undergone direct bypass surgery were analyzed. In all cases, FLAIR images were obtained during postoperative days (PODs) 1-3 and during the chronic period (3.2 ± 1.13 months after surgery). The CHB sign was defined as an intraparenchymal high-intensity signal within the cortex of the surgically treated hemisphere with no infarction or hemorrhage present. The territory of the middle cerebral artery was divided into anterior and posterior parts, with the extent of the CHB sign in each part scored as 0 for none; 1 for presence in less than half of the part; and 2 for presence in more than half of the part. The sum of these scores provided the CHB score (0-4). TNEs were defined as reversible neurological deficits detected both objectively and subjectively. The rCBF was measured with SPECT using N-isopropyl-p-[123I]iodoamphetamine before surgery and during PODs 1-3. The rCBF increase ratio was calculated by comparing the pre- and postoperative count activity. RESULTS Cortical hyperintensity belt signs were detected in 112 cases (79.4%) and all disappeared during the chronic period. Although all bypass grafts were anastomosed to the anterior part of the middle cerebral artery territory, CHB signs were much more pronounced in the posterior part (p < 0.0001). TNEs were observed in 86 cases (61.0%). Patients with TNEs showed significantly higher CHB scores than those without (2.31 ± 0.13 vs 1.24 ± 0.16, p < 0.0001). The CHB score, on the other hand, showed no relationship with the rCBF increase ratio (p = 0.775). In addition, the rCBF increase ratio did not differ between those patients with TNEs and those without (1.15 ± 0.033 vs 1.16 ± 0.037, p = 0.978). CONCLUSIONS The findings strongly suggest that the presence of the CHB sign during PODs 1-3 can be a predictor of TNEs after bypass surgery for moyamoya disease. On the other hand, presence of this sign appears to have no direct relationship with the postoperative local hyperperfusion phenomenon. Vasogenic edema can be hypothesized as the pathophysiology of the CHB sign, because the sign was transient and never accompanied by infarction in the present series.
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Affiliation(s)
| | | | - Naomi Morita
- Radiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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A neuroradiologist's guide to arterial spin labeling MRI in clinical practice. Neuroradiology 2015; 57:1181-202. [PMID: 26351201 PMCID: PMC4648972 DOI: 10.1007/s00234-015-1571-z] [Citation(s) in RCA: 173] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 08/05/2015] [Indexed: 01/01/2023]
Abstract
Arterial spin labeling (ASL) is a non-invasive MRI technique to measure cerebral blood flow (CBF). This review provides a practical guide and overview of the clinical applications of ASL of the brain, as well its potential pitfalls. The technical and physiological background is also addressed. At present, main areas of interest are cerebrovascular disease, dementia and neuro-oncology. In cerebrovascular disease, ASL is of particular interest owing to its quantitative nature and its capability to determine cerebral arterial territories. In acute stroke, the source of the collateral blood supply in the penumbra may be visualised. In chronic cerebrovascular disease, the extent and severity of compromised cerebral perfusion can be visualised, which may be used to guide therapeutic or preventative intervention. ASL has potential for the detection and follow-up of arteriovenous malformations. In the workup of dementia patients, ASL is proposed as a diagnostic alternative to PET. It can easily be added to the routinely performed structural MRI examination. In patients with established Alzheimer’s disease and frontotemporal dementia, hypoperfusion patterns are seen that are similar to hypometabolism patterns seen with PET. Studies on ASL in brain tumour imaging indicate a high correlation between areas of increased CBF as measured with ASL and increased cerebral blood volume as measured with dynamic susceptibility contrast-enhanced perfusion imaging. Major advantages of ASL for brain tumour imaging are the fact that CBF measurements are not influenced by breakdown of the blood–brain barrier, as well as its quantitative nature, facilitating multicentre and longitudinal studies.
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