Abstract TMP39: Identifying Cerebrovascular Reserve Capacity by Arterial Spin Labeling MR in Patients with Moyamoya Disease

Abstract

Background— The diagnostic accuracy to identify the cerebrocascular reserve capacity (CVRC) by arterial spin labeling (ASL) MR in patients with moyamoya disease is unclear. Methods— We conducted a prospective study to examine the accuracy of ASL as compared with single-photon emission CT (SPECT) in patients with moyamoya disease. Preoperative ASL and SPECT images from 61 adult patients with moyamoya disease were analyzed. For 122 hemispheres from the patients, voxels of interest consisting of bilateral ICA and MCA territories were applied to the spatially normalized cerebral blood flow maps from basal and acetazolamide challenge ASL and SPECT. The correlation between cerebrovascular reserve capacity (CVRC) from ASL and SPECT was analyzed by a using Pearson correlation analysis and the area under the receiver-operating-characteristic curve (AUC) was used to evaluate diagnostic accuracy relative to that of SPECT for various cutoff points by CVRC. Results— Significant relationships were observed between CVRC from ASL and SPECT for the internal carotid artery (ICA) and middle cerebral artery (MCA) (correlation coefficient r = .7093, P < .0001 and r = .7319, P < .0001, respectively) (Table). The diagnostic accuracies of ASL for detecting ICA and MCA areas, in which CVRC are < -5.0%, revealed an AUC of 0.96 (95% confidence interval [CI], 0.91 to 0.99) and 0.96 (95% CI, 0.91 to 0.99, respectively). Conclusions— ASL can identify the reduced CVRC with good performance and has the potential as a noninvasive imaging tool for determining CVRC in patients with moyamoya disease. Table. Correlations between CBF and CVRI values from ASL and SPECT