Abstract
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. 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. 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. 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.
Highlights
BACKGROUND AND PURPOSEAdult patients with ischemic Moyamoya disease are advised to undergo selective revascularization surgery based on cerebral hemodynamics
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 and negative predictive value for the standard postlabeling delay–CBF ratio, respectively
Arterial spin-labeling (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
Summary
The purpose of this study was to determine the diagnostic accuracy of arterial spinlabeling MR imaging using Hadamard-encoded multiple postlabeling delays for the detection of reduced CBF in such patients. The aims of this study were to determine the diagnostic accuracy of ASL MR imaging using Hadamardencoded multiple PLDs for the detection of reduced CBF, a key determinant for revascularization surgery, in adult patients with ischemic MMD, and to propose practical clinical algorithms using ASL MR imaging and subsequent management in such patients
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