Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Arterial Spin Labeling MRI for Quantitative Assessment of Cerebral Perfusion Before and After Cerebral Revascularization in Children with Moyamoya Disease

  • Ji Young Ha (Department of Radiology, Gyeongsang National University Changwon Hospital) ;
  • Young Hun Choi (Department of Radiology, Seoul National University Hospital) ;
  • Seunghyun Lee (Department of Radiology, Seoul National University Hospital) ;
  • Yeon Jin Cho (Department of Radiology, Seoul National University Hospital) ;
  • Jung-Eun Cheon (Department of Radiology, Seoul National University Hospital) ;
  • In-One Kim (Department of Radiology, Seoul National University Hospital) ;
  • Woo Sun Kim (Department of Radiology, Seoul National University Hospital)
  • Received : 2018.09.20
  • Accepted : 2019.03.13
  • Published : 2019.06.01
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Abstract

Objective: To determine the correlation between cerebral blood flow (CBF) on arterial spin labeling (ASL) MRI and the degree of postoperative revascularization assessed on digital subtraction angiography in children with moyamoya disease (MMD). Materials and Methods: Twenty-one children (9 boys and 12 girls; mean age, 8.4 ± 3.6 years; age range, 3-16 years) with MMD who underwent both pseudocontinuous ASL MRI at 1.5T and catheter angiography before and after superficial temporal artery encephaloduroarteriosynangiosis were included in this retrospective study. The degree of revascularization in the middle cerebral artery (MCA) territory was evaluated on external carotid angiography and was graded on a 3-point scale. On ASL CBF maps, regions of interest were manually drawn over the MCA territory of the operated side at the level of the centrum semi-ovale and over the cerebellum. The normalized CBF (nCBF) was calculated by dividing the CBF of the MCA territory by the CBF of the cerebellum. Changes in nCBFs were calculated by subtracting the preoperative nCBF values from the postoperative nCBF values. The correlation between nCBF changes measured with ASL and the revascularization grade from direct angiography was evaluated. Results: The nCBF value on the operated side increased after the operation (p = 0.001). The higher the degree of revascularization, the greater the nCBF change was: poor revascularization (grade 1), -0.043 ± 0.212; fair revascularization (grade 2), 0.345 ± 0.176; good revascularization (grade 3), 0.453 ± 0.182 (p = 0.005, Jockheere-Terpstra test). The interobserver agreement was excellent for the measured CBF values of the three readers (0.91-0.97). Conclusion: The nCBF values of the MCA territory obtained from ASL MRI increased after the revascularization procedure in children with MMD, and the degree of nCBF change showed a significant correlation with the degree of collateral formation evaluated via catheter angiography.

Keywords

Acknowledgement

The authors would like to thank Munyoung Paek for her advice regarding to technical background of the arterial spin labelling MRI into this work.

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