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Assessment of cerebrovascular reactivity using real-time BOLD fMRI in children with moyamoya disease: a pilot study
Bejoy Thomas1, William Logan, Elizabeth J Donner
1Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
Insights
Real-time cerebrovascular reactivity (CVR) assessment using blood-oxygen-level-dependent functional MRI (rtCVR) is reliable and clinically valid in children with moyamoya disease, offering faster results than traditional off-line analysis.
Area of Science:
- Neurology
- Radiology
- Pediatric Imaging
Background:
- Moyamoya disease is a rare cerebrovascular disorder affecting children.
- Assessing cerebrovascular reactivity (CVR) is crucial for diagnosis and management.
- Standard off-line analysis of CVR data is time-consuming.
Purpose of the Study:
- To evaluate the reliability and clinical validity of real-time BOLD fMRI (rtCVR) for CVR assessment.
- To compare rtCVR with standard off-line processing in pediatric moyamoya disease patients.
- To determine the feasibility of rtCVR in a pediatric population.
Main Methods:
- Eight pediatric moyamoya patients underwent BOLD fMRI CVR studies.
- Studies were performed using breath-holding or general anesthesia (GA).
- CVR data were processed using both real-time and off-line methods for comparison.
Main Results:
- All eight GA sessions achieved the highest quality rating (class 3).
- Breath-holding technique yielded best quality in 41.7% of studies.
- rtCVR demonstrated 90% sensitivity and 100% specificity compared to off-line analysis.
Conclusions:
- Real-time CVR assessment (rtCVR) is feasible and reliable in children with moyamoya disease.
- rtCVR results are comparable to standard off-line analysis.
- rtCVR offers a significant advantage by providing immediate results, unlike delayed off-line analysis.
Purpose:
This pilot study aims to test the reliability and clinical validity of the assessment of cerebrovascular reactivity (CVR) with real-time blood-oxygen-level-dependent (BOLD) fMRI (rtCVR) in comparison with standard off-line processing in children with moyamoya disease.
Methods:
Eight consecutive pediatric patients with moyamoya cerebral arteriopathy underwent BOLD fMRI CVR studies either on a 1.5-T or on a 3-T scanner with breath-holding techniques in six patients and under general anesthesia (GA) in three patients. One patient had undergone CVR study initially without and later with GA, and another had undergone CVR study before and after a revascularization procedure. The off-line and real-time processing of the data was done, and the results were compared for general quality and adequacy of the study (scale 0-3, 3 being the best) and for the presence or absence of abnormal reactivity and the location, pattern, and extent of abnormal reactivity.
Results:
A total of 20 CVR series each was studied on real-time functional MRI and off-line analysis (eight patients, ten sessions, two series per session). All eight sessions done under GA were rated as quality class 3 (100 %), whereas only 5 of the 12 (41.7 %) studies with breath-holding technique were considered to be of best quality (class 3). In comparison to the off-line processing, the overall sensitivity of the rtCVR technique was 90 % with a specificity of 100 %.
Conclusions:
rtCVR assessment in children with moyamoya disease is feasible, and the results are comparable to that of standard off-line analysis. The results from off-line analysis are only available, at the earliest, several hours after the MRI has been completed. rtCVR can overcome this difficulty and may be equally reliable.
