Multi-delay arterial spin labeling perfusion MRI in moyamoya disease--comparison with CT perfusion imaging

Area of Science:

• Neuroimaging
• Radiology
• Vascular Neurology

Background:

• Moyamoya disease is a cerebrovascular disorder characterized by progressive stenosis of intracranial arteries.
• Accurate assessment of cerebral blood flow (CBF) and arterial transit time (ATT) is crucial for diagnosis and management.
• Existing perfusion imaging techniques have limitations in simultaneous CBF and ATT quantification.

Purpose of the Study:

• To introduce a multi-delay pseudo-continuous arterial spin labeling (pCASL) protocol for simultaneous CBF and ATT measurement.
• To evaluate the correlation between multi-delay pCASL and CT perfusion imaging in patients with moyamoya disease.
• To assess the potential of multi-delay pCASL as a prognostic imaging biomarker.

Main Methods:

• A 4 post-labeling delay (PLD) pCASL protocol was implemented in 17 moyamoya disease patients undergoing CT perfusion.
• Arterial transit time (ATT) was estimated using the multi-delay pCASL data and incorporated into CBF calculations.
• Voxel-wise and region-of-interest (ROI)-based analyses were performed to compare ASL and CT perfusion measures.

Main Results:

• Significant associations were found between multi-delay pCASL and CT perfusion across subjective ratings, grey matter, white matter, and major vascular territories.
• The multi-delay pCASL protocol demonstrated improved correlation for CBF compared to single delay (2s PLD) ASL.
• These findings highlight the enhanced accuracy of multi-delay ASL in quantifying perfusion parameters.

Conclusions:

• Multi-delay pCASL allows for simultaneous measurement of CBF and ATT.
• A strong correlation exists between multi-delay ASL and CT perfusion in moyamoya disease.
• Multi-delay ASL offers improved CBF quantification and holds promise as a prognostic imaging biomarker for moyamoya disease.