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Arterial transit artifacts observed by arterial spin labeling in Moyamoya disease
Ryo Ukai1, Takeshi Mikami1, Hiroshi Nagahama2
1Department of Neurosurgery, Sapporo Medical University School of Medicine, Chuo-ku, South 1, West 16, Sapporo, Hokkaido 060-8543 Japan.
Objectives:
Arterial spin labeling (ASL) is a magnetic resonance imaging (MRI) technique used to assess cerebral perfusion. When tissue perfusion is impaired, such as in Moyamoya disease, a hyperintense band called the arterial transit artifact (ATA) may occur, which interferes with accurate measurements on ASL-MRI. In this study, we evaluated the correlation of ATAs with magnetic resonance angiography (MRA) and single-photon emission computed tomography (SPECT) imaging results in Moyamoya disease. The aim of our study was to elucidate the pathophysiology of ATAs and risk factors for high ATA scores.
Materials And Methods:
This retrospective study included 28 patients (56 hemispheres) with Moyamoya disease treated at our institution. MRI, MRA, ASL perfusion, and N-isopropyl-[123I] b-iodoamphetamine (123I-IMP) SPECT were performed. In order to semi-quantitatively evaluate the degree of ATA, the ATA scores were measured according to the number of hyperintense signal bands in the cerebral cortex. The relationship between the ATA scores and clinical and radiological factors were analyzed.
Results:
Regional cerebral blood flow (rCBF) determined with ASL weakly correlated with that determined by 123I-IMP SPECT (ρ=0.31, p=0.027). There was no significant association between the ATA scores and rCBF values determined with 123I-IMP SPECT (p=0.872, 0.745, 0.743 at PLD1000 (post-labeling delay), 1500, and 2000, respectively). However, there was a significant correlation between ATA scores and MRA scores (ρ=0.427 p=0.001; ρ=0.612 p=0.001; ρ=0.563 p=0.001 at PLD1000, 1500, and 2000, respectively). An analysis of patient background characteristics revealed a significantly higher incidence of high ATA scores in female patients, patients with high MRA scores, and patients with a distinguishable ivy sign. A multivariate analysis confirmed that female sex, high MRA score, and presence of an ivy sign were risk factors for high ATA scores.
Conclusion:
ATA scores were moderately correlated with MRA scores, and presence of an ivy sign was the most predictive factor for high ATA scores. A high ATA score determined using ASL in a patient with Moyamoya disease might suggest an advanced disease stage and a reduction in cerebrovascular reserve capacity.
Insights
Arterial transit artifacts (ATAs) in ASL-MRI correlate with MRA findings in Moyamoya disease. Female sex, high MRA scores, and the ivy sign predict higher ATA scores, indicating advanced disease.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Arterial spin labeling (ASL) is a non-invasive MRI technique for assessing cerebral perfusion.
- Arterial transit artifacts (ATAs) can complicate ASL-MRI in conditions like Moyamoya disease, affecting perfusion measurements.
- Understanding ATA pathophysiology is crucial for accurate diagnosis and management.
Purpose of the Study:
- To evaluate the correlation between arterial transit artifact (ATA) scores from ASL-MRI and findings from magnetic resonance angiography (MRA) and single-photon emission computed tomography (SPECT) in Moyamoya disease.
- To identify risk factors associated with high ATA scores in Moyamoya disease patients.
- To elucidate the underlying pathophysiology of ATAs in this patient population.
Main Methods:
- Retrospective analysis of 28 Moyamoya disease patients (56 hemispheres).
- ASL-MRI, MRA, and 123I-IMP SPECT imaging were performed.
- Semi-quantitative ATA scoring based on hyperintense signal bands in the cerebral cortex; correlation with clinical and radiological factors analyzed.
Main Results:
- ASL-derived regional cerebral blood flow (rCBF) showed weak correlation with 123I-IMP SPECT (ρ=0.31, p=0.027).
- No significant association between ATA scores and SPECT-derived rCBF values.
- Significant correlation found between ATA scores and MRA scores (ρ=0.427 to 0.612, p<0.001).
- High ATA scores were more frequent in females, patients with high MRA scores, and those with a distinguishable ivy sign.
- Multivariate analysis confirmed female sex, high MRA score, and ivy sign as risk factors for high ATA scores.
Conclusions:
- ATA scores on ASL-MRI moderately correlate with MRA scores in Moyamoya disease.
- The presence of an ivy sign is the most significant predictor of high ATA scores.
- Elevated ATA scores may indicate advanced Moyamoya disease stage and reduced cerebrovascular reserve capacity.
