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Diagnostic Accuracy of Screening Arterial Spin-Labeling MRI Using Hadamard Encoding for the Detection of Reduced CBF
K Setta1, T Matsuda2, M Sasaki3,2
1From the Department of Neurosurgery (K.S., T.C., S.F., M.K., K. Yoshida, Y. Kubo, K.O.), Institute for Biomedical Sciences, Iwate Medical University School of Medicine, Yahaba-cho, Japan.
Background And Purpose:
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.
Materials And Methods:
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.
Results:
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.
Conclusions:
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.
Insights
Arterial spin-labeling MR imaging with Hadamard-encoded multiple delays accurately detects reduced cerebral blood flow in Moyamoya disease. This advanced ASL MR technique shows 100% sensitivity and negative predictive value for screening.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Ischemic Moyamoya disease requires surgical intervention guided by cerebral hemodynamics.
- Accurate assessment of cerebral blood flow (CBF) is crucial for patient management.
Purpose of the Study:
- To evaluate the diagnostic accuracy of arterial spin-labeling (ASL) MR imaging with Hadamard-encoded multiple postlabeling delays for detecting reduced CBF in adult patients with ischemic Moyamoya disease.
Main Methods:
- Thirty-seven adult patients with ischemic Moyamoya disease underwent brain perfusion SPECT and ASL MR imaging.
- ASL MR imaging utilized both standard and Hadamard-encoded multiple postlabeling delays to calculate voxel-wise CBF corrected for arterial transit time.
- Region of interest (ROI) ratios (MCA territory to cerebellar hemisphere) were computed for comparison.
Main Results:
- Hadamard-encoded ASL MR imaging demonstrated a significantly higher area under the receiver operating characteristic curve (0.885) compared to standard ASL MR imaging (0.786) for detecting reduced CBF.
- The sensitivity and negative predictive value of Hadamard-encoded ASL MR imaging were 100%, significantly outperforming the standard method.
Conclusions:
- ASL MR imaging with Hadamard-encoded multiple postlabeling delays is a highly sensitive and specific tool for detecting reduced CBF in adult patients with ischemic Moyamoya disease.
- This ASL MR technique shows potential as an effective screening tool, comparable to brain perfusion SPECT.
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