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Updated: Sep 15, 2025
A Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia
Published on: September 16, 2017
Characterizing pre- and post-operative cerebral blood flow and transit time in pediatric moyamoya patients using
Moss Y Zhao1,2, Sasha Alexander1, Chris Antonio Lopez1
1Department of Neurosurgery and Stanford Stroke Center, Stanford University, Stanford, CA, USA.
Insights
Multi-delay arterial spin labeling (ASL) effectively measures cerebral blood flow (CBF) and transit time in children with Moyamoya disease. Revascularization surgery improved hemodynamics, as confirmed by both ASL and DSC MRI.
Area of Science:
- Neuroimaging
- Pediatric Neurology
- Cerebrovascular Diseases
Background:
- Cerebral blood flow (CBF) and transit time are critical for brain health assessment.
- Dynamic susceptibility contrast (DSC) MRI is limited in pediatric populations due to contrast agent requirements.
- Multi-delay arterial spin labeling (ASL) offers a non-invasive method to measure CBF and transit time simultaneously.
Purpose of the Study:
- To investigate the utility of multi-delay ASL in pediatric Moyamoya disease patients.
- To characterize vascular hemodynamics before and after revascularization surgery using multi-delay ASL and DSC MRI.
- To compare the efficacy of multi-delay ASL and DSC MRI in assessing hemodynamic changes.
Main Methods:
- A cohort study involving 22 pediatric patients with Moyamoya disease.
- Utilized multi-delay ASL and DSC MRI to evaluate CBF and transit time in various brain regions.
- Assessed hemodynamic parameters pre- and post-revascularization surgery.
Main Results:
- Revascularization significantly increased CBF by 24% (ASL) and 7.6% (DSC).
- Revascularization significantly decreased transit time by 12% (ASL) and 15% (DSC).
- ASL and DSC measurements showed significant positive correlations across all brain regions.
Conclusions:
- Revascularization surgery improves hemodynamics in pediatric Moyamoya patients.
- Multi-delay ASL is an effective tool for characterizing CBF and transit time in the pediatric population.
- Multi-delay ASL provides reliable, non-invasive hemodynamic assessment comparable to DSC MRI.
Abstract:
Cerebral blood flow (CBF) and transit time are essential biomarkers for assessing brain health. While dynamic susceptibility contrast (DSC) MRI has been widely applied to measure these metrics, it is limited in the pediatric population due to the need for contrast agents. Arterial spin labeling is a non-invasive and quantitative MR modality, and multi-delay ASL can measure CBF and transit time simultaneously. Although multi-delay ASL has been used in adult neuroimaging studies, its application in children requires investigation. Moyamoya disease, a progressive steno-occlusive cerebrovascular disorder, often manifests in childhood. In this work, we present a cohort study that examines multi-delay ASL and DSC MRI to characterize vascular hemodynamics in 22 pediatric patients. We evaluate CBF and transit time in different brain regions before and after revascularization surgeries. Results show that revascularization significantly increased CBF by 24% and 7.6%, respectively, as measured by ASL and DSC; it also significantly decreased transit time by 12% and 15%, indicating improved hemodynamics and metabolism. ASL and DSC results also showed significantly positive correlations in all brain regions. Thus, revascularization improved hemodynamics in pediatric moyamoya patients and shows that multi-delay ASL can effectively characterize CBF and transit time in the pediatric population.
