title: Preoperative and postoperative mapping of cerebrovascular reactivity in moyamoya disease by using blood oxygen level-dependent magnetic resonance imaging.
abstract: OBJECTIVE
  The ability to map cerebrovascular reactivity (CVR) at the tissue level in patients with moyamoya disease could have considerable impact on patient management, especially in guiding surgical intervention and assessing the effectiveness of surgical revascularization. This paper introduces a new noninvasive magnetic resonance (MR) imaging-based method to map CVR. Preoperative and postoperative results are reported in three cases to demonstrate the efficacy of this technique in assessing vascular reserve at the microvascular level.
  
  
  METHODS
  Three patients with angiographically confirmed moyamoya disease were evaluated before and after surgical revascularization. Measurements of CVR were obtained by rapidly manipulating end-tidal PCO2 between hypercapnic and hypocapnic states during MR imaging. The CVR maps were then calculated by comparing the percentage of changes in MR signal with changes in end-tidal PCO2. Presurgical CVR maps showed distinct regions of positive and negative reactivity that correlated precisely with the vascular territories supplied by severely narrowed vessels. Postsurgical reactivity maps demonstrated improvement in the two patients with positive clinical outcome and no change in the patient in whom a failed superficial temporal artery-middle cerebral artery bypass was performed.
  
  
  CONCLUSIONS
  Magnetic imaging-based CVR mapping during rapid manipulation of end-tidal PCO2 is an exciting new method for determining the location and extent of abnormal vascular reactivity secondary to proximal large-vessel stenoses in moyamoya disease. Although the study group is small, there seems to be considerable potential for guiding preoperative decisions and monitoring efficacy of surgical revascularization.
authors.affiliation: Department of Medical Imaging (Division of Neuroradiology), The Toronto Western Hospital of the University Health Network, University of Toronto, Toronto, Canada. mikulis@uhnres.utoronto.ca
authors.forename: David J
authors.initials: DJ
authors.lastname: Mikulis
authors.forename: Gregory
authors.initials: G
authors.lastname: Krolczyk
authors.forename: Hubert
authors.initials: H
authors.lastname: Desal
authors.forename: William
authors.initials: W
authors.lastname: Logan
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Deveber
authors.forename: Peter
authors.initials: P
authors.lastname: Dirks
authors.forename: Michael
authors.initials: M
authors.lastname: Tymianski
authors.forename: Adrian
authors.initials: A
authors.lastname: Crawley
authors.forename: Alex
authors.initials: A
authors.lastname: Vesely
authors.forename: Andrea
authors.initials: A
authors.lastname: Kassner
authors.forename: David
authors.initials: D
authors.lastname: Preiss
authors.forename: Ron
authors.initials: R
authors.lastname: Somogyi
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Fisher
mesh_terms: D000328:Adult; D002245:Carbon Dioxide; D002548:Cerebral Revascularization / Q000379:methods*; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000473:pathology*; D002648:Child; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D009072:Moyamoya Disease / Q000503:physiopathology*; D011184:Postoperative Period; D011300:Preoperative Care; D012039:Regional Blood Flow; D012680:Sensitivity and Specificity
chemical_list: D002245:Carbon Dioxide