title: Arterial spin labelling MRI for assessment of cerebral perfusion in children with moyamoya disease: comparison with dynamic susceptibility contrast MRI.
abstract: BACKGROUND
  This study seeks to evaluate the diagnostic accuracy of cerebral perfusion imaging with arterial spin labelling (ASL) MR imaging in children with moyamoya disease compared to dynamic susceptibility contrast (DSC) imaging.
  
  
  METHODS
  Ten children (7 females; age, 9.2 ± 5.4 years) with moyamoya disease underwent cerebral perfusion imaging with ASL and DSC on a 3-T MRI scanner in the same session. Cerebral perfusion images were acquired with ASL (pulsed continuous 3D ASL sequence, 32 axial slices, TR = 5.5 s, TE = 25 ms, FOV = 24 cm, matrix = 128 × 128) and DSC (gradient echo EPI sequence, 35 volumes of 28 axial slices, TR = 2,000 ms, TE = 36 ms, FOV = 24 cm, matrix = 96 × 96, 0.2 ml/kg Gd-DOTA). Cerebral blood flow maps were generated. ASL and DSC images were qualitatively assessed regarding perfusion of left and right ACA, MCA, and PCA territories by two independent readers using a 3-point-Likert scale and quantitative relative cerebral blood flow (rCBF) was calculated. Correlation between ASL and DSC for qualitative and quantitative assessment and the accuracy of ASL for the detection of reduced perfusion per territory with DSC serving as the standard of reference were calculated.
  
  
  RESULTS
  With a good interreader agreement (κ = 0.62) qualitative perfusion assessment with ASL and DSC showed a strong and significant correlation (ρ = 0.77; p < 0.001), as did quantitative rCBF (r = 0.79; p < 0.001). ASL showed a sensitivity, specificity and accuracy of 94 %, 93 %, and 93 % for the detection of reduced perfusion per territory.
  
  
  CONCLUSIONS
  In children with moyamoya disease, unenhanced ASL enables the detection of reduced perfusion per vascular territory with a good accuracy compared to contrast-enhanced DSC.
authors: Department of Diagnostic Imaging, University Children's Hospital Zurich, Zurich, Switzerland. robertpaul.goetti@usz.ch
authors: Robert
authors: R
authors: Goetti
authors: Ruth
authors: R
authors: O'Gorman
authors: Nadia
authors: N
authors: Khan
authors: Christian J
authors: CJ
authors: Kellenberger
authors: Ianina
authors: I
authors: Scheer
mesh_terms: D000293:Adolescent; D002533:Cerebral Angiography / Q000379:methods*; D002536:Cerebral Arteries / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media; D005260:Female; D006801:Humans; D007223:Infant; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D009072:Moyamoya Disease / Q000473:pathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013113:Spin Labels
chemical_list: D003287:Contrast Media; D013113:Spin Labels
references: J Cereb Blood Flow Metab. 1999 Jul;19(7):701-35
references: 10413026
references: Eur J Radiol. 2011 Dec;80(3):e557-62
references: 21315533
references: J Nucl Med. 2004 Aug;45(8):1344-50
references: 15299060
references: Eur Radiol. 2004 Jan;14(1):59-72
references: 12827431
references: J Magn Reson Imaging. 2007 Apr;25(4):696-702
references: 17279531
references: Acta Neurochir (Wien). 2003 Dec;145(12):1061-71; discussion 1071
references: 14663563
references: Childs Nerv Syst. 1986;2(3):134-8
references: 3779669
references: Stroke. 2005 Jul;36(7):1485-9
references: 15947261
references: Pediatr Radiol. 1997 Sep;27(9):727-35
references: 9285733
references: Neurosurgery. 1992 Sep;31(3):401-5
references: 1407421
references: Magn Reson Med. 2008 Dec;60(6):1488-97
references: 19025913
references: Neurology. 1998 Mar;50(3):633-41
references: 9521248
references: Stroke. 2001 Dec 1;32(12):2810-6
references: 11739978
references: Ann Nucl Med. 2012 Jan;26(1):47-57
references: 22033781
references: Clin Nucl Med. 1993 Jan;18(1):43-5
references: 8422719
references: Neuroradiology. 2010 Apr;52(4):307-17
references: 19841916
references: J Comput Assist Tomogr. 2012 Jan-Feb;36(1):143-9
references: 22261785
references: AJNR Am J Neuroradiol. 2003 Apr;24(4):741-7
references: 12695215
references: Magn Reson Med. 2000 Sep;44(3):466-73
references: 10975900
references: AJNR Am J Neuroradiol. 2008 Sep;29(8):1487-93
references: 18499785
references: J Cereb Blood Flow Metab. 1996 Nov;16(6):1236-49
references: 8898697
references: J Cereb Blood Flow Metab. 2010 Jan;30(1):222-9
references: 19809464
references: Stroke. 1983 Jan-Feb;14(1):104-9
references: 6823678
references: Stroke. 2012 Apr;43(4):1018-24
references: 22328551
references: Clin Neurol Neurosurg. 1997 Oct;99 Suppl 2:S74-8
references: 9409411
references: Magn Reson Med. 2010 Jun;63(6):1548-56
references: 20512858
references: Arch Neurol. 1969 Mar;20(3):288-99
references: 5775283
references: AJNR Am J Neuroradiol. 1995 Mar;16(3):563-70
references: 7793382
references: J Nucl Med. 1994 Jan;35(1):44-50
references: 8271059
references: J Stroke Cerebrovasc Dis. 2013 Aug;22(6):811-6
references: 22721824
references: Radiology. 2009 Apr;251(1):216-23
references: 19332853
references: J Magn Reson Imaging. 2005 Dec;22(6):704-9
references: 16261570
references: Radiology. 2005 Apr;235(1):218-28
references: 15716390
references: Neurosurg Clin N Am. 2010 Jul;21(3):553-63
references: 20561503
references: NMR Biomed. 2007 Jun;20(4):429-38
references: 17044140