title: Monitoring Cerebrovascular Reactivity through the Use of Arterial Spin Labeling in Patients with Moyamoya Disease.
abstract: OBJECTIVE
  To assess arterial spin labeling in the identification of impaired cerebrovascular reactivity in patients with moyamoya disease.
  
  
  METHODS
  The institutional review board approved this prospective study, and written informed consent was obtained from all patients. A prospective study was conducted in 78 subjects with moyamoya disease (of whom 31 underwent unilateral direct arterial anastomosis). The concordance between the cerebrovascular reactivity index values from arterial spin labeling and single photon emission computed tomography (SPECT) was assessed by using Bland-Altman analysis, and the area under the receiver operating characteristic curve was used to evaluate the diagnostic accuracy of arterial spin labeling to depict impaired cerebrovascular reactivity (in which the cerebrovascular reactivity index value is less than 0% on SPECT images).
  
  
  RESULTS
  The cerebrovascular reactivity index from arterial spin labeling had a lower value than that from SPECT (mean difference, -4.2%). The area under the receiver operating characteristic curve for arterial spin labeling in the detection of impaired cerebrovascular reactivity was at least 0.85. On the anastomotic side, a significant increase was found between the cerebrovascular reactivity index values on arterial spin labeling images obtained preoperatively and those obtained 6 months after surgery, as well as on SPECT images (mean ± standard deviation values of cerebrovascular reactivity index increased by 5.9% ± 10.9 and 3.0% ± 6.3 for arterial spin labeling and SPECT, respectively).
  
  
  CONCLUSIONS
  Arterial spin labeling has excellent performance in the identification of impaired cerebrovascular reactivity in patients with moyamoya disease, and it has the potential to serve as a noninvasive imaging tool to monitor cerebrovascular reactivity in patients with moyamoya disease.
authors.affiliation: From the Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea (T.J.Y., C.H.S., S.H.C., J.H.K., M.H.H.); Department of Radiology (T.J.Y., C.H.S., S.H.C., J.H.K., M.H.H.), Department of Nuclear Medicine (J.C.P.), Department of Neurosurgery (J.E.K., H.S.K., M.H.H.), Clinical Research Center for Stroke, Clinical Research Institute (B.W.Y.), and Department of Neurology (B.W.Y.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, South Korea; Department of Nuclear Medicine, Seoul National University, Boramae Medical Center, Seoul, South Korea (H.Y.L.); and Department of Radiology, Stanford University Medical Center, Stanford, Calif (G.Z.).
authors.forename: Tae Jin
authors.initials: TJ
authors.lastname: Yun
authors.affiliation: From the Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea (T.J.Y., C.H.S., S.H.C., J.H.K., M.H.H.); Department of Radiology (T.J.Y., C.H.S., S.H.C., J.H.K., M.H.H.), Department of Nuclear Medicine (J.C.P.), Department of Neurosurgery (J.E.K., H.S.K., M.H.H.), Clinical Research Center for Stroke, Clinical Research Institute (B.W.Y.), and Department of Neurology (B.W.Y.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, South Korea; Department of Nuclear Medicine, Seoul National University, Boramae Medical Center, Seoul, South Korea (H.Y.L.); and Department of Radiology, Stanford University Medical Center, Stanford, Calif (G.Z.).
authors.forename: Jin Chul
authors.initials: JC
authors.lastname: Paeng
authors.affiliation: From the Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea (T.J.Y., C.H.S., S.H.C., J.H.K., M.H.H.); Department of Radiology (T.J.Y., C.H.S., S.H.C., J.H.K., M.H.H.), Department of Nuclear Medicine (J.C.P.), Department of Neurosurgery (J.E.K., H.S.K., M.H.H.), Clinical Research Center for Stroke, Clinical Research Institute (B.W.Y.), and Department of Neurology (B.W.Y.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, South Korea; Department of Nuclear Medicine, Seoul National University, Boramae Medical Center, Seoul, South Korea (H.Y.L.); and Department of Radiology, Stanford University Medical Center, Stanford, Calif (G.Z.).
authors.forename: Chul-Ho
authors.initials: CH
authors.lastname: Sohn
authors.affiliation: From the Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea (T.J.Y., C.H.S., S.H.C., J.H.K., M.H.H.); Department of Radiology (T.J.Y., C.H.S., S.H.C., J.H.K., M.H.H.), Department of Nuclear Medicine (J.C.P.), Department of Neurosurgery (J.E.K., H.S.K., M.H.H.), Clinical Research Center for Stroke, Clinical Research Institute (B.W.Y.), and Department of Neurology (B.W.Y.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, South Korea; Department of Nuclear Medicine, Seoul National University, Boramae Medical Center, Seoul, South Korea (H.Y.L.); and Department of Radiology, Stanford University Medical Center, Stanford, Calif (G.Z.).
authors.forename: Jeong Eun
authors.initials: JE
authors.lastname: Kim
authors.affiliation: From the Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea (T.J.Y., C.H.S., S.H.C., J.H.K., M.H.H.); Department of Radiology (T.J.Y., C.H.S., S.H.C., J.H.K., M.H.H.), Department of Nuclear Medicine (J.C.P.), Department of Neurosurgery (J.E.K., H.S.K., M.H.H.), Clinical Research Center for Stroke, Clinical Research Institute (B.W.Y.), and Department of Neurology (B.W.Y.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, South Korea; Department of Nuclear Medicine, Seoul National University, Boramae Medical Center, Seoul, South Korea (H.Y.L.); and Department of Radiology, Stanford University Medical Center, Stanford, Calif (G.Z.).
authors.forename: Hyun-Seung
authors.initials: HS
authors.lastname: Kang
authors.affiliation: From the Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea (T.J.Y., C.H.S., S.H.C., J.H.K., M.H.H.); Department of Radiology (T.J.Y., C.H.S., S.H.C., J.H.K., M.H.H.), Department of Nuclear Medicine (J.C.P.), Department of Neurosurgery (J.E.K., H.S.K., M.H.H.), Clinical Research Center for Stroke, Clinical Research Institute (B.W.Y.), and Department of Neurology (B.W.Y.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, South Korea; Department of Nuclear Medicine, Seoul National University, Boramae Medical Center, Seoul, South Korea (H.Y.L.); and Department of Radiology, Stanford University Medical Center, Stanford, Calif (G.Z.).
authors.forename: Byung-Woo
authors.initials: BW
authors.lastname: Yoon
authors.affiliation: From the Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea (T.J.Y., C.H.S., S.H.C., J.H.K., M.H.H.); Department of Radiology (T.J.Y., C.H.S., S.H.C., J.H.K., M.H.H.), Department of Nuclear Medicine (J.C.P.), Department of Neurosurgery (J.E.K., H.S.K., M.H.H.), Clinical Research Center for Stroke, Clinical Research Institute (B.W.Y.), and Department of Neurology (B.W.Y.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, South Korea; Department of Nuclear Medicine, Seoul National University, Boramae Medical Center, Seoul, South Korea (H.Y.L.); and Department of Radiology, Stanford University Medical Center, Stanford, Calif (G.Z.).
authors.forename: Seung Hong
authors.initials: SH
authors.lastname: Choi
authors.affiliation: From the Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea (T.J.Y., C.H.S., S.H.C., J.H.K., M.H.H.); Department of Radiology (T.J.Y., C.H.S., S.H.C., J.H.K., M.H.H.), Department of Nuclear Medicine (J.C.P.), Department of Neurosurgery (J.E.K., H.S.K., M.H.H.), Clinical Research Center for Stroke, Clinical Research Institute (B.W.Y.), and Department of Neurology (B.W.Y.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, South Korea; Department of Nuclear Medicine, Seoul National University, Boramae Medical Center, Seoul, South Korea (H.Y.L.); and Department of Radiology, Stanford University Medical Center, Stanford, Calif (G.Z.).
authors.forename: Ji-hoon
authors.initials: JH
authors.lastname: Kim
authors.affiliation: From the Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea (T.J.Y., C.H.S., S.H.C., J.H.K., M.H.H.); Department of Radiology (T.J.Y., C.H.S., S.H.C., J.H.K., M.H.H.), Department of Nuclear Medicine (J.C.P.), Department of Neurosurgery (J.E.K., H.S.K., M.H.H.), Clinical Research Center for Stroke, Clinical Research Institute (B.W.Y.), and Department of Neurology (B.W.Y.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, South Korea; Department of Nuclear Medicine, Seoul National University, Boramae Medical Center, Seoul, South Korea (H.Y.L.); and Department of Radiology, Stanford University Medical Center, Stanford, Calif (G.Z.).
authors.forename: Ho-Young
authors.initials: HY
authors.lastname: Lee
authors.affiliation: From the Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea (T.J.Y., C.H.S., S.H.C., J.H.K., M.H.H.); Department of Radiology (T.J.Y., C.H.S., S.H.C., J.H.K., M.H.H.), Department of Nuclear Medicine (J.C.P.), Department of Neurosurgery (J.E.K., H.S.K., M.H.H.), Clinical Research Center for Stroke, Clinical Research Institute (B.W.Y.), and Department of Neurology (B.W.Y.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, South Korea; Department of Nuclear Medicine, Seoul National University, Boramae Medical Center, Seoul, South Korea (H.Y.L.); and Department of Radiology, Stanford University Medical Center, Stanford, Calif (G.Z.).
authors.forename: Moon Hee
authors.initials: MH
authors.lastname: Han
authors.affiliation: From the Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea (T.J.Y., C.H.S., S.H.C., J.H.K., M.H.H.); Department of Radiology (T.J.Y., C.H.S., S.H.C., J.H.K., M.H.H.), Department of Nuclear Medicine (J.C.P.), Department of Neurosurgery (J.E.K., H.S.K., M.H.H.), Clinical Research Center for Stroke, Clinical Research Institute (B.W.Y.), and Department of Neurology (B.W.Y.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, South Korea; Department of Nuclear Medicine, Seoul National University, Boramae Medical Center, Seoul, South Korea (H.Y.L.); and Department of Radiology, Stanford University Medical Center, Stanford, Calif (G.Z.).
authors.forename: Greg
authors.initials: G
authors.lastname: Zaharchuk
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity; D002560:Cerebrovascular Circulation / Q000502:physiology*; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009072:Moyamoya Disease / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011446:Prospective Studies; D013113:Spin Labels; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D013113:Spin Labels