title: Cerebral blood flow, transit time, and apparent diffusion coefficient in moyamoya disease before and after acetazolamide.
abstract: BACKGROUND
  The goal of this study was to assess the changes in arterial spin labeling (ASL) cerebral blood flow (CBF) and arterial transit time (ATT), and in apparent diffusion coefficient (ADC), before and after an acetazolamide challenge in moyamoya patients, as function of arterial stenosis severity.
  
  
  METHODS
  Pre-operative patients diagnosed with moyamoya disease who could undergo MRI at 3.0T were recruited for this study. A multi-delay pseudo-continuous ASL and a diffusion-weighted sequence were acquired before and 15 min after acetazolamide injection. The severity of anterior, middle, and posterior cerebral artery pathology was graded on time-of-flight MR angiographic images. CBF, ATT, and ADC were measured on standardized regions of interest as function of the vessel stenosis severity.
  
  
  RESULTS
  Thirty patients were included. Fifty-four percent of all vessels were normal, 28% mildly/moderately stenosed, and 18% severely stenosed/occluded. Post-acetazolamide, a significantly larger CBF (ml/100 g/min) increase was observed in territories of normal (+19.6 ± 14.9) compared to mildly/moderately stenosed (+14.2 ± 27.2, p = 0.007), and severely stenosed/occluded arteries (+9.9 ± 24.2, p < 0.0001). ATT was longer in territories of vessel anomalies compared with normal regions at baseline. ATT decreases were observed in all territories post-acetazolamide. ADC did not decrease after acetazolamide in any regions, and no correlation was found between ADC changes and baseline ATT, change in ATT, or CVR.
  
  
  CONCLUSIONS
  The hemodynamic response in moyamoya disease, as measured with ASL CBF, is impaired mostly in territories with severe arterial stenosis/occlusion, while ATT was prolonged in all non-normal regions. No significant changes in ADC were observed after acetazolamide.
authors.affiliation: Stanford University Medical Center, Department of Radiology, Neuroradiology Division, Lucas Center, 1201 Welch Rd, Stanford, CA, 94305, USA. cfederau@stanford.edu.
authors.forename: Christian
authors.identifier: http://orcid.org/0000-0002-3803-6602
authors.initials: C
authors.lastname: Federau
authors.affiliation: Stanford University Medical Center, Stroke Center, Department of Neurology, Stanford, CA, USA.
authors.forename: Soren
authors.initials: S
authors.lastname: Christensen
authors.affiliation: Children's National Medical Center, Washington, DC, USA.
authors.forename: Zungho
authors.initials: Z
authors.lastname: Zun
authors.affiliation: Seoul National University, Seoul, Republic of Korea.
authors.forename: Sun-Won
authors.initials: SW
authors.lastname: Park
authors.affiliation: Stanford University Medical Center, Department of Radiology, Neuroradiology Division, Lucas Center, 1201 Welch Rd, Stanford, CA, 94305, USA.
authors.forename: Wendy
authors.initials: W
authors.lastname: Ni
authors.affiliation: Stanford University Medical Center, Department of Radiology, Neuroradiology Division, Lucas Center, 1201 Welch Rd, Stanford, CA, 94305, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Moseley
authors.affiliation: Stanford University Medical Center, Department of Radiology, Neuroradiology Division, Lucas Center, 1201 Welch Rd, Stanford, CA, 94305, USA.
authors.forename: Greg
authors.initials: G
authors.lastname: Zaharchuk
mesh_terms: D000086:Acetazolamide / Q000008:administration & dosage*; D000328:Adult; D001783:Blood Flow Velocity; D002257:Carbonic Anhydrase Inhibitors / Q000008:administration & dosage*; D002533:Cerebral Angiography / Q000379:methods*; D002560:Cerebrovascular Circulation; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D009072:Moyamoya Disease / Q000000981:diagnostic imaging* / Q000473:pathology*; D012720:Severity of Illness Index; D013113:Spin Labels
chemical_list: D002257:Carbonic Anhydrase Inhibitors; D013113:Spin Labels; D000086:Acetazolamide
keywords: Acetazolamide challenge; Apparent diffusion coefficient; Arterial spin labeling; Cerebral blood flow; Moyamoya disease