Quantification of Cerebrovascular Reactivity by Blood Oxygen Level-Dependent MR Imaging and Correlation with Conventional Angiography in Patients with Moyamoya Disease

BOLD MR imaging combined with a technique for precision control of end-tidal pCO(2) was used to produce quantitative maps of CVR in patients with Moyamoya disease. The technique was validated against measures of disease severity by using conventional angiography; it then was used to study the relati...

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Bibliographic Details
Published in:American journal of neuroradiology : AJNR 2010-05, Vol.31 (5), p.862-867
Main Authors: HEYN, C, POUBLANC, J, CRAWLEY, A, MANDELL, D, HAN, J. S, TYMIANSKI, M, TERBRUGGE, K, FISHER, J. A, MIKULIS, D. J
Format: Article
Language:English
Subjects:
Adult
Biological and medical sciences
Brain
Cerebral Arteries - pathology
Child
Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases
Humans
Investigative techniques, diagnostic techniques (general aspects)
Magnetic Resonance Angiography - methods
Male
Medical sciences
Middle Aged
Moyamoya Disease - pathology
Nervous system
Neurology
Oxygen - blood
Radiodiagnosis. Nmr imagery. Nmr spectrometry
Reproducibility of Results
Sensitivity and Specificity
Statistics as Topic
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Summary:BOLD MR imaging combined with a technique for precision control of end-tidal pCO(2) was used to produce quantitative maps of CVR in patients with Moyamoya disease. The technique was validated against measures of disease severity by using conventional angiography; it then was used to study the relationship between CVR, vascular steal, and disease severity. A retrospective analysis comparing conventional angiography with BOLD MR imaging was performed on 11 patients with Moyamoya disease. Iso-oxic cycling of end-tidal pCO(2) between 2 target values was performed during BOLD MR imaging. CVR was calculated as the BOLD signal difference per Delta pCO(2). CVR was correlated with the presence of Moyamoya or pial collaterals and the degree of Moyamoya disease as graded by using a modified Suzuki score. A good correlation between mean CVR and Suzuki score was found for the MCA and ACA territories (Pearson correlation coefficient, -0.7560 and -0.6140, respectively; P < .0001). A similar correlation was found between mean CVR and the presence of pial and Moyamoya collateral vessels for combined MCA and ACA territories (Pearson correlation coefficient, -0.7466; P < .0001). On a voxel-for-voxel basis, there was a greater extent of steal within vascular territories with increasing disease severity (higher modified Suzuki score). Mean CVR was found to scale nonlinearly with the extent of vascular steal. Quantitative measures of CVR show direct correlation with impaired vascular supply as measured by the modified Suzuki score and enable direct investigation of the physiology of autoregulatory reserve, including steal phenomenon, within a given vascular territory.
ISSN:0195-6108
1936-959X
DOI:10.3174/ajnr.A1922