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Assessment of blood supply of the external carotid artery in moyamoya disease using super-selective pseudo-continuous arterial spin labeling technique

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To evaluate the diagnostic accuracy of super-selective pseudo-continuous arterial spin labeling (ss-pCASL) at depicting external carotid artery (ECA) perfusion territory in moyamoya disease (MMD).

Methods

In total, 103 patients with MMD who underwent both ss-pCASL and digital subtraction angiography (DSA, the reference standard) were included. There were 3, 184, and 19 normal, preoperative, and postoperative MMD hemispheres, respectively. The ss-pCASL results were interpreted by two different visual inspection criteria: presence or absence and definite or indefinite ECA perfusion territory. The performance of ss-pCASL at depiction of ECA perfusion territory was compared to that of DSA. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. The κ statistic was used to assess intermodality and inter-reader agreement.

Results

When interpreted as presence or absence, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of ss-pCASL for depicting ECA perfusion territory were 78.3 %, 79.6 %, 92.5 %, 53.4 %, and 78.6 %, respectively, and the intermodality and inter-reader agreement were κ = 0.49 (CI: 0.43 – 0.55, p < 0.01) and 0.71 (CI: 0.66 – 0.76, p < 0.01), respectively. When interpreted as definite or indefinite, the respective values were 61.1%, 100%, 100%, 44.5%, 70.4%, κ = 0.42 (CI: 0.37 – 0.47, p < 0.01), and 0.90 (CI: 0.87 – 0.93, p < 0.01).

Conclusion

ss-pCASL has substantial sensitivity and specificity compared with DSA for depicting the presence versus absence of ECA perfusion territory in MMD. As a noninvasive method in which no ion radiation or contrast medium is needed, ss-pCASL may potentially reduce the need for repeated DSA examination.

Key Points

• Super-selective pseudo-continuous arterial spin labeling (ss-pCASL) is a noninvasive vessel-selective MR technique to demonstrate perfusion territory of a single cerebral artery.

• Compared with digital subtraction angiography, ss-pCASL has substantial sensitivity and specificity for depicting the perfusion territory of the external carotid artery in brain parenchyma in moyamoya disease.

• ss-pCASL may potentially reduce the need for repeated DSA examination.

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Abbreviations

3D:

Three-dimensional

DSA:

Digital subtraction angiography

ECA:

External carotid artery

FOV:

Field of view

ICA:

Internal carotid artery

MMD:

Moyamoya disease

MR:

Magnetic resonance

NEX:

Number of excitations

pCASL:

Pseudo-continuous arterial spin labeling

PLD:

Post-labeling delay

SNR:

Signal-to-noise ratio

ss-pCASL:

Super-selective pseudo-continuous arterial spin labeling

TASL:

Territory arterial spin labeling

TE:

Echo time

TR:

Repetition time

VA:

Vertebral artery

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Acknowledgements

We thank Bronwen Gardner, PhD, and Richard Lipkin, PhD, from Liwen Bianji, Edanz Editing China (www.liwenbianji.cn/ac), for editing the English text of a draft of this manuscript.

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The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Radiology Department, Bei**g Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Bei**g, 100070, People’s Republic of China

    **g Yuan, Zheng Lv, Chunxue Wu & Yaou Liu

  2. GE Healthcare, Shanghai, China

    Jianxun Qu

  3. Neurosurgery Department, Bei**g Tiantan Hospital, Capital Medical University, Bei**g, China

    Dong Zhang, **ngju Liu & Bao Yang

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  1. **g Yuan
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  4. Chunxue Wu
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  5. Dong Zhang
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  6. **ngju Liu
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  8. Yaou Liu
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Correspondence to Yaou Liu.

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The scientific guarantor of this publication is Yaou Liu

Conflict of interest

One of the authors of this manuscript (Jianxun Qu) is an employee of GE Healthcare. The remaining authors declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was obtained from all subjects (patients) in this study.

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• prospective

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• performed at one institution

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Yuan, J., Qu, J., Lv, Z. et al. Assessment of blood supply of the external carotid artery in moyamoya disease using super-selective pseudo-continuous arterial spin labeling technique. Eur Radiol 31, 9287–9295 (2021). https://doi.org/10.1007/s00330-021-07893-y

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