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MR perfusion imaging in moyamoya syndrome: potential implications for clinical evaluation of occlusive cerebrovascular disease

MR perfusion imaging in moyamoya syndrome: potential implications for clinical evaluation of occlusive cerebrovascular disease
MR perfusion imaging in moyamoya syndrome: potential implications for clinical evaluation of occlusive cerebrovascular disease

Background and Purpose - Ischemic symptoms in patients with moyamoya syndrome (MMS) are usually due to hemodynamically mediated perfusion failure, and identification of abnormal tissue perfusion in these patients is therefore clinically important. Although dynamic susceptibility contrast (DSC) MRI can be used to study tissue perfusion, there are potential technical problems in MMS. This study investigates the scope and limitations of perfusion MRI in the clinical evaluation of such patients.

Methods - Thirteen patients with bilateral MMS were studied with the use of structural, diffusion, and perfusion MRI. The DSC MRI data were analyzed both visually and by a quantitative regional analysis, and the relationship between perfusion status and clinical symptoms was investigated.

Results - Extensive bilateral DSC MRI abnormalities were observed in all the patients. There was a very heterogeneous distribution of bolus arrival time. The areas of abnormality included the major arterial border zones in all cases, although these usually appeared normal on structural and diffusion MRI. Only the most clinically unstable patients had peak width (defined as time to peak minus bolus arrival time) >5 seconds on the quantitative regional analysis. Several technical limitations of perfusion quantification in MMS are described, as well as the implications of these limitations in patients with other forms of occlusive large-vessel disease.

Conclusions - The technical limitations of DSC MRI described in this study are important for the accurate interpretation of perfusion MRI in MMS. Despite these limitations, these preliminary findings suggest that the use of quantitative regional analysis of summary parameters may provide clinically useful information in patients with MMS.

Cerebral ischemia, Hypoperfusion, Moyamoya disease, Perfusion, Stenosis
0039-2499
2810-2816
Calamante, Fernando
63d493e7-04b6-4147-8353-5f487b994cab
Ganesan, V.
0541b25d-409b-434a-b628-8df993f1d8c8
Kirkham, F.J.
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
Jan, W.
5c0812d0-7b0a-45db-a4be-cf741f8bb5ba
Chong, W.K.
bb7bc2ce-1866-4fb0-8b82-5a6d2381b67a
Gadian, D.G.
2b0e526e-9bd0-4173-b5cd-ee32c8f66c57
Connelly, A.
0cb19e67-b09d-458b-8c30-1e9f8a279887
Calamante, Fernando
63d493e7-04b6-4147-8353-5f487b994cab
Ganesan, V.
0541b25d-409b-434a-b628-8df993f1d8c8
Kirkham, F.J.
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
Jan, W.
5c0812d0-7b0a-45db-a4be-cf741f8bb5ba
Chong, W.K.
bb7bc2ce-1866-4fb0-8b82-5a6d2381b67a
Gadian, D.G.
2b0e526e-9bd0-4173-b5cd-ee32c8f66c57
Connelly, A.
0cb19e67-b09d-458b-8c30-1e9f8a279887

Calamante, Fernando, Ganesan, V., Kirkham, F.J., Jan, W., Chong, W.K., Gadian, D.G. and Connelly, A. (2001) MR perfusion imaging in moyamoya syndrome: potential implications for clinical evaluation of occlusive cerebrovascular disease. Stroke, 32 (12), 2810-2816. (doi:10.1161/hs1201.099893).

Record type: Article

Abstract

Background and Purpose - Ischemic symptoms in patients with moyamoya syndrome (MMS) are usually due to hemodynamically mediated perfusion failure, and identification of abnormal tissue perfusion in these patients is therefore clinically important. Although dynamic susceptibility contrast (DSC) MRI can be used to study tissue perfusion, there are potential technical problems in MMS. This study investigates the scope and limitations of perfusion MRI in the clinical evaluation of such patients.

Methods - Thirteen patients with bilateral MMS were studied with the use of structural, diffusion, and perfusion MRI. The DSC MRI data were analyzed both visually and by a quantitative regional analysis, and the relationship between perfusion status and clinical symptoms was investigated.

Results - Extensive bilateral DSC MRI abnormalities were observed in all the patients. There was a very heterogeneous distribution of bolus arrival time. The areas of abnormality included the major arterial border zones in all cases, although these usually appeared normal on structural and diffusion MRI. Only the most clinically unstable patients had peak width (defined as time to peak minus bolus arrival time) >5 seconds on the quantitative regional analysis. Several technical limitations of perfusion quantification in MMS are described, as well as the implications of these limitations in patients with other forms of occlusive large-vessel disease.

Conclusions - The technical limitations of DSC MRI described in this study are important for the accurate interpretation of perfusion MRI in MMS. Despite these limitations, these preliminary findings suggest that the use of quantitative regional analysis of summary parameters may provide clinically useful information in patients with MMS.

Full text not available from this repository.

More information

Published date: December 2001
Keywords: Cerebral ischemia, Hypoperfusion, Moyamoya disease, Perfusion, Stenosis

Identifiers

Local EPrints ID: 429823
URI: https://eprints.soton.ac.uk/id/eprint/429823
ISSN: 0039-2499
PURE UUID: 93e11383-9211-433c-a472-8f8202390849
ORCID for F.J. Kirkham: ORCID iD orcid.org/0000-0002-2443-7958

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Date deposited: 05 Apr 2019 16:30
Last modified: 20 Jul 2019 01:05

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Contributors

Author: Fernando Calamante
Author: V. Ganesan
Author: F.J. Kirkham ORCID iD
Author: W. Jan
Author: W.K. Chong
Author: D.G. Gadian
Author: A. Connelly

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