Background: Evaluating cerebrovascular reserve (CVR) is important for patients with moyamoya disease (MMD). 123I-iodoamphetamine single-photon emission CT (SPECT) with acetazolamide (ACZ) challenge is widely carried out, but using ACZ becomes problematic owing to its off-label use and its adverse effects. Here, we report the efficacy of dynamic susceptibility contrast MRI (DSC-MRI) for the evaluation of CVR in MMD patients. Methods: All 33 MMD patients underwent both SPECT and DSC-MRI at an interval of <10 days from each other (mean age 38.3 years). The region of interest (ROI) was the anterior cerebral artery (ACA) territory, middle cerebral artery (MCA) territory, basal ganglia and cerebellum hemisphere for cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) images. The ratios of the ROIs to the ipsilateral cerebellum were calculated for each parameter and evaluated. The CVR was calculated using images acquired by SPECT before and after ACZ administration. The ratios of DSC-MRI parameters and CVR were compared and evaluated for each ROI. Results: The MTT of the ACA and MCA territories significantly correlated with CVR (p < 0.0001). However, CBF and CBV had no correlation with CVR. The MTT ratio had a threshold of 1.966, with a sensitivity of 68.4% and a specificity of 91.5% for predicting decreased CVR (<10%). Conclusion: MTT had a negative correlation with CVR. DSC-MRI is easy, safe and useful for detecting decreased CVR and can be used as a standard examination in MMD patient's care.

1.
Suzuki J, Kodama N: Moyamoya disease - a review. Stroke 1983;14:104-109.
2.
Suzuki J, Takaku A: Cerebrovascular ‘moyamoya' disease. Disease showing abnormal net-like vessels in base of brain. Arch Neurol 1969;20:288-299.
3.
Bersano A, Guey S, Bedini G, Nava S, Hervé D, Vajkoczy P, et al: Research progresses in understanding the pathophysiology of moyamoya disease. Cerebrovasc Dis 2016;41:105-118.
4.
Nariai T, Matsushima Y, Imae S, Tanaka Y, Ishii K, Senda M, et al: Severe haemodynamic stress in selected subtypes of patients with moyamoya disease: a positron emission tomography study. J Neurol Neurosurg Psychiatry 2005;76:663-669.
5.
Lee M, Zaharchuk G, Guzman R, Achrol A, Bell-Stephens T, Steinberg GK: Quantitative hemodynamic studies in moyamoya disease: a review. Neurosurg Focus 2009;26:E5.
6.
Derdeyn CP, Videen TO, Yundt KD, Fritsch SM, Carpenter DA, Grubb RL, et al: Variability of cerebral blood volume and oxygen extraction: stages of cerebral haemodynamic impairment revisited. Brain 2002;125(pt 3):595-607.
7.
Grubb RL Jr, Derdeyn CP, Fritsch SM, Carpenter DA, Yundt KD, Videen TO, et al: Importance of hemodynamic factors in the prognosis of symptomatic carotid occlusion. JAMA 1998;280:1055-1060.
8.
Ogasawara K, Ito H, Sasoh M, Okuguchi T, Kobayashi M, Yukawa H, et al: Quantitative measurement of regional cerebrovascular reactivity to acetazolamide using 123I-N-isopropyl-p-iodoamphetamine autoradiography with SPECT: validation study using H2 15O with PET. J Nucl Med 2003;44:520-525.
9.
Nariai T, Suzuki R, Hirakawa K, Maehara T, Ishii K, Senda M: Vascular reserve in chronic cerebral ischemia measured by the acetazolamide challenge test: comparison with positron emission tomography. AJNR Am J Neuroradiol 1995;16:563-570.
10.
Honda M, Ezaki Y, Kitagawa N, Tsutsumi K, Ogawa Y, Nagata I: Quantification of the regional cerebral blood flow and vascular reserve in moyamoya disease using split-dose iodoamphetamine I 123 single-photon emission computed tomography. Surg Neurol 2006;66:155-159; discussion 159.
11.
Zimmermann S, Achenbach S, Wolf M, Janka R, Marwan M, Mahler V: Recurrent shock and pulmonary edema due to acetazolamide medication after cataract surgery. Heart Lung 2014;43:124-126.
12.
Hu CY, Lee BJ, Cheng HF, Wang CY: Acetazolamide-related life-threatening hypophosphatemia in a glaucoma patient. J Glaucoma 2015;24:e31-e33.
13.
Campbell DA, Renner NE, Tonks E: Effect of Diamox on plasma bicarbonate and on the electrolyte balance in relation to intra-ocular pressure in man. Br J Ophthalmol 1958;42:732-738.
14.
Kikuchi K, Murase K, Miki H, Yasuhara Y, Sugawara Y, Mochizuki T, et al: Quantitative evaluation of mean transit times obtained with dynamic susceptibility contrast-enhanced MR imaging and with (133)Xe SPECT in occlusive cerebrovascular disease. AJR Am J Roentgenol 2002;179:229-235.
15.
Kim JH, Lee SJ, Shin T, Kang KH, Choi PY, Kim JH, et al: Correlative assessment of hemodynamic parameters obtained with T2*-weighted perfusion MR imaging and SPECT in symptomatic carotid artery occlusion. AJNR Am J Neuroradiol 2000;21:1450-1456.
16.
Hirai T, Murakami R, Nakamura H, Kitajima M, Fukuoka H, Sasao A, et al: Prognostic value of perfusion MR imaging of high-grade astrocytomas: long-term follow-up study. AJNR Am J Neuroradiol 2008;29:1505-1510.
17.
Saito T, Yamasaki F, Kajiwara Y, Abe N, Akiyama Y, Kakuda T, et al: Role of perfusion-weighted imaging at 3T in the histopathological differentiation between astrocytic and oligodendroglial tumors. Eur J Radiol 2012;81:1863-1869.
18.
Yamauchi M, Imabayashi E, Matsuda H, Nakagawara J, Takahashi M, Shimosegawa E, et al: Quantitative assessment of rest and acetazolamide CBF using quantitative SPECT reconstruction and sequential administration of (123)I-iodoamphetamine: comparison among data acquired at three institutions. Ann Nucl Med 2014;28:836-850.
19.
Hirai T, Kitajima M, Nakamura H, Okuda T, Sasao A, Shigematsu Y, et al: Quantitative blood flow measurements in gliomas using arterial spin-labeling at 3T: intermodality agreement and inter- and intraobserver reproducibility study. AJNR Am J Neuroradiol 2011;32:2073-2079.
20.
Kim E, Sohn CH, Na DG, Kim JE, Chang KH, Kim JH, et al: Perfusion computed tomography evaluation of cerebral hemodynamic impairment in patients with unilateral chronic steno-occlusive disease: a comparison with the acetazolamide challenge 99mTc-hexamethylpropyleneamine oxime single-photon emission computed tomography. J Comput Assist Tomogr 2009;33:546-551.
21.
Park JC, Kim JE, Kang HS, Sohn CH, Lee DS, Oh CW, et al: CT perfusion with angiography as a substitute for both conventional digital subtraction angiography and acetazolamide-challenged SPECT in the follow-up of postbypass patients. Cerebrovasc Dis 2010;30:547-555.
22.
Eicker SO, Turowski B, Heiroth HJ, Steiger HJ, Hänggi D: A comparative study of perfusion CT and 99m Tc-HMPAO SPECT measurement to assess cerebrovascular reserve capacity in patients with internal carotid artery occlusion. Eur J Med Res 2011;16:484-490.
23.
Tanaka Y, Nariai T, Nagaoka T, Akimoto H, Ishiwata K, Ishii K, et al: Quantitative evaluation of cerebral hemodynamics in patients with moyamoya disease by dynamic susceptibility contrast magnetic resonance imaging - comparison with positron emission tomography. J Cereb Blood Flow Metab 2006;26:291-300.
24.
Kuhl DE, Barrio JR, Huang SC, Selin C, Ackermann RF, Lear JL, et al: Quantifying local cerebral blood flow by N-isopropyl-p-[123I]iodoamphetamine (IMP) tomography. J Nucl Med 1982;23:196-203.
25.
Ogasawara K, Ito H, Sasoh M, Okuguchi T, Kobayashi M, Yukawa H, et al: Quantitative measurement of regional cerebrovascular reactivity to acetazolamide using 123I-N-isopropyl-p-iodoamphetamine autoradiography with SPECT: validation study using H2 15O with PET. J Nucl Med 2003;44:520-525.
26.
Goetti R, O'Gorman R, Khan N, Kellenberger CJ, Scheer I: Arterial spin labelling MRI for assessment of cerebral perfusion in children with moyamoya disease: comparison with dynamic susceptibility contrast MRI. Neuroradiology 2013;55:639-647.
27.
Noguchi T, Kawashima M, Nishihara M, Egashira Y, Azama S, Irie H: Noninvasive method for mapping CVR in moyamoya disease using ASL-MRI. Eur J Radiol 2015;84:1137-1143.
28.
Conklin J, Fierstra J, Crawley AP, Han JS, Poublanc J, Mandell DM, et al: Impaired cerebrovascular reactivity with steal phenomenon is associated with increased diffusion in white matter of patients with moyamoya disease. Stroke 2010;41:1610-1616.
29.
Calviere L, Ssi Yan Kai G, Catalaa I, Marlats F, Bonneville F, Larrue V: Executive dysfunction in adults with moyamoya disease is associated with increased diffusion in frontal white matter. J Neurol Neurosurg Psychiatry 2012;83:591-593.
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