4D ASL-based MR angiography for visualization of distal arteries and leptomeningeal collateral vessels in moyamoya disease: a comparison of techniques
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To evaluate the performance of four-dimensional pseudo-continuous arterial spin labeling (4D-pCASL)-based angiography using CENTRA-keyhole and view sharing (4D-PACK) in the visualization of flow dynamics in distal cerebral arteries and leptomeningeal anastomosis (LMA) collaterals in moyamoya disease in comparison with contrast inherent inflow-enhanced multiphase angiography (CINEMA), with reference to digital subtraction angiography (DSA).
Thirty-two cerebral hemispheres from 19 patients with moyamoya disease (mean age, 29.7 ± 19.6 years; five males, 14 females) underwent both 4D-MR angiography and DSA. Qualitative evaluations included the visualization of anterograde middle cerebral artery (MCA) flow and retrograde flow via LMA collaterals with reference to DSA. Quantitative evaluations included assessments of the contrast-to-noise ratio (CNR) on these vessels. The linear mixed-effect model was used to compare the 4D-PACK and CINEMA methods.
The vessel visualization scores were significantly higher with 4D-PACK than with CINEMA in the visualization of anterograde flow for both Observer 1 (CINEMA, 3.53 ± 1.39; 4D-PACK, 4.53 ± 0.80; p < 0.0001) and Observer 2 (CINEMA, 3.50±1.39; 4D-PACK, 4.31 ± 0.86; p = 0.0009). The scores were higher with 4D-PACK than with CINEMA in the visualization of retrograde flow for both Observer 1 (CINEMA, 3.44 ± 1.05; 4D-PACK, 4.47 ± 0.88; p < 0.0001) and Observer 2 (CINEMA, 3.19 ± 1.20; 4D-PACK, 4.38 ± 0.91; p < 0.0001). The maximum CNR in the anterograde flow was higher in 4D-PACK (40.1 ± 16.1, p = 0.0001) than in CINEMA (27.0 ± 16.6). The maximum CNR in the retrograde flow was higher in 4D-PACK (36.1 ± 10.0, p < 0.0001) than in CINEMA (15.4 ± 8.0).
The 4D-PACK provided better visualization and higher CNRs in distal cerebral arteries and LMA collaterals compared with CINEMA in patients with this disease.
• The 4D-PACK enables good visualization of distal cerebral arteries in moyamoya disease.
• The 4D-PACK enables direct visualization of leptomeningeal collateral vessels in moyamoya disease.
• Vessel visualization by 4D-PACK can be useful in assessing cerebral hemodynamics.
KeywordsMagnetic resonance imaging Magnetic resonance angiography Moyamoya disease Collateral circulation Cerebrovascular disorders
Four-dimensional pseudo-continuous arterial spin labeling-based angiography using CENTRA-keyhole and view sharing
Cerebral blood flow
Contrast-enhanced timing-robust angiography
Contrast inherent inflow-enhanced multiphase angiography
Digital subtraction angiography
Echo planer imaging
Internal carotid artery
Middle cerebral artery
Maximum intensity projection
Posterior cerebral artery
Pseudo-continuous arterial spin labeling
Region of interest
Time of flight
This study has received funding by JSPS KAKENHI grant no. JP 17K10410.
Compliance with ethical standards
The scientific guarantor of this publication is Hiroshi Honda.
Conflict of interest
The authors of this manuscript declare relationships with the following companies: Philips Japan.
Two authors (M.O., M.V.C.) were employees of Philips Japan and provided technical support in sequence development but were not involved in the study design or interpretation of the data.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was waived by the Institutional Review Board.
Institutional Review Board approval was obtained.
• diagnostic study
• performed at one institution