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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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Abstract

Objectives

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).

Methods

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.

Results

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).

Conclusions

The 4D-PACK provided better visualization and higher CNRs in distal cerebral arteries and LMA collaterals compared with CINEMA in patients with this disease.

Key Points

• 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.

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Abbreviations

4D-PACK:

Four-dimensional pseudo-continuous arterial spin labeling-based angiography using CENTRA-keyhole and view sharing

4D:

Four dimensional

AccASL:

Acceleration-selective ASL

CBF:

Cerebral blood flow

CENTRA:

Contrast-enhanced timing-robust angiography

CINEMA:

Contrast inherent inflow-enhanced multiphase angiography

CNR:

Contrast-to-noise ratio

DSA:

Digital subtraction angiography

EPI:

Echo planer imaging

ICA:

Internal carotid artery

LMA:

Leptomeningeal anastomosis

MCA:

Middle cerebral artery

MIP:

Maximum intensity projection

PCA:

Posterior cerebral artery

pCASL:

Pseudo-continuous arterial spin labeling

RF:

Radiofrequency

ROI:

Region of interest

ST:

Stationary tissue

TOF:

Time of flight

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Funding

This study has received funding by JSPS KAKENHI grant no. JP 17K10410.

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Authors and Affiliations

  1. Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Osamu Togao, Akio Hiwatashi, Koji Yamashita, Daichi Momosaka & Hiroshi Honda

  2. Philips Japan, 13-37, Kohnan 2-chome, Minato-ku, Tokyo, 108-8507, Japan

    Makoto Obara & Marc Van Cauteren

  3. Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Ataru Nishimura, Koichi Arimura, Nobuhiro Hata, Koji Yoshimoto & Koji Iihara

Authors
  1. Osamu Togao
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  2. Akio Hiwatashi
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  11. Marc Van Cauteren
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  12. Hiroshi Honda
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Corresponding author

Correspondence to Akio Hiwatashi.

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Guarantor

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.

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Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

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• retrospective

• diagnostic study

• performed at one institution

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Cite this article

Togao, O., Hiwatashi, A., Obara, M. et al. 4D ASL-based MR angiography for visualization of distal arteries and leptomeningeal collateral vessels in moyamoya disease: a comparison of techniques. Eur Radiol 28, 4871–4881 (2018). https://doi.org/10.1007/s00330-018-5462-7

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  • DOI: https://doi.org/10.1007/s00330-018-5462-7

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