Quantitative Cerebral Perfusion Imaging in Children and Young Adults with Moyamoya Disease: Comparison of Arterial Spin-Labeling–MRI and H2[15O]-PET

BACKGROUND AND PURPOSE: Cerebral perfusion assessment is important in the preoperative evaluation and postoperative follow-up of patients with Moyamoya disease. The objective of this study was to evaluate the correlation of quantitative CBF measurements performed with arterial spin-labeling–MR imaging and H2[15O]-PET in children and young adults with Moyamoya disease. MATERIALS AND METHODS: Thirteen children and young adults (8 female patients; age, 9.7 ± 7.1 years; range, 1–23 years) with Moyamoya disease underwent cerebral perfusion imaging with H2[15O]-PET (Discovery STE PET/CT, 3D Fourier rebinning filtered back-projection, 128 × 128 × 47 matrix, 2.34 × 2.34 × 3.27 mm3 voxel spacing) and arterial spin-labeling (3T scanner, 3D pulsed continuous arterial spin-labeling sequence, 32 axial sections, TR = 5.5 seconds, TE = 25 ms, FOV = 24 cm, 128 × 128 matrix, 1.875 × 1.875 × 5 mm3 voxel spacing) within less than 2 weeks of each other. Perfusion of left and right anterior cerebral artery, MCA, and posterior cerebral artery territories was qualitatively assessed for arterial spin-labeling–MR imaging and H2[15O]-PET by 2 independent readers by use of a 3-point-Likert scale. Quantitative correlation of relative CBF with cerebellar normalization between arterial spin-labeling–MR imaging and H2[15O]-PET was evaluated in a volume-based approach for each vascular territory after 3D image coregistration. RESULTS: Interreader agreement was good (κ = 0.67–0.69), and strong and significant correlations were found between arterial spin-labeling–MR imaging and H2[15O]-PET for both qualitative perfusion scoring (ρ = 0.77; P < .001) and quantitative perfusion assessment of relative CBF with cerebellar normalization (r = 0.67, P < .001). CONCLUSIONS: In children and young adults with Moyamoya disease, quantitative evaluation of CBF is possible with the use of arterial spin-labeling–MR imaging without ionizing radiation or contrast injection with a good correlation to H2[15O]-PET after cerebellar normalization.