Assessment of MR blood-oxygen-level-dependent (BOLD) cerebrovascular reactivity under general anesthesia in children with moyamoya

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发表日期：

2024年5月23日

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Eun Jung Choi,
David Levin,
Amanda Robertson,
Fenella J. Kirkham,
Prakash Muthusami,
Pradeep Krishnan,
Manohar Shroff,
Mahendranath Moharir,
Peter Dirks,
Daune MacGregor,
Elizabeth Pulcine,
Ishvinder Bhathal,
Andrea Kassner,
Kirstin Walker,
Warwick Allan,
Gabrielle deVeber,
William J. Logan,
Nomazulu Dlamini

摘要

Background

Moyamoya is a progressive, non-atherosclerotic cerebral arteriopathy that may present in childhood and currently has no cure. Early diagnosis is critical to prevent a lifelong risk of neurological morbidity. Blood-oxygen-level-dependent (BOLD) MRI cerebrovascular reactivity (CVR) imaging provides a non-invasive, in vivo measure of autoregulatory capacity and cerebrovascular reserve. However, non-compliant or younger children require general anesthesia to achieve BOLD-CVR imaging.

Objective

To determine the same-day repeatability of BOLD-CVR imaging under general anesthesia in children with moyamoya.

Materials and methods

Twenty-eight examination pairs were included (mean patient age = 7.3 ± 4.0 years). Positive and negatively reacting voxels were averaged over signals and counted over brain tissue and vascular territory. The intraclass correlation coefficient (ICC), Wilcoxon signed-rank test, and Bland–Altman plots were used to assess the variability between the scans.

Results

There was excellent-to-good (≥ 0.59) within-day repeatability in 18 out of 28 paired studies (64.3%). Wilcoxon signed-rank tests demonstrated no significant difference in the grey and white matter CVR estimates, between repeat scans (all p-values > 0.05). Bland–Altman plots of differences in mean magnitude of positive and negative and fractional positive and negative CVR estimates illustrated a reasonable degree of agreement between repeat scans and no systematic bias.

Conclusion

BOLD-CVR imaging provides repeatable assessment of cerebrovascular reserve in children with moyamoya imaged under general anesthesia.