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Research ArticleAdult Brain
Open Access

Diagnostic Accuracy of Screening Arterial Spin-Labeling MRI Using Hadamard Encoding for the Detection of Reduced CBF in Adult Patients with Ischemic Moyamoya Disease

K. Setta, T. Matsuda, M. Sasaki, T. Chiba, S. Fujiwara, M. Kobayashi, K. Yoshida, Y. Kubo, M. Suzuki, K. Yoshioka and K. Ogasawara
American Journal of Neuroradiology August 2021, 42 (8) 1403-1409; DOI: https://doi.org/10.3174/ajnr.A7167
K. Setta
aFrom the Department of Neurosurgery (K.S., T.C., S.F., M.K., K. Yoshida, Y. Kubo, K.O.), Institute for Biomedical Sciences, Iwate Medical University School of Medicine, Yahaba-cho, Japan
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T. Matsuda
cDivision of Ultrahigh Field MRI, Institute for Biomedical Sciences (T.M., M. Sasaki), Iwate Medical University School of Medicine, Yahaba-cho, Japan
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M. Sasaki
bDepartment of Radiology (M. Suzuki, K. Yoshioka) Institute for Biomedical Sciences (TM, MS), Iwate Medical University School of Medicine, Yahaba-cho, Japan
cDivision of Ultrahigh Field MRI, Institute for Biomedical Sciences (T.M., M. Sasaki), Iwate Medical University School of Medicine, Yahaba-cho, Japan
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T. Chiba
aFrom the Department of Neurosurgery (K.S., T.C., S.F., M.K., K. Yoshida, Y. Kubo, K.O.), Institute for Biomedical Sciences, Iwate Medical University School of Medicine, Yahaba-cho, Japan
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S. Fujiwara
aFrom the Department of Neurosurgery (K.S., T.C., S.F., M.K., K. Yoshida, Y. Kubo, K.O.), Institute for Biomedical Sciences, Iwate Medical University School of Medicine, Yahaba-cho, Japan
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M. Kobayashi
aFrom the Department of Neurosurgery (K.S., T.C., S.F., M.K., K. Yoshida, Y. Kubo, K.O.), Institute for Biomedical Sciences, Iwate Medical University School of Medicine, Yahaba-cho, Japan
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K. Yoshida
aFrom the Department of Neurosurgery (K.S., T.C., S.F., M.K., K. Yoshida, Y. Kubo, K.O.), Institute for Biomedical Sciences, Iwate Medical University School of Medicine, Yahaba-cho, Japan
bDepartment of Radiology (M. Suzuki, K. Yoshioka) Institute for Biomedical Sciences (TM, MS), Iwate Medical University School of Medicine, Yahaba-cho, Japan
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Y. Kubo
aFrom the Department of Neurosurgery (K.S., T.C., S.F., M.K., K. Yoshida, Y. Kubo, K.O.), Institute for Biomedical Sciences, Iwate Medical University School of Medicine, Yahaba-cho, Japan
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M. Suzuki
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K. Yoshioka
aFrom the Department of Neurosurgery (K.S., T.C., S.F., M.K., K. Yoshida, Y. Kubo, K.O.), Institute for Biomedical Sciences, Iwate Medical University School of Medicine, Yahaba-cho, Japan
bDepartment of Radiology (M. Suzuki, K. Yoshioka) Institute for Biomedical Sciences (TM, MS), Iwate Medical University School of Medicine, Yahaba-cho, Japan
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K. Ogasawara
aFrom the Department of Neurosurgery (K.S., T.C., S.F., M.K., K. Yoshida, Y. Kubo, K.O.), Institute for Biomedical Sciences, Iwate Medical University School of Medicine, Yahaba-cho, Japan
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    FIG 1.

    Comparisons (upper graphs) and Bland-Altman plots (lower graphs) of SPECT-CBF and sASL-CBF ratios and sASL-CBF (left graphs) or hASL-CBF ratios (right graphs) for each MCA ROI in each patient. In the upper graphs, each horizontal line denotes the cutoff point for indicating a reduced SPECT-CBF ratio (0.686) and each vertical line denotes the cutoff point lying closest to the upper left corner of the receiver operating characteristic curve for detecting a reduced SPECT-CBF ratio (0.502 for sASL-CBF, 0.801 for hASL-CBF).

  • FIG 2.
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    FIG 2.

    Receiver operating characteristic curves used to compare the accuracy of sASL-CBF and hASL-CBF ratios for detecting a reduced SPECT-CBF ratio. Pair-wise comparison analysis shows a significantly greater area under the receiver operating characteristic curve for the hASL-CBF (dotted line) than for the sASL-CBF ratio (solid line).

  • FIG 3.
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    FIG 3.

    MRA (B), brain perfusion SPECT images (A, left), and sASL (A, middle) and hASL (A, right) MR images of a 43-year-old male patient with transient ischemic attacks complicated by right-sided hemiparesis. MRA shows stage 3 Moyamoya disease. On all 3 SPECT and ASL images, the CBF in the left parietal region is severely reduced compared with that in the left cerebellar hemisphere.

  • FIG 4.
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    FIG 4.

    MRA (B), brain perfusion SPECT images (A, left), and sALS (A, middle) and hASL (A, right) MR images of a 34-year-old female patient with transient ischemic attacks complicated by left-sided hemiparesis. MRA shows stage 3 Moyamoya disease. On perfusion SPECT images, the CBF in the right MCA territory is slightly reduced compared with that in the right cerebellar hemisphere. The CBF on sASL MR images is severely reduced in the right central, parietal, and angular regions, whereas the CBF on hASL MR imaging is not reduced relative to the right cerebellar hemisphere.

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American Journal of Neuroradiology: 42 (8)
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K. Setta, T. Matsuda, M. Sasaki, T. Chiba, S. Fujiwara, M. Kobayashi, K. Yoshida, Y. Kubo, M. Suzuki, K. Yoshioka, K. Ogasawara
Diagnostic Accuracy of Screening Arterial Spin-Labeling MRI Using Hadamard Encoding for the Detection of Reduced CBF in Adult Patients with Ischemic Moyamoya Disease
American Journal of Neuroradiology Aug 2021, 42 (8) 1403-1409; DOI: 10.3174/ajnr.A7167

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Diagnostic Accuracy of Screening Arterial Spin-Labeling MRI Using Hadamard Encoding for the Detection of Reduced CBF in Adult Patients with Ischemic Moyamoya Disease
K. Setta, T. Matsuda, M. Sasaki, T. Chiba, S. Fujiwara, M. Kobayashi, K. Yoshida, Y. Kubo, M. Suzuki, K. Yoshioka, K. Ogasawara
American Journal of Neuroradiology Aug 2021, 42 (8) 1403-1409; DOI: 10.3174/ajnr.A7167
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