Choi, EJ; Levin, D; Robertson, A; Kirkham, FJ; Muthusami, P; Krishnan, P; Shroff, M; ... Dlamini, N; + view all Choi, EJ; Levin, D; Robertson, A; Kirkham, FJ; Muthusami, P; Krishnan, P; Shroff, M; Moharir, M; Dirks, P; MacGregor, D; Pulcine, E; Bhathal, I; Kassner, A; Walker, K; Allan, W; deVeber, G; Logan, WJ; Dlamini, N; - view fewer (2024) Assessment of MR blood-oxygen-level-dependent (BOLD) cerebrovascular reactivity under general anesthesia in children with moyamoya. Pediatric Radiology 10.1007/s00247-024-05930-8. (In press).

Text Kirkham_GACVR_repeatability_Feb 27 2024_ND_EJC_ND_CLEAN.pdf Access restricted to UCL open access staff until 24 May 2025. Download (184kB)

Abstract

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.

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