Acceleration-selective Arterial Spin-labeling MR Angiography Used to Visualize Distal Cerebral Arteries and Collateral Vessels in Moyamoya Disease

Purpose: To evaluate and compare the performance of acceleration-selective arterial spin labeling (AccASL) magnetic resonance (MR) angiography in the visualization of cerebral arteries and collateral vessels in patients with Moyamoya disease with that of time-of-flight (TOF) MR angiography, with digital subtraction angiography (DSA) as the reference standard. Materials and Methods: Thirty-six cerebral hemispheres from 22 patients with Moyamoya disease underwent TOF and AccASL MR angiography and DSA. Qualitative evaluations included imaging of the terminal internal carotid artery (ICA), distal middle cerebral arteries (MCAs), Moyamoya vessels, and leptomeningeal anastomosis (LMA) collaterals with reference to DSA. Quantitative evaluations included assessment of contrast-to-noise ratio (CNR) and number of vessels in MCA branches. The linear mixed-effect model was used to compare the two methods. Results: Mean scores for qualitative evaluation were significantly higher with AccASL angiography than with TOF angiography for imaging distal MCAs (3.9 +/- 0.3 [standard deviation] vs 2.9 +/- 1.1; P<.001), Moyamoya vessels (3.6 +/- 0.6 vs 2.7 +/- 0.9, P<.001), and LMA collaterals (3.8 +/- 0.6 vs 1.8 +/- 0.7, P<.001). Scores for steno-occlusive degree around the terminal ICAs were better with TOF angiography than with AccASL angiography (2.6 +/- 0.5 vs 2.4 +/- 0.6, P=.023). CNRs in the M4 segment were significantly higher with AccASL angiography (11.9 +/- 12.9, P<.001) than with TOF angiography (4.1 +/- 7.9). The number of vessels was significantly higher with AccASL angiography (18.3 +/- 5.0, P<.001) than with TOF angiography (8.9 +/- 4.9). The increase in the number of vessels from TOF angiography to AccASL angiography was greater in patients with severe ICA stenoocclusion (late ICA stage group, 11.4 +/- 4.5; early ICA stage group, 6.8 +/- 4.0; P=.007) and well-developed leptomeningeal anastomosis (mildly developed LMA group, 7.1 +/- 4.3; well-developed LMA group, 11.3 +/- 4.5; P=.011). Conclusion: AccASL MR angiography enables better visualization of distal cerebral arteries and collateral vessels in patients with Moyamoya disease than does TOF MR angiography, while TOF MR angiography enables better visualization of stenosis of proximal arteries. Both methods work in a mutually beneficial manner in the assessment of cerebral arteries.