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pCASL is an MR technique that measures cerebral blood flow (CBF), an important physiologic parameter commonly altered in many cerebrovascular conditions. Compared to conventional vessel imaging techniques that detect changes in lumen diameter, VWI shows changes in the vessel wall itself. 3D turbo spin-echo with variable refocusing flip angles, which was also used in their work, has become a method of choice for non-invasive assessment of the intracranial vessel wall ( 7). VWI is a black blood MR imaging technique that has substantially been optimized over the past decade for the intracranial vessels ( 6). Ya and colleagues investigated the use of combined high-resolution intracranial vessel wall MR imaging (VWI) and pseudo-continuous arterial spin labeling (pCASL) techniques to determine differences in morphologic and perfusional characteristics of ICAS and MMD ( 5). Multimodal approaches using both structural and physiologic data may be of added value to diagnose and support management strategies.
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However, because treatment strategies and prognoses differ between ICAS and MMD, it is important to distinguish these two entities. Clinical outcome is associated with the neurologic status at the time of treatment ( 3) and given a 2.6% rate of symptomatic progression after surgical revascularization ( 4), early diagnosis and therapy are critical for a better prognosis.Īngiographic appearances of MMD can be similar to stenosis related to other vasculopathies, such as intracranial atherosclerosis (ICAS), and pose a diagnostic challenge. Despite compensatory collateralization, up to two thirds of patients with MMD have symptomatic progression over a 5-year period and outcomes are poor without treatment ( 1, 2). Compensatory development of basal, cortical, and leptomeningeal collateral vessels is associated with MMD. It can lead to hypoperfusion and ischemia due to reduced blood flow in the major vessels of the anterior circulation. Moyamoya disease (MMD) is a steno-occlusive vasculopathy most commonly affecting the intracranial internal carotid artery terminus.
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High-resolution combined arterial spin labeling MR for identifying cerebral arterial stenosis induced by moyamoya disease or atherosclerosis. Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Pacific Theatres 400, Los Angeles, CA 90048, USA.