CO(2)BOLD assessment of moyamoya syndrome: Validation with single photon emission computed tomography and positron emission tomography imaging

AIM: To compare the assessment of cerebrovascular reserve (CVR) using CO(2)BOLD magnetic resonance imaging (MRI) vs positron emission tomography (PET) and single photon emission computed tomography (SPECT) as reference standard. METHODS: Ten consecutive patients (8 women, mean age of 41 ± 26 years) with moyamoya syndrome underwent 14 pre-surgical evaluations for external-internal carotid artery bypass surgery. CVR was assessed using CO(2)BOLD and PET (4)/SPECT (11) with a maximum interval of 36 d, and evaluated by two experienced neuroradiologists. RESULTS: The inter-rater agreement was 0.81 for SPECT (excellent), 0.43 for PET (fair) and 0.7 for CO(2)BOLD (good). In 9/14 cases, there was a correspondence between CO(2)BOLD and PET/SPECT. In 4/14 cases, CVR was over-estimated in CO(2)BOLD, while in 1/14 case, CVR was underestimated in CO(2)BOLD. The sensitivity of CO(2)BOLD was 86% and a specificity of 43%. CONCLUSION: CO(2)BOLD can be used for pre-surgical assessment of CVR in patients with moyamoya syndrome and combines the advantages of absent irradiation, high availability of MRI and assessment of brain parenchyma, cerebral vessels and surrogate CVR in one stop.