Published online Nov 28, 2016. doi: 10.4329/wjr.v8.i11.887
Peer-review started: April 22, 2016
First decision: July 5, 2016
Revised: September 5, 2016
Accepted: September 21, 2016
Article in press: September 22, 2016
Published online: November 28, 2016
To compare the assessment of cerebrovascular reserve (CVR) using CO2BOLD magnetic resonance imaging (MRI) vs positron emission tomography (PET) and single photon emission computed tomography (SPECT) as reference standard.
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 CO2BOLD and PET (4)/SPECT (11) with a maximum interval of 36 d, and evaluated by two experienced neuroradiologists.
The inter-rater agreement was 0.81 for SPECT (excellent), 0.43 for PET (fair) and 0.7 for CO2BOLD (good). In 9/14 cases, there was a correspondence between CO2BOLD and PET/SPECT. In 4/14 cases, CVR was over-estimated in CO2BOLD, while in 1/14 case, CVR was underestimated in CO2BOLD. The sensitivity of CO2BOLD was 86% and a specificity of 43%.
CO2BOLD 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.
Core tip: Inter-rater agreement of cerebrovascular reserve (CVR) assessment in CO2BOLD is similar to positron emission tomography (PET)/single photon emission computed tomography (SPECT); CO2BOLD has a sensitivity of 86% and specificity of 43% compared to PET/SPECT; Overall, CO2BOLD tends to over-estimate reduction in CVR compared to PET and SPECT as reference standard; Taking this over-estimation of CO2BOLD into account would further improve its sensitivity and specificity; CVR can be assessed using CO2BOLD for pre-surgical evaluation and follow-up of moyamoya syndrome patients.