Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Nov 28, 2016; 8(11): 887-894
Published online Nov 28, 2016. doi: 10.4329/wjr.v8.i11.887
CO2BOLD assessment of moyamoya syndrome: Validation with single photon emission computed tomography and positron emission tomography imaging
Alain Pellaton, Philippe Bijlenga, Laurie Bouchez, Victor Cuvinciuc, Isabelle Barnaure, Valentina Garibotto, Karl-Olof Lövblad, Sven Haller
Alain Pellaton, Laurie Bouchez, Victor Cuvinciuc, Isabelle Barnaure, Karl-Olof Lövblad, Sven Haller, Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, 1211 Geneva, Switzerland
Philippe Bijlenga, Neurosurgery, Geneva University Hospitals, 1211 Geneva, Switzerland
Valentina Garibotto, Nuclear Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland
Author contributions: Pellaton A contributed to data acquisition, data analysis, manuscript preparation; Bijlenga P contributed to patient selection, biostatistics, manuscript preparation; Bouchez L contributed to manuscript preparation; Cuvinciuc V and Barnaure I contributed to data analysis; Garibotto V contributed to data analysis, manuscript preparation; Lövblad KO contributed to manuscript preparation; Haller S contributed to data acquisition, biostatistics, manuscript preparation.
Supported by The Swiss National Science Foundation grant, No. 140340.
Institutional review board statement: We declare that the current study has been approved by the University of Geneva Ethical Committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
Informed consent statement: Individual patient consent was waived by the local ethical committee for this retrospective study.
Conflict-of-interest statement: No conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Karl-Olof Lövblad, MD, Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, 4 rue Gabrielle-Perret Gentil, 1211 Geneva, Switzerland.
Telephone: +41-22-3727045 Fax: +41-22-3727072
Received: April 21, 2016
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.

Keywords: Moyamoya, Vascular reserve, CO2BOLD, Cerebrovascular reserve

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.