COBOLD 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 COBOLD magnetic resonance imaging (MRI) 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 COBOLD 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 COBOLD (good). In 9/14 cases, there was a correspondence between COBOLD and PET/SPECT. In 4/14 cases, CVR was over-estimated in COBOLD, while in 1/14 case, CVR was underestimated in COBOLD. The sensitivity of COBOLD was 86% and a specificity of 43%.

Conclusion: COBOLD 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.