Vascular territorial analysis of cerebral blood flow in pediatric Moyamoya to exclude arterial transit time bias

Delayed perfusion in patients with Moyamoya vasculopathy can lead to a bias in CBF quantification, especially for single-delay ASL acquisitions. In this work, we investigate the clinical utility of arterial transit time corrected CBF derived from a 7-delay prototype ASL sequence for assessment of hemodynamically mediated perfusion failure in pediatric Moyamoya patients. The multi-delay ASL acquisition proved successful in capturing the whole distribution of transit times in the investigated patient cohort and may thus be a valid contrast agent-free alternative to DSC-enhanced perfusion imaging.