The usefulness of super-selective arterial spin labeling for postoperative evaluation of pediatric moyamoya disease: technical note

Moyamoya disease is characterized by progressive internal carotid artery (ICA) occlusion. Extracranial-intracranial bypass surgery is effective, particularly in pediatric patients; imaging plays a crucial role in evaluating intracranial perfusion pre- and post-surgery. Arterial spin labeling (ASL) is a magnetic resonance technique employed for noninvasive, whole-brain perfusion assessment by magnetically labeling inflowing blood. However, ASL cannot evaluate the territories and development of each vessel perfusion compared with digital subtraction angiography (DSA). Recently, super-selective ASL (SS-ASL) has been developed, performing pinpoint labeling on a specific artery at a time, and offering a tomographic view that distinctly displays blood supply areas for each vessel. Unlike DSA, SS-ASL is noninvasive and can be repeatedly performed in pediatric patients. In conclusion, SS-ASL is useful for evaluating bypass development over time and understanding the pathophysiology of pediatric moyamoya disease.