We directly compared multi-delay arterial spin labeling (ASL) and standard ASL measurements of cerebral blood flow (CBF) to simultaneously acquired [15O]-PET scans on hybrid PET/MRI in Moyamoya disease. For these Moyamoya patients (N=15) with extremely long arterial transit times, multi-delay ASL outperforms standard ASL in regional correlation and reduces bias relative to PET. We also constructed a voxelwise, normative CBF database based on healthy controls (N=15) with PET/MRI, and identified regions of hypoperfusion in frontal and parietal regions of patients. Multi-delay ASL is more specific to areas of Moyamoya hypoperfusion (more similar to PET), whereas standard ASL overestimates these areas due to low signal.
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