We used single-delayed (SD) pseudo-continuous arterial spin labeling (PCASL), multi-delay (MD) ASL and a new, synthesized (Synth) ASL to longitudinally monitor cerebral blood flow (CBF) before and after direct bypass surgery in Moyamoya disease. The Synth-ASL was generated from a deep convolutional neural network, previously trained on a simultaneous [15O]-water PET/MRI dataset to generate a PET-like CBF map from MRI inputs. The Synth-ASL demonstrated a more homogenous CBF change across the brain and significantly greater CBF increase globally and regionally than SD-ASL and MD-ASL after surgery. Synth-ASL reduces bias in long arterial delay and measurement noise, and may enable robust CBF imaging follow-up in cerebrovascular patients.
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