Comparison of whole-brain cerebrovascular reactivity mapping measured by resting-state and carbogen-based BOLD fMRI for moyamoya disease

Motivation: Mapping of cerebrovascular reactivity (CVR) using resting-state BOLD fMRI (RS-fMRI) was raised in 2017 and 2021 with verification using the moyamoya disease (MD). But pathological hemodynamics of MD was missing by RS-fMRI. Goal(s): Arterial stealing phenomenon can be demonstrated by carbogen-based fMRI (CO2-CVR), but not by RS-fMRI. Approach: Both RS-CVR and CO2-CVR using a 3T MR and an automatic delivery system of carbogens were acquired for eleven subjects and ten patients with MD. Bland-Altman plots was applied for both RS-CVR and CO2-CVR. Results: By using CO2-CVR, unique negative CVR of MD verified the arterial stealing phenomenon which was missed by RS-CVR. Impact: Arterial stealing phenomenon of moyamoya disease/syndrome can be demonstrated as negative cerebrovascular reactivity by carbogen-based fMRI (CO2-CVR), but not by resting-state fMRI (RS-CVR).