Purpose To determine whether arterial spin-labeling (ASL) magnetic resonance (MR) imaging could be used to identify changes in cerebral blood flow (CBF), collateral blood flow, and anastomosis site patency after revascularization in patients with moyamoya disease. Materials and Methods This retrospective study was conducted in 145 patients with moyamoya disease who underwent middle cerebral artery (MCA)-superficial temporal artery anastomosis. Preoperative, early postoperative, and late postoperative ASL and digital subtraction angiography images were analyzed. In the MCA territory, absolute CBF (hereafter, CBF_MCA) and normalized CBF values adjusted to nonanastomosis side (hereafter, nCBF_MCA) and to cerebellum (hereafter, nCBF_Cbll) were calculated. Collateral grading in the MCA territory was assessed according to Alberta Stroke Program Early CT Score methodology, and anastomosis site patency were also assessed. Changes in CBF were compared by using one-way analysis of variance with Bonferroni correction for multiple comparisons. Intermodality agreement was determined by κ statistics. Results Significant increases in CBF_MCA, nCBF_MCA, and nCBF_Cbll were found after revascularization (preoperative and postoperative values of CBF_MCA, 35.2 mL/100 g per minute ± 7.8 [mean ± standard deviation] and 51.5 mL/100 g per minute ± 12.0; nCBF_MCA, 0.73 mL/100 g per minute ± 0.14 and 1.01 mL/100 g per minute ± 0.18; nCBF_Cbll, 0.74 mL/100 g per minute ± 0.12 and 1.12 mL/100 g per minute ± 0.16; all P < .001). Agreements for collateral grading and anastomosis patency between ASL MR imaging and digital subtraction angiography were moderate to good, with weighted κ values of 0.77 (95% confidence interval: 0.73, 0.81) and 0.57 (95% confidence interval: 0.37, 0.76), respectively. Conclusion ASL MR imaging can be used to identify perfusion changes in patients with moyamoya disease after revascularization as a noninvasive monitoring tool.

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