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Patients commonly need revascularization surgery to optimize cerebral blood flow (CBF). Estimation of CBF and cerebrovascular reserve (CVR) is therefore necessary before and after surgery. However, assessment of CBF before and after indirect revascularization surgery with the multiple burr hole (MBH) technique in MM has not been studied extensively. In this study, we describe our initial experience using arterial spin labeling magnetic resonance perfusion imaging (ASL-MRI) for CBF and CVR assessment before and after indirect MBH revascularization surgery in MM patients.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Eleven MM patients (initial age 6\u201350\u00a0years, 1 male\/10 female) with 19 affected hemispheres were included. A total of 35 ASL-MRI examinations were performed using a 3D-pCASL acquisition before and after i.v. acetazolamide challenge (1000\u00a0mg in adults and 10\u00a0mg\/kg in children). Twelve MBH procedures were performed in seven patients. The first follow-up ASL-MRI was performed 7\u201321 (mean 12) months after surgery.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Before surgery, CBF was 46\u2009\u00b1\u200916 (mean\u2009\u00b1\u2009SD) ml\/100\u00a0g\/min and CVR after acetazolamide challenge was 38.5\u2009\u00b1\u20099.9 (mean\u2009\u00b1\u2009SD)% in the most affected territory (middle cerebral artery). In cases in which surgery was not performed, CVR was 56\u2009\u00b1\u200912 (mean\u2009\u00b1\u2009SD)% in affected hemispheres. After MBH surgery, there was a relative change in CVR compared to baseline (preop) of\u2009+\u200923.5\u2009\u00b1\u200923.3% (mean\u2009\u00b1\u2009SD). There were no new ischemic events.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Using ASL-MRI we followed changes in CBF and CVR in patients with MM. The technique was encouraging for assessments before and after revascularization surgery.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00701-023-05641-3","type":"journal-article","created":{"date-parts":[[2023,6,16]],"date-time":"2023-06-16T12:02:05Z","timestamp":1686916925000},"page":"2057-2069","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["ASL-MRI-guided evaluation of multiple burr hole revascularization surgery in Moyamoya disease"],"prefix":"10.1007","volume":"165","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4925-1348","authenticated-orcid":false,"given":"Anders","family":"Lew\u00e9n","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Markus","family":"Fahlstr\u00f6m","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ljubisa","family":"Borota","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elna-Marie","family":"Larsson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johan","family":"Wikstr\u00f6m","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Per","family":"Enblad","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2023,6,16]]},"reference":[{"key":"5641_CR1","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1002\/mrm.25197","volume":"73","author":"DC Alsop","year":"2015","unstructured":"Alsop DC, Detre JA, Golay X, Gunther M, Hendrikse J, Hernandez-Garcia L, Lu H, MacIntosh BJ, Parkes LM, Smits M, van Osch MJ, Wang DJ, Wong EC, Zaharchuk G (2015) Recommended implementation of arterial spin-labeled perfusion MRI for clinical applications: a consensus of the ISMRM perfusion study group and the European consortium for ASL in dementia. 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