{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T14:31:56Z","timestamp":1777991516088,"version":"3.51.4"},"reference-count":59,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2023,6,29]],"date-time":"2023-06-29T00:00:00Z","timestamp":1687996800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Friends of the UMC\/Wilhelmina Children\u2019s Hospital","award":["1619144"],"award-info":[{"award-number":["1619144"]}]},{"name":"Friends of the UMC\/Wilhelmina Children\u2019s Hospital","award":["1519131"],"award-info":[{"award-number":["1519131"]}]},{"name":"Brain Technology Institute Foundation","award":["1619144"],"award-info":[{"award-number":["1619144"]}]},{"name":"Brain Technology Institute Foundation","award":["1519131"],"award-info":[{"award-number":["1519131"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Measurements of cerebrovascular reactivity (CVR) are essential for treatment decisions in moyamoya vasculopathy (MMV). Since MMV patients are often young or cognitively impaired, anesthesia is commonly used to limit motion artifacts. Our aim was to investigate the effect of anesthesia on the CVR in pediatric MMV. We compared the CVR with multidelay-ASL and BOLD MRI, using acetazolamide as a vascular stimulus, in all awake and anesthesia pediatric MMV scans at our institution. Since a heterogeneity in disease and treatment influences the CVR, we focused on the (unaffected) cerebellum. Ten awake and nine anesthetized patients were included. The post-acetazolamide CBF and ASL-CVR were significantly lower in anesthesia patients (47.1 \u00b1 15.4 vs. 61.4 \u00b1 12.1, p = 0.04; 12.3 \u00b1 8.4 vs. 23.7 \u00b1 12.2 mL\/100 g\/min, p = 0.03, respectively). The final BOLD-CVR increase (0.39 \u00b1 0.58 vs. 3.6 \u00b1 1.2% BOLD-change (mean\/SD), p &lt; 0.0001), maximum slope of increase (0.0050 \u00b1 0.0040%\/s vs. 0.017 \u00b1 0.0059%, p &lt; 0.0001), and time to maximum BOLD-increase (~463 \u00b1 136 and ~697 \u00b1 144 s, p = 0.0028) were all significantly lower in the anesthesia group. We conclude that the response to acetazolamide is distinctively different between awake and anesthetized MMV patients, and we hypothesize that these findings can also apply to other diseases and methods of measuring CVR under anesthesia. Considering that treatment decisions heavily depend on CVR status, caution is warranted when assessing CVR under anesthesia.<\/jats:p>","DOI":"10.3390\/jcm12134393","type":"journal-article","created":{"date-parts":[[2023,6,30]],"date-time":"2023-06-30T01:02:41Z","timestamp":1688086961000},"page":"4393","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Anesthesia Depresses Cerebrovascular Reactivity to Acetazolamide in Pediatric Moyamoya Vasculopathy"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5476-547X","authenticated-orcid":false,"given":"Pieter T.","family":"Deckers","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Universitair Medisch Centrum Utrecht, 3584 CX Utrecht, The Netherlands"},{"name":"Department of Radiology and Nuclear Medicine, Meander Medisch Centrum, 3813 TZ Amersfoort, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5079-2868","authenticated-orcid":false,"given":"Jeroen C. W.","family":"Siero","sequence":"additional","affiliation":[{"name":"Department of Radiology, Universitair Medisch Centrum Utrecht, 3584 CX Utrecht, The Netherlands"},{"name":"Spinoza Center for Neuroimaging, 1105 BK Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9844-8721","authenticated-orcid":false,"given":"Maarten O.","family":"Mensink","sequence":"additional","affiliation":[{"name":"Pediatric Anesthesiology, Prinses M\u00e1xima Centrum, 3584 CS Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0031-3130","authenticated-orcid":false,"given":"Annick","family":"Kronenburg","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands"},{"name":"Department of Neurosurgery, Haaglanden Medical Center, 2512 VA The Hague, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kees P. J.","family":"Braun","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurology, Wilhelmina Children\u2019s Hospital, Universitair Medisch Centrum Utrecht, 3584 CX Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3458-7108","authenticated-orcid":false,"given":"Albert","family":"van der Zwan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Universitair Medisch Centrum Utrecht, 3584 CX Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3211-1760","authenticated-orcid":false,"given":"Alex A.","family":"Bhogal","sequence":"additional","affiliation":[{"name":"Department of Radiology, Universitair Medisch Centrum Utrecht, 3584 CX Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,6,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"483","DOI":"10.3171\/jns.1993.79.4.0483","article-title":"Increased Stroke Risk Predicted by Compromised Cerebral Blood Flow Reactivity","volume":"79","author":"Yonas","year":"1993","journal-title":"J. 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