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This study assesses the accuracy of combined velocity-selective arterial spin-labeling and traditional pulsed arterial spin-labeling CBF measurements in pediatric Moyamoya disease, with comparison with blood flow patterns on conventional angiography. Twenty-two neurologically stable pediatric patients with Moyamoya disease and 5 asymptomatic siblings without frank Moyamoya disease were imaged with velocity-selective arterial spin-labeling, pulsed arterial spin-labeling, and DSA (patients). Qualitatively, velocity-selective arterial spin-labeling perfusion maps reflect the DSA parenchymal phase, regardless of postinjection timing. Conversely, pulsed arterial spin-labeling maps reflect the DSA appearance at postinjection times closer to pulsed arterial spin-labeling postlabeling delay, regardless of vascular phase. ASPECTS comparison showed excellent agreement between arterial spin-labeling and DSA, suggesting velocity-selective arterial spin-labeling and pulsed arterial spin-labeling capture key perfusion and transit delay information, respectively. Velocity-selective arterial spin-labeling offers a powerful approach to image perfusion in pediatric Moyamoya disease due to transit delay insensitivity.

Seven studies were included, reporting 5938 children (mean age, 11.3 ± 2.8 years). Incidental findings were present in 16.4% of healthy children, intracranial cysts being the most frequent (10.2%). Nonspecific white matter hyperintensities were reported in 1.9%, Chiari I malformation was found in 0.8%, and intracranial neoplasms were reported in 0.2%. In total, the prevalence of incidental findings needing follow-up was 2.6%. The prevalence of incidental findings is much more frequent in children than previously reported in adults, but clinically significant incidental findings were present in <1 in 38 children.