Measuring cerebrovascular reactivity (CVR) under narcosis is underreported, while narcosis is often necessary for pediatric or cognitively impaired patients. When acetazolamide is used in awake patients, maximum CBF increase reaches a plateau after ~12min. Using ASL- and BOLD-MRI with acetazolamide we showed that for pediatric moyamoya patients the response is different. Patients under narcosis show lower CVR and reach peak CBF earlier (after around six minutes), after which CBF decreases again without the plateau-phase. This shows the response to acetazolamide is distinctively different between awake and narcosis patients and caution is warranted during interpretation of narcosis CVR images.
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