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Cerebral Blood Flow Improvement after Indirect Revascularization for Pediatric Moyamoya Disease: A Statistical
T Blauwblomme1, H Lemaitre2, O Naggara3
1From the Université René Descartes (T.B., O.N., R.C., B.M., S.P., M.Z., F.B., C.S.-R., N.B.), PRES Sorbonne Paris Cité, Paris, France APHP, Departments of Pediatric Neurosurgery (T.B., M.B., S.P., M.Z., C.S.-R.) French Institute of Health and Medical Research U1000 (T.B., H.L., R.C., N.B.), Institut Imagine, University Paris-Sud 11 and University Paris Descartes, Paris, France thomas.blauwblomme@nck.aphp.fr.
Background And Purpose:
The severity of Moyamoya disease is generally scaled with conventional angiography and nuclear medicine. Arterial spin-labeling MR imaging is now acknowledged for the noninvasive quantification of cerebral blood flow. This study aimed to analyze CBF modifications with statistical parametric mapping of arterial spin-labeling MR imaging in children undergoing an operation for Moyamoya disease.
Materials And Methods:
We included 15 children treated by indirect cerebral revascularization with multiple burr-holes between 2011 and 2013. Arterial spin-labeling MR imaging and T1 sequences were then analyzed under SPM8, according to the general linear model, before and after the operation (3 and 12 months). Voxel-based analysis was performed at the group level, comparing all diseased hemispheres with all normal hemispheres and, at the individual level, comparing each patient with a control group.
Results:
Group analysis showed statistically significant preoperative hypoperfusion in the MCA territory in the Moyamoya hemispheres and a significant increase of cerebral perfusion in the same territory after revascularization (P < .05 family-wise error-corrected). Before the operation, individual analysis showed significant hypoperfusion for each patient co-localized with the angiographic defect on DSA. All except 1 patient had improvement of CBF after revascularization, correlated with their clinical status.
Conclusions:
SPM analysis of arterial spin-labeling MR imaging offers a noninvasive evaluation of preoperative cerebral hemodynamic impairment and an objective assessment of postoperative improvement in children with Moyamoya disease.
