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Monitoring Cerebral Perfusion Changes after Revascularization in Patients with Moyamoya Disease by Using Arterial
Seunghyun Lee1, Tae Jin Yun1, Roh-Eul Yoo1
1From the Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (S.L., T.J.Y., R.E.Y., K.M.K., S.H.C., J.H.K., C.H.S., M.H.H.); Department of Radiology (S.L., T.J.Y., R.E.Y., K.M.K., S.H.C., J.H.K., C.H.S., M.H.H.), Clinical Research Center for Stroke, Clinical Research Institute (B.W.Y.), Department of Neurology (B.W.Y.), and Department of Neurosurgery (J.E.K.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 03080, Republic of Korea.
Abstract:
Purpose To determine whether arterial spin-labeling (ASL) magnetic resonance (MR) imaging could be used to identify changes in cerebral blood flow (CBF), collateral blood flow, and anastomosis site patency after revascularization in patients with moyamoya disease. Materials and Methods This retrospective study was conducted in 145 patients with moyamoya disease who underwent middle cerebral artery (MCA)-superficial temporal artery anastomosis. Preoperative, early postoperative, and late postoperative ASL and digital subtraction angiography images were analyzed. In the MCA territory, absolute CBF (hereafter, CBFMCA) and normalized CBF values adjusted to nonanastomosis side (hereafter, nCBFMCA) and to cerebellum (hereafter, nCBFCbll) were calculated. Collateral grading in the MCA territory was assessed according to Alberta Stroke Program Early CT Score methodology, and anastomosis site patency were also assessed. Changes in CBF were compared by using one-way analysis of variance with Bonferroni correction for multiple comparisons. Intermodality agreement was determined by κ statistics. Results Significant increases in CBFMCA, nCBFMCA, and nCBFCbll were found after revascularization (preoperative and postoperative values of CBFMCA, 35.2 mL/100 g per minute ± 7.8 [mean ± standard deviation] and 51.5 mL/100 g per minute ± 12.0; nCBFMCA, 0.73 mL/100 g per minute ± 0.14 and 1.01 mL/100 g per minute ± 0.18; nCBFCbll, 0.74 mL/100 g per minute ± 0.12 and 1.12 mL/100 g per minute ± 0.16; all P < .001). Agreements for collateral grading and anastomosis patency between ASL MR imaging and digital subtraction angiography were moderate to good, with weighted κ values of 0.77 (95% confidence interval: 0.73, 0.81) and 0.57 (95% confidence interval: 0.37, 0.76), respectively. Conclusion ASL MR imaging can be used to identify perfusion changes in patients with moyamoya disease after revascularization as a noninvasive monitoring tool.
Insights
Arterial spin-labeling (ASL) MR imaging effectively monitors cerebral blood flow changes after revascularization in moyamoya disease patients. This noninvasive tool assesses perfusion and anastomosis patency, aiding post-surgical management.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Moyamoya disease is a cerebrovascular disorder characterized by progressive stenosis of intracranial arteries.
- Revascularization surgery, such as middle cerebral artery (MCA)-superficial temporal artery anastomosis, is performed to improve cerebral blood flow.
- Noninvasive monitoring of perfusion changes and surgical outcomes is crucial for managing moyamoya disease.
Purpose of the Study:
- To evaluate the utility of arterial spin-labeling (ASL) magnetic resonance (MR) imaging in assessing cerebral blood flow (CBF) and collateral circulation after revascularization in moyamoya disease.
- To determine if ASL MR imaging can assess anastomosis site patency and identify perfusion changes post-surgery.
- To compare ASL MR imaging findings with digital subtraction angiography (DSA) for collateral grading and anastomosis assessment.
Main Methods:
- Retrospective analysis of 145 moyamoya disease patients who underwent MCA-superficial temporal artery anastomosis.
- Preoperative and postoperative ASL MR imaging and DSA were reviewed.
- Absolute and normalized CBF (CBFMCA, nCBFMCA, nCBFCbll) were calculated.
- Collateral grading and anastomosis patency were assessed using established methodologies and compared between ASL and DSA via κ statistics.
Main Results:
- Significant increases in CBFMCA, nCBFMCA, and nCBFCbll were observed post-revascularization (P < .001).
- ASL MR imaging demonstrated moderate to good agreement with DSA for collateral grading (κ = 0.77) and anastomosis patency (κ = 0.57).
- ASL identified perfusion changes and assessed surgical site patency effectively.
Conclusions:
- ASL MR imaging is a valuable noninvasive tool for monitoring perfusion changes in moyamoya disease patients following revascularization.
- ASL can reliably assess collateral blood flow and anastomosis patency, complementing DSA.
- This imaging modality aids in the post-operative management and evaluation of revascularization efficacy in moyamoya disease.
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