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Published on: February 16, 2016
Predictive value of CT perfusion-derived parameters in Moyamoya disease
Anming Xie1, Liuxian Wang1, Peiji Song2
1Department of Radiology, The 908th Hospital of Chinese People's Liberation Army Joint Logistics Support Force, Nanchang, Jiangxi 330002, China.
Insights
The collateral index of the hypointensity ratio (HIR) effectively predicts outcomes in Moyamoya disease (MMD) patients. This CT perfusion parameter shows strong correlation with functional and clinical status, aiding in patient management.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Moyamoya disease (MMD) is a rare cerebrovascular disorder characterized by progressive stenosis of intracranial arteries.
- Predicting functional and clinical outcomes in untreated MMD patients is crucial for management.
- CT perfusion (CTP) imaging offers insights into cerebral hemodynamics.
Purpose of the Study:
- To evaluate the utility of CTP-derived parameters and collateral index in predicting outcomes for surgically untreated MMD patients.
- To assess the correlation between hemodynamic parameters and clinical outcomes (survival, mRS, ADL).
Main Methods:
- Retrospective analysis of 21 MMD patients (36 hemispheres) with CTP data.
- Hemispheres categorized into ischemic (IS), hemorrhagic (HE), subarachnoid hemorrhage (SAH), and normal (NH) groups.
- Calculation of CTP parameters and collateral index (hypointensity ratio - HIR).
Main Results:
- Ischemic hemispheres exhibited significantly abnormal hemodynamics compared to normal hemispheres.
- The collateral index (HIR) demonstrated excellent predictive capability for primary outcomes (AUC=0.955).
- HIR showed significant correlations with modified Rankin Scale (mRS) and ADL scores.
Conclusions:
- CTP-derived hemodynamic parameters clearly differentiate IS hemispheres in MMD.
- The collateral index (HIR) is a promising, clinically accessible indicator for functional and clinical outcomes in MMD.
Objective:
To explore the applicability of CT perfusion-derived parameters and collateral index in prediction of functional and clinical outcomes in patients with Moyamoya disease (MMD) who have not been treated surgically.
Methods:
All hemispheres were categorized into four groups: those with ischemic (IS) lesions, hemorrhagic (HE) lesions, subarachnoid hemorrhage (SAH) and normal hemisphere (NH). The clinical review included primary outcomes (whether a patient survived the cerebrovascular event) and secondary outcomes (the modified Rankin scale [mRS] and Katz-activity of daily living [ADL] scale). CTP-derived parameters of the frontal, temporal lobe and basal ganglia were calculated. Collateral index of the hypointensity ratio (HIR) was defined as a volume of Tmax >10 s/ Tmax >4 s.
Results:
Between December 2020 and December 2021, 21 MMD patients (15 bilateral cases and 6 unilateral cases, for a total of 36 hemispheres) were retrospectively included. Compared with the NH group, the IS group showed obviously abnormal hemodynamics. As for the primary outcomes, HIR showed an excellent area under the curve of 0.955 (95 % CI: 0.886-1.000, p < 0.001). Significant correlations were found between CTP-derived parameters and secondary outcomes. Furthermore, HIR was significantly correlated with mRS (r = 0.576, p = 0.001) and ADL scores (r = 0.644, p < 0.001).
Conclusion:
Among different imaging types, IS hemispheres were characterized by distinct changes of hemodynamic parameters. Collateral index of HIR could be considered a clinically accessible and promising indictor of functional and clinical outcomes in MMD.
