Blood-brain barrier disruption imaging in postoperative cerebral hyperperfusion syndrome using DCE-MRI

Little has been reported about the association between cerebral hyperperfusion syndrome (CHS) and blood-brain barrier (BBB) disruption in human. We aimed to investigate the changes in permeability after bypass surgery in cerebrovascular steno-occlusive diseases using dynamic contrast-enhanced MRI (DCE-MRI) and to demonstrate the association between CHS and BBB disruption. This retrospective study included 36 patients (21 hemispheres in 18 CHS patients and 20 hemispheres in 18 controls) who underwent combined bypass surgery for moyamoya and atherosclerotic steno-occlusive diseases. DCE-MRI and arterial spin labeling perfusion-weighted imaging (ASL-PWI) were obtained at the baseline, postoperative state, and discharge. Perfusion and permeability parameters were calculated at the MCA territory (CBF_{(territorial)}, K^trans_{(territorial)}, V_{p(territorial)}) and focal perianastomotic area (CBF_(focal), K^trans_(focal), V_p(focal)) of operated hemispheres. As compared with the baseline, both CBF_{(territorial)} and CBF_(focal) increased in the postoperative period and decreased at discharge, corresponding well to symptoms in the CHS group. V_p(focal) was lower in the postoperative period and at discharge, as compared with the baseline. In the control group, no parameters significantly differed among the three points. In conclusion, V_p at the focal perianastomotic area significantly decreased in patients with CHS during the postoperative period. BBB disruption may be implicated in the development of CHS after bypass surgery.