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Noninvasively Evaluating the Cerebral Blood Flow Changes After Surgery in Adult Moyamoya Patients Using 3D Pulsed
Zhenfang Zhu1, Biaoling Chen1, Wei Zhao2
1Department of Radiology, Huadong Hospital Fudan University, Shanghai, China.
Purpose:
To explore the feasibility of phase contrast (PC) MRI and three-dimensional pulsed arterial spin labelling (3D PASL)-MRI in assessing cerebrovascular blood flow changes after surgical revascularization in patients with moyamoya disease (MMD).
Methods:
This study was a prospective study and comprised two sections. In the first section, 43 patients with MMD who never underwent any revascularization surgery and 19 healthy control volunteers were enrolled. In the second section, 51 patients with MMD who underwent revascularization surgery were included. PC-MRI and 3D PASL-MRI were performed. The average blood flow in the internal carotid (ICA), basilar (BA), superficial temporal (STA) arteries and cerebral blood flow (CBF) were compared between the MMD patients and control volunteers (first section) as well as before and after surgery (second section). Then, MMD patients were divided into haemorrhage and non-haemorrhage subgroups and the average blood flow and CBF before and after surgery were compared between the subgroups.
Results:
The average flow in the ICA, BA, STA was lower in the MMD patients than in the healthy control group (p = 0.000, p = 0.001, p = 0.001). The CBF of the seven clusters was higher in the healthy controls than in the MMD patients' groups. The average flow in the ICA, BA and STA was increased in MMD patients after combined surgery (p = 0.000, p = 0.002, p = 0.000). Fifteen clusters of elevated CBF and one of reduced CBF were postoperatively evident. Eight clusters of elevated CBF were compared with the preoperative status in the patients without haemorrhage. In the haemorrhage group, postoperative CBF did not significantly change after combined surgery (p > 0.05).
Conclusion:
Both 3D PASL-MRI and PC-MRI can noninvasively evaluate CBF changes in patients with MMD after surgery. The CBF of the cerebral was significantly improved after surgery. Moreover, the improvement of CBF was more obvious in patients with non-hemorrhagic rather than hemorrhagic MMD.
Insights
Phase contrast (PC) MRI and 3D pulsed arterial spin labelling (PASL)-MRI can assess cerebrovascular blood flow changes in moyamoya disease (MMD) patients post-surgery. Cerebral blood flow significantly improves after surgery, especially in non-hemorrhagic MMD.
Area of Science:
- Neuroimaging
- Vascular Neurology
- Medical Imaging
Background:
- Moyamoya disease (MMD) is a rare cerebrovascular disorder characterized by progressive stenosis of the internal carotid arteries.
- Surgical revascularization aims to restore blood flow to the brain in MMD patients.
- Non-invasive imaging techniques are crucial for evaluating treatment efficacy.
Purpose of the Study:
- To assess the feasibility of phase contrast (PC) MRI and 3D pulsed arterial spin labelling (PASL)-MRI in evaluating cerebrovascular blood flow changes after surgical revascularization in MMD.
- To compare blood flow parameters between MMD patients and healthy controls.
- To analyze blood flow changes before and after surgery in MMD patients.
Main Methods:
- Prospective study involving 43 MMD patients without prior surgery, 19 healthy controls, and 51 MMD patients who underwent revascularization.
- Utilized PC-MRI and 3D PASL-MRI to measure blood flow in major arteries (ICA, BA, STA) and cerebral blood flow (CBF).
- Compared blood flow parameters between groups and before/after surgery, including subgroup analysis for hemorrhage status.
Main Results:
- MMD patients showed significantly lower blood flow in ICA, BA, and STA compared to controls.
- Cerebral blood flow (CBF) was higher in healthy controls than in MMD patients.
- Post-surgery, MMD patients exhibited increased blood flow in ICA, BA, and STA, with significant improvements in CBF, particularly in non-hemorrhagic cases.
Conclusions:
- Both 3D PASL-MRI and PC-MRI are effective non-invasive tools for assessing post-surgical CBF changes in MMD.
- Surgical revascularization leads to significant improvement in cerebral blood flow in MMD patients.
- The improvement in CBF is more pronounced in non-hemorrhagic MMD patients compared to those with hemorrhage.
