[Three-dimensional pseudo-continuous arterial spin labeling for evaluation of cerebral hemodynamic changes after revascularization in adult patients with moyamoya disease]

Abstract

Objective: To evaluate cerebral hemodynamic changes using three-dimensional pseudo-continuous arterial spin labeling (3D-pCASL) and its association with the changes of neurological symptoms in adult patients with moyamoya disease after revascularization.

Methods: We prospectively collected the clinical and radiographic data of 40 adult patients with moyamoya disease diagnosed by digital subtraction angiography (DSA) or magnetic resonance angiography (MRA) undergoing unilateral superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis. All the patients underwent 3D-pCASL examination before and after the surgery, and were followed up for 3 to 11 months after the operation. The region of interest (ROI) was located in the middle cerebral artery cortical territory covering the surgical side and ipsilateral cerebellar hemisphere. Cerebral blood flow (CBF) and relative CBF (rCBF) values were compared before and after the surgery, and the changes in cerebral hemodynamics were evaluated. The correlations were analyzed between preoperative rCBF and Suzuki stage and between the changes in postoperative neurological symptoms and rCBF.

Results: The mean CBF of the patients increased significantly from 53.96±10.04 mL·100 g^-1·min^-1 to 58.90±13.57 mL·100 g^-1·min^-1 after the operation (t=-3.068, P=0.004); the mean rCBF also increased significantly after the operation (0.96 ± 0.14 vs 1.15 ± 0.18; t=-7.155, P < 0.001). The changes in postoperative neurological symptoms were significantly correlated with the changes in rCBF (P=0.017) and the type of disease onset (P < 0.001).

Conclusion: 3D-pCASL is an valuable means for noninvasive monitoring of hemodynamic changes after revascularization in adult patients with moyamoya disease without the use of contrast agent.

Keywords: Moyamoya disease; cerebral hemodynamics; revascularization; three-dimensional pseudo-continuous arterial spin labeling.

图 1

依据ASPECTS的分区原则绘制的感兴趣区域示意图 Location of the region of interest based on the zoning principle of ASPECTS. A: Basal ganglia level M1-M3; B: Lateral ventricle apical level M4-M6.

图 2

成年烟雾病患者术前rCBF与Suzuki分期的关系 Correlation of preoperative rCBF with operative Suzuki stage (A) and contralateral Suzuki stage (B).

图 3

患者女，53岁，左侧肢体无力5月余，脑梗死，右侧大脑半球进行了颞浅动脉-大脑中动脉搭桥术 A 53-year-old woman with moyamoya disease, who had left limb weakness for more than 5 months and underwent superficial temporal artery-middle cerebral artery bypass grafting in the right cerebral hemisphere. A: MR examination showing large cerebral infarction in the right frontal lobe and bilateral centrum semiovale. B: MRA showing stenosis of the right internal carotid artery C3-C7 segment and the distal branch of the right middle cerebral artery, localized narrowing of the right anterior cerebral artery A1 segment, and distal occlusion of A2. The left internal carotid artery C7 segment, the proximal of the anterior cerebral artery A1 segment, and the middle cerebral artery M1 segment were locally occluded with several tiny and tortuous collateral circulation. C: Preoperative 3D-pCASL showing significantly decreased CBF in the right cerebral hemisphere. D: After 6 months of re-examination, the neurological symptom of the patient was improved, and 3D-pCASL showed improvement of CBF in the area supplied by the right middle cerebral artery.