Abstract TP139: Revascularization Improves Vascular Hemodynamics in Pediatric Moyamoya Patients

Abstract

Introduction: Cerebrovascular reactivity (CVR) reflects the change in cerebral blood flow (CBF) in response to vasodilation. Studies have demonstrated that impaired CVR was associated with a higher risk of acute stroke in patients with intracranial vasculopathy and that bypass surgeries can reduce the risk of strokes. Moyamoya disease is a progress cerebrovascular disorder that begins during childhood. Arterial spin labeling (ASL) is a quantitative MRI technique for non-invasive CBF and CVR measurement; ASL with multiple delays can also measure arterial transit time (ATT). Here, we compare the CBF, CVR, and ATT in pediatric Moyamoya patients before and after bypass using multi-delay ASL. Hypothesis: CVR will increase significantly after bypass surgeries. Methods: Imaging data were acquired from 22 Moyamoya patients (11 months - 18 years, 14 females) using a 3T MRI system. All patients had unilateral or bilateral occlusion at ACA, MCA and/or PCA. Multi-delay ASL data (7 delays) were acquired at baseline and 15 minutes after acetazolamide administration. CBF and ATT were computed using the general kinetic model. CVR was computed as the percentage of CBF change compared with baseline CBF. Flow territories (right and left ACA, MCA, and PCA) were defined using the Harvard-Oxford atlases. Paired t-tests were conducted to compare the mean CVR, CBF, and ATT changes before and after bypass surgeries. Results: The figure shows the hemodynamic maps of an example patients. Overall, CVR and CBF in the affected regions increased after bypass; ATT in these regions decreased after bypass. For this cohort, our analysis showed that CVR of the affected regions increased significantly by 68% and ATT reduced significantly by 10.7% measured by multi-delay ASL, implying improved circulation and lower risk for strokes. Discussion: Multi-delay ASL was effective to detect improved CVR and reduced ATT in pediatric Moyamoya patients after bypass surgeries.