Assessment of postoperative revascularization of adult patients with Moyamoya disease using MRI territory arterial spin labeling

Abstract

Objective To assess postoperative revascularization of adult patients with Moyamoya disease (MMD) operated on with different surgical methods using the technology of MRI territory arterial spin labeling (T-ASL). Methods The clinical data of 84 adult MMD patients surgically treated at Department of Neurosurgery, Huashan Hospital, Fudan University from June 2018 to December 2018 were reviewed. Seventy patients received superficial temporal artery to middle cerebral artery bypass (STA-MCA bypass) combined with encephalo-duro-myo-synangiosis (EDMS) and were categorized into combined-bypass group. Fourteen patients underwent merely EDMS and categorized into indirect-bypass group. Digital subtraction angiography (DSA) and T-ASL were performed pre- and postoperatively. Matsushima staging system was applied to assess the outcome of revascularization. T-ASL scan used to investigate the revascularization area (RA) and perfusion of deep brain structures by external carotid artery (ECA) on operated side. Results The follow-up period of 84 patients ranged from 4 to 8 months (mean: 6.3±1.2 months). There was no difference in baseline data (sex, age, clinical presentations, and pre-surgical spontaneous collaterals), peri-operative complications, postoperative stroke control rate, Matsushima stage (grade A or B) between 2 groups (P>0.05). The volume of RA in combined-bypass group was larger than that in indirect-bypass group (101.5 ± 35.5 ml vs. 45.3 ± 14.2 ml, P<0.01). In the combined group, 81.4% (57/70) of operated ECA could perfuse deep structures such as basal ganglia and thalamus, compared with 2/14 in the control group (P<0.01). Conclusions The T-ASL results have suggested that RA of combined bypass seems larger and deeper than that of indirect bypass. T-ASL could an objective and sensitive method to evaluate surgical results of adult MMD in terms of RA volume and spatial distribution. Key words: Moyamoya disease; Cerebral revascularization; Territory arterial spin labeling; Treatment outcome