Abstract
ObjectiveThis study aimed to investigate the feasibility of preoperative intravoxel incoherent motion (IVIM) MRI for the screening of high-risk patients with moyamoya disease (MMD) who may develop postoperative cerebral hyperperfusion syndrome (CHS).MethodsThis study composed of two parts. In the first part 24 MMD patients and 24 control volunteers were enrolled. IVIM-MRI was performed. The relative pseudo-diffusion coefficient, perfusion fraction, apparent diffusion coefficient, and diffusion coefficient (rD*, rf, rADC, and rD) values of the IVIM sequence were compared according to hemispheres between MMD patient and healthy control groups. In the second part, 98 adult patients (124 operated hemispheres) with MMD who underwent surgery were included. Preoperative IVIM-MRI was performed. The rD*, rf, rADC, rD, and rfD* values of the IVIM sequence were calculated and analyzed. Operated hemispheres were divided into CHS and non-CHS groups. Patients’ age, sex, Matsushima type, Suzuki stage, and IVIM-MRI examination results were compared between CHS and non-CHS groups.ResultsOnly the rf value was significantly higher in the healthy control group than in the MMD group (P < 0.05). Out of 124 operated hemispheres, 27 were assigned to the CHS group. Patients with clinical presentation of Matsushima types I–V were more likely to develop CHS after surgery (P < 0.05). The rf values of the ipsilateral hemisphere were significantly higher in the CHS group than in the non-CHS group (P < 0.05). The rfD* values of the ACA and MCA supply areas of the ipsilateral hemisphere were significantly higher in the CHS group than in the non-CHS group (P < 0.05). Only the rf value of the anterior cerebral artery supply area in the contralateral hemisphere was higher in the CHS group than in the non-CHS group (P < 0.05). The rf values of the middle and posterior cerebral artery supply areas and the rD, rD*, and rADC values of the both hemispheres were not significantly different between the CHS and non-CHS groups (P > 0.05).ConclusionPreoperative non-invasive IVIM-MRI analysis, particularly the f-value of the ipsilateral hemisphere, may be helpful in predicting CHS in adult patients with MMD after surgery. MMD patients with ischemic onset symptoms are more likely to develop CHS after surgery.
Highlights
Moyamoya disease (MMD) is a common neurological disease characterized by progressive steno-occlusion of the distal internal carotid artery, leading to the compensatory development of collateral vessels at the base of the brain (Suzuki and Takaku, 1969)
No significant differences were found in rADC, rD, and rD∗ between the MMD and healthy control groups (P > 0.05)
No significant differences were found in apparent diffusion coefficient (ADC), f, D, and D∗ of cerebellum between the MMD and healthy control groups (P > 0.05)
Summary
Moyamoya disease (MMD) is a common neurological disease characterized by progressive steno-occlusion of the distal internal carotid artery, leading to the compensatory development of collateral vessels (moyamoya vessels) at the base of the brain (Suzuki and Takaku, 1969). Superficial temporal arterymiddle cerebral artery (STA-MCA) bypass in combination with indirect procedures has been employed as treatment for patients with MMD (Kazumata et al, 2014). An STA-MCA bypass carries a relatively small amount of blood, cerebral hyperperfusion is frequently observed after revascularization surgery, in adult patients (Zhao et al, 2013; Kazumata et al, 2014). Patients with MMD are more likely to develop cerebral hyperperfusion syndrome (CHS) after revascularization surgery than those with other atherosclerotic occlusive cerebrovascular diseases (Fujimura et al, 2011). In clinical practice, lowering the blood pressure of patients with MMD after surgery may lead to cerebral vascular insufficiency and cerebral infarction (Lee et al, 2018). Identifying patients with MMD who are at high risk for CHS development after surgery and implementing appropriate perioperative management are important to prevent the occurrence of postoperative hyperperfusion and improve the prognosis of these patients (Ostergaard et al, 2014)
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