Time-Course Analysis of Brain Perfusion Single Photon Emission Computed Tomography Using a Three-Dimensional Stereotactic Region-of-Interest Template in Patients with Moyamoya Disease

Abstract

To verify the usefulness of the time-course analysis of regional cerebral blood flow (CBF) and cerebrovascular reserve (CVR) estimated quantitatively using the three-dimensional stereotactic region-of-interest template (3DSRT) to assess clinical status in patients with moyamoya disease. The study comprised 12 patients (5 men and 7 women, age 35.1 years ± 14.7), with 21 hemispheres with the diagnosis of moyamoya disease. During the period 2005-2009, the patients underwent initial and follow-up technetium-99m ethyl cysteinate dimer (Tc-99m ECD) single photon emission computed tomography (SPECT). The 3DSRT was applied to estimate regional CBF at rest and CVR. Time-course changes in CBF and CVR in a region of the middle cerebral artery were analyzed, considering the presence or absence of an ischemic event and revascularization surgery. CBF in hemispheres with ischemic events was significantly lower than CBF in hemispheres without ischemic events based on the initial SPECT study (P = 0.001). In 15 hemispheres with a hemodynamic disorder, CBF of the hemispheres in which revascularization was performed was increased significantly after surgery (P = 0.01). In contrast, the follow-up CVR of the hemispheres in which revascularization was not performed was decreased significantly compared with the CVR determined in the initial SPECT study (P = 0.0008). Time-course analysis and quantitative SPECT using the 3DSRT were useful for the evaluation of hemodynamic changes involved in disease progression and revascularization surgery in patients with moyamoya disease. Regular hemodynamic studies are important for patients with hemodynamic disorders to determine whether revascularization surgery is indicated to reduce the risk of future stroke.