Abstract
Moyamoya disease (MMD) is a chronic, progressive, cerebrovascular occlusive disease that causes abnormal enlargement of collateral pathways (moyamoya vessels) in the region of the basal ganglia and thalamus. Cerebral revascularization procedures remain the preferred treatment for patients with MMD, improving the compromised cerebral blood flow (CBF). However, voxel based analysis (VBA) of revascularization surgery for MMD based on data from pre- and postoperative data has not been established. The latest algorithm called as Diffeomorphic Anatomical Registration Through Exponentiated Lie Algebra (DARTEL) has been introduced for VBA as the function of statistical parametric mapping (SPM8), and improved registration has been achieved by SPM8 with DARTEL. In this study, VBA was conducted to evaluate pre- and postoperative single photon emission computed tomography (SPECT) images for MMD by SPM8 with DARTEL algorithm, and the results were compared with those from SPM8 without DARTEL (a conventional method). Thirty-two patients with MMD who underwent superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery as the first surgery were included and all patients underwent pre- and postoperative 3D T1-weighted imaging and SPECT. Pre- and postoperative SPECT images were registered to 3D T1-weighted images, then VBA was conducted. Postoperative SPECT showed more statistically increased CBF areas in the bypassed side cerebral hemisphere by using SPM8 with DARTEL (58,989 voxels; P<0.001), and increased ratio of CBF after operation was less than 15%. Meanwhile, postoperative SPECT showed less CBF increased areas by SPM8 without DARTEL. In conclusion, VBA was conducted for patients with MMD, and SPM8 with DARTEL revealed that postoperative SPECT showed statistically significant CBF increases over a relatively large area and with at most 15% increase ratio.
Highlights
Moyamoya disease (MMD) is a chronic, progressive, cerebrovascular occlusive disease that causes abnormal enlargement of collateral pathways in the region of the basal ganglia and thalamus
These findings suggest that increased cerebral blood flow (CBF) due to superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis at the central branch of MCA appears at the site of anastomosis, and in the wider area
Increased ratio (%) at the area of significantly increased CBF on postoperative single photon emission computed tomography (SPECT) compared with preoperative SPECT is shown in Fig 4A, and increased ratio was less than 15%
Summary
Moyamoya disease (MMD) is a chronic, progressive, cerebrovascular occlusive disease that causes abnormal enlargement of collateral pathways (moyamoya vessels) in the region of the basal ganglia and thalamus. Cerebral revascularization procedures remain the preferred treatment for patients with MMD [1], improving the compromised cerebral blood flow (CBF), reducing ischemic attacks, and resulting in sufficiently good long-term results [2]. Revascularization surgery in patients with MMD carries a low risk, is effective at preventing future ischemic events, and improves quality of life [6, 7]. A recent study reported that cerebral hyperperfusion syndrome after superficial temporal artery (STA)-middle cerebral artery (MCA) bypass occurs more frequently in patients with MMD than in those with arteriosclerotic disease, with a diagnostic criteria of qualitative observation of focal intense CBF increase [8]. It is evident that favorable postoperative CBF increase as the effect of STA-MCA bypass should be differentiated from unwanted hyperperfusion syndrome
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