1
|
Uchino H, Ito M, Tokairin K, Tatezawa R, Sugiyama T, Kazumata K, Fujimura M. Association of RNF213 polymorphism and cortical hyperintensity sign on fluid-attenuated inversion recovery images after revascularization surgery for moyamoya disease: possible involvement of intrinsic vascular vulnerability. Neurosurg Rev 2023; 46:119. [PMID: 37166684 DOI: 10.1007/s10143-023-02030-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/29/2023] [Accepted: 05/06/2023] [Indexed: 05/12/2023]
Abstract
A cortical hyperintensity on fluid-attenuated inversion recovery images (FLAIR cortical hyperintensity (FCH)) is an abnormal finding after revascularization surgery for moyamoya disease. This study aimed to investigate the pathophysiology of FCH through genetic analyses of RNF213 p.R4810K polymorphism and perioperative hemodynamic studies using single-photon emission computed tomography. We studied 96 hemispheres in 65 adults and 47 hemispheres in 27 children, who underwent combined direct and indirect revascularization. Early or late FCH was defined when it was observed on postoperative days 0-2 and 6-9, respectively. FCH scores (range: 0-6) were evaluated according to the extent of FCH in the operated hemisphere. FCHs were significantly more prevalent in adult patients than pediatric patients (early: 94% vs. 78%; late: 97% vs. 59%). In pediatric patients, FCH scores were significantly improved from the early to late phase regardless of the RNF213 genotype (mutant median [IQR]: 2 [1-5] vs. 1 [0-2]; wild-type median: 4 [0.5-6] vs. 0.5 [0-1.75]). In adults, FCH scores were significantly improved in patients with the wild-type RNF213 allele (median: 4 [2-5.25] vs. 2 [2, 3]); however, they showed no significant improvement in patients with the RNF213 mutation. FCH scores were significantly higher in patients with symptomatic cerebral hyperperfusion than those without it (early median: 5 [4, 5] vs. 4 [2-5]; late median: 4 [3-5] vs. 3 [2-4]). In conclusion, the RNF213 p.R4810K polymorphism was associated with prolonged FCH, and extensive FCH was associated with symptomatic cerebral hyperperfusion in adult patients with moyamoya disease.
Collapse
Affiliation(s)
- Haruto Uchino
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, 060-8638, Japan.
| | - Masaki Ito
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Kikutaro Tokairin
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Ryota Tatezawa
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Taku Sugiyama
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Ken Kazumata
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Miki Fujimura
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, 060-8638, Japan
| |
Collapse
|
2
|
Hao X, Liu Z, He S, Wang Y, Zhao Y, Wang R. Application of DTI and fMRI in moyamoya disease. Front Neurol 2022; 13:948830. [PMID: 35989917 PMCID: PMC9391058 DOI: 10.3389/fneur.2022.948830] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
Moyamoya disease (MMD) is a chronic and progressive cerebrovascular stenosis or occlusive disease that occurs near Willis blood vessels. Diffusion tensor imaging (DTI) and functional magnetic resonance imaging (fMRI) are used to detect the microstructure of white matter and the function of gray matter, respectively. The damage of these structures will lead to the change of cognitive level in patients with moyamoya disease. In this paper, the principles of DTI and fMRI, their applications and challenges in moyamoya disease are reviewed.
Collapse
Affiliation(s)
- Xiaokuan Hao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ziqi Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shihao He
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yanru Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuanli Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Rong Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- *Correspondence: Rong Wang
| |
Collapse
|
3
|
Ren Q, An P, Jin K, Xia X, Huang Z, Xu J, Huang C, Jiang Q, Meng X. A Pilot Study of Radiomic Based on Routine CT Reflecting Difference of Cerebral Hemispheric Perfusion. Front Neurosci 2022; 16:851720. [PMID: 35431785 PMCID: PMC9009332 DOI: 10.3389/fnins.2022.851720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/03/2022] [Indexed: 11/30/2022] Open
Abstract
Background To explore the effectiveness of radiomics features based on routine CT to reflect the difference of cerebral hemispheric perfusion. Methods We retrospectively recruited 52 patients with severe stenosis or occlusion in the unilateral middle cerebral artery (MCA), and brain CT perfusion showed an MCA area with deficit perfusion. Radiomics features were extracted from the stenosis side and contralateral of the MCA area based on precontrast CT. Two different region of interest drawing methods were applied. Then the patients were randomly grouped into training and testing sets by the ratio of 8:2. In the training set, ANOVA and the Elastic Net Regression with fivefold cross-validation were conducted to filter and choose the optimized features. Moreover, different machine learning models were built. In the testing set, the area under the receiver operating characteristic (AUC) curve, calibration, and clinical utility were applied to evaluate the predictive performance of the models. Results The logistic regression (LR) for the triangle-contour method and artificial neural network (ANN) for the semiautomatic-contour method were chosen as radiomics models for their good prediction efficacy in the training phase (AUC = 0.869, 0.873) and the validation phase (AUC = 0.793, 0.799). The radiomics algorithms of the triangle-contour and semiautomatic-contour method were implemented in the whole training set (AUC = 0.870, 0.867) and were evaluated in the testing set (AUC = 0.760, 0.802). According to the optimal cutoff value, these two methods can classify the vascular stenosis side class and normal side class. Conclusion Radiomic predictive feature based on precontrast CT image could reflect the difference of cerebral hemispheric perfusion to some extent.
Collapse
Affiliation(s)
- Qingguo Ren
- Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Panpan An
- Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Ke Jin
- Deepwise AI Lab, Beijing Deepwise and League of PHD Technology Co., Ltd., Beijing, China
| | - Xiaona Xia
- Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Zhaodi Huang
- Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Jingxu Xu
- Deepwise AI Lab, Beijing Deepwise and League of PHD Technology Co., Ltd., Beijing, China
| | - Chencui Huang
- Deepwise AI Lab, Beijing Deepwise and League of PHD Technology Co., Ltd., Beijing, China
| | - Qingjun Jiang
- Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Xiangshui Meng
- Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Qingdao, China
- *Correspondence: Xiangshui Meng,
| |
Collapse
|
4
|
Kazumata K, Tokairin K, Ito M, Uchino H, Sugiyama T, Kawabori M, Osanai T, Tha KK, Houkin K. Combined structural and diffusion tensor imaging detection of ischemic injury in moyamoya disease: relation to disease advancement and cerebral hypoperfusion. J Neurosurg 2021; 134:1155-1164. [PMID: 32244209 DOI: 10.3171/2020.1.jns193260] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 01/20/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The microstructural integrity of gray and white matter is decreased in adult moyamoya disease, suggesting covert ischemic injury as a mechanism of cognitive dysfunction. Establishing a microstructural brain imaging marker is critical for monitoring cognitive outcomes following surgical interventions. The authors of the present study determined the pathophysiological basis of altered microstructural brain injury in relation to advanced arterial occlusion, cerebral hypoperfusion, and cognitive function. METHODS The authors examined 58 patients without apparent brain lesions and 30 healthy controls by using structural MRI, as well as diffusion tensor imaging (DTI). Arterial occlusion in each hemisphere was classified as early or advanced stage based on MRA and posterior cerebral artery (PCA) involvement. Regional cerebral blood flow (rCBF) was measured with N-isopropyl-p-[123I]-iodoamphetamine SPECT. Furthermore, cognitive performance was examined using the Wechsler Adult Intelligence Scale, Third Edition and the Trail Making Test (TMT). Both voxel- and region of interest-based analyses were performed for groupwise comparisons, as well as correlation analysis, using parameters such as cognitive test scores; gray matter volume; fractional anisotropy (FA) of association fiber tracts, including the inferior frontooccipital fasciculus (IFOF) and superior longitudinal fasciculus (SLF); PCA involvement; and rCBF. RESULTS Compared to the early stages, advanced stages of arterial occlusion in the left hemisphere were associated with a lower Performance IQ (p = 0.031), decreased anterior cingulate volumes (p = 0.0001, uncorrected), and lower FA in the IFOF, cingulum, and forceps major (all p < 0.01, all uncorrected). There was no significant difference in rCBF between the early and the advanced stage. In patients with an advanced stage, PCA involvement was correlated with a significantly lower Full Scale IQ (p = 0.036), cingulate volume (p < 0.01, uncorrected), and FA of the left SLF (p = 0.0002, uncorrected) compared to those with an intact PCA. The rCBF was positively correlated with FA of the SLF, IFOF, and forceps major (r > 0.34, p < 0.05). Global gray matter volumes were moderately correlated with TMT part A (r = 0.40, p = 0.003). FA values in the left SLF were moderately associated with processing speed (r = 0.40, p = 0.002). CONCLUSIONS Although hemodynamic compensation may mask cerebral ischemia in advanced stages of adult moyamoya disease, the disease progression is detrimental to gray and white matter microstructure as well as cognition. In particular, additional PCA involvement in advanced disease stages may impair key neural substrates such as the cingulum and SLF. Thus, combined structural MRI and DTI are potentially useful for tracking the neural integrity of key neural substrates associated with cognitive function and detecting subtle anatomical changes associated with persistent ischemia, as well as disease progression.
Collapse
Affiliation(s)
- Ken Kazumata
- 1Department of Neurosurgery, Hokkaido University Graduate School of Medicine; and
| | - Kikutaro Tokairin
- 1Department of Neurosurgery, Hokkaido University Graduate School of Medicine; and
| | - Masaki Ito
- 1Department of Neurosurgery, Hokkaido University Graduate School of Medicine; and
| | - Haruto Uchino
- 1Department of Neurosurgery, Hokkaido University Graduate School of Medicine; and
| | - Taku Sugiyama
- 1Department of Neurosurgery, Hokkaido University Graduate School of Medicine; and
| | - Masahito Kawabori
- 1Department of Neurosurgery, Hokkaido University Graduate School of Medicine; and
| | - Toshiya Osanai
- 1Department of Neurosurgery, Hokkaido University Graduate School of Medicine; and
| | - Khin Khin Tha
- 2Clinical Research and Medical Innovation Center, Hokkaido University Hospital, Sapporo, Japan
| | - Kiyohiro Houkin
- 1Department of Neurosurgery, Hokkaido University Graduate School of Medicine; and
| |
Collapse
|
5
|
Chen Y, Ma L, Lu J, Chen X, Ye X, Zhang D, Zhang Y, Wang R, Zhao Y. Postoperative hemorrhage during the acute phase after direct or combined revascularization for moyamoya disease: risk factors, prognosis, and literature review. J Neurosurg 2020; 133:1450-1459. [PMID: 31628285 DOI: 10.3171/2019.7.jns19885] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 07/26/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Postoperative hemorrhage during the acute phase is rarely observed after revascularization surgery for moyamoya disease (MMD) but can have severe complications. Its risk factors and outcomes are still unclear. The aim of this study was to investigate the predictors of postoperative hemorrhage during the acute phase in MMD and examine the outcomes of the hemorrhage. METHODS The authors reviewed the preoperative clinical characteristics and radiographic features of 465 consecutive MMD cases (518 procedures) that had undergone direct or combined bypass surgery at their institution between 2009 and 2015. Patients with postoperative intracerebral hemorrhage (ICH) or ICH plus intraventricular hemorrhage (IVH) during the acute phase were screened, and then the incidence, location, and risk factors of hemorrhage in these patients were analyzed. Short-term and long-term outcomes (modified Rankin Scale scores) for these patients were also collected. Outcomes were compared between patients with and those without postoperative ICH using propensity score analysis to reduce the between-group differences in baseline characteristics. RESULTS Postoperative hemorrhage occurred in 11 (2.1%; ICH = 9, IVH = 2) of 518 procedures (mean patient age 39.82 ± 8.8 years). Hemorrhage occurred in the first 24 hours after the operation in 8 cases (72.7%). In the ICH group, most of the hemorrhage sites (77.8%) were located beneath the anastomosed area, and the mean hematoma volume was 16.98 ± 22.45 ml (range 3-57 ml). One case from the ICH group required hematoma evacuation. Among the adult patients (463 procedures [89.4%]), preoperative hypertension (p = 0.008), CT perfusion (CTP) stage > III (p = 0.013), and posterior circulation involvement (p = 0.022) were significantly associated with postoperative ICH. No significant differences between the postoperative ICH group and the no-hemorrhage group were detected in terms of postoperative neurofunctional status at discharge (p = 0.569) or at the last follow-up (p = 1.000). Neither was there a significant difference in future stroke risk (p = 0.538) between these two groups. CONCLUSIONS Preoperative hypertension, CTP stage > III, and posterior circulation involvement are independent risk factors for postoperative ICH after direct or combined revascularization for MMD. After appropriate perioperative management, postoperative ICH has no significant correlations with the postoperative short-term and long-term neurofunctional status.
Collapse
Affiliation(s)
- Yu Chen
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University
| | - Li Ma
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University
- 3China National Clinical Research Center for Neurological Diseases
- 4Stroke Center, Beijing Institute for Brain Disorders
- 5Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease; and
| | - Junlin Lu
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University
| | - Xiaolin Chen
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University
- 3China National Clinical Research Center for Neurological Diseases
- 4Stroke Center, Beijing Institute for Brain Disorders
- 5Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease; and
| | - Xun Ye
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University
- 2Department of Neurosurgery, Peking University International Hospital, Peking University
- 3China National Clinical Research Center for Neurological Diseases
- 4Stroke Center, Beijing Institute for Brain Disorders
- 5Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease; and
| | - Dong Zhang
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University
- 3China National Clinical Research Center for Neurological Diseases
- 4Stroke Center, Beijing Institute for Brain Disorders
| | - Yan Zhang
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University
- 3China National Clinical Research Center for Neurological Diseases
- 4Stroke Center, Beijing Institute for Brain Disorders
| | - Rong Wang
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University
- 2Department of Neurosurgery, Peking University International Hospital, Peking University
- 3China National Clinical Research Center for Neurological Diseases
- 4Stroke Center, Beijing Institute for Brain Disorders
| | - Yuanli Zhao
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University
- 2Department of Neurosurgery, Peking University International Hospital, Peking University
- 3China National Clinical Research Center for Neurological Diseases
- 4Stroke Center, Beijing Institute for Brain Disorders
- 5Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease; and
- 6Beijing Translational Engineering Center for 3D Printer in Clinical Neuroscience, Beijing, People's Republic of China
| |
Collapse
|
6
|
Hara S, Kudo T, Hayashi S, Inaji M, Tanaka Y, Maehara T, Ishii K, Nariai T. Improvement in cognitive decline after indirect bypass surgery in adult moyamoya disease: implication of 15O-gas positron emission tomography. Ann Nucl Med 2020; 34:467-475. [PMID: 32378149 DOI: 10.1007/s12149-020-01473-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 04/26/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To investigate the characteristics of patients with moyamoya disease (MMD) who show improvement in their cognitive decline after bypass surgery by analyzing the hemodynamic and metabolic parameters of 15O-gas positron emission tomography (PET). MATERIALS AND METHODS We retrospectively analyzed adult patients with MMD who were evaluated with PET and cognitive tests before and approximately one year after indirect bypass surgery. The PET parameters of the left Rolandic area were compared between patients who did and did not show improvement in their cognitive decline. RESULTS Of the 19 patients analyzed, fourteen (74%) showed improvement in either the verbal or performance intelligence quotient (VIQ or PIQ). Three out of four patients with perioperative infarction experienced significant cognitive decline. The preoperative oxygen extraction fraction (OEF) was significantly higher in patients who showed improvement in their cognitive decline in terms of the PIQ than in those patients who did not (P = 0.03). The postoperative increase in the cerebral metabolic rate of oxygen (CMRO2) was significantly higher in patients who showed improvement in their cognitive decline in terms of the VIQ than in those who did not (P = 0.02). CONCLUSION Adult patients with MMD might show improvement in their cognitive decline after successful indirect bypass surgery if they have a severely increased regional OEF before the surgery and an increased regional CMRO2 after the surgery. CLINICAL TRIAL REGISTRATION URL: https://www.umin.ac.jp/ctr/. Unique identifier: UMIN000027949.
Collapse
Affiliation(s)
- Shoko Hara
- Department of Neurosurgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
- Department of Radiology, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan.
| | - Takumi Kudo
- Department of Neurosurgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Shihori Hayashi
- Department of Neurosurgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
- Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakaecho, Itabashi-ku, Tokyo, Japan
| | - Motoki Inaji
- Department of Neurosurgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
- Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakaecho, Itabashi-ku, Tokyo, Japan
| | - Yoji Tanaka
- Department of Neurosurgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Taketoshi Maehara
- Department of Neurosurgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Kenji Ishii
- Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakaecho, Itabashi-ku, Tokyo, Japan
| | - Tadashi Nariai
- Department of Neurosurgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
- Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakaecho, Itabashi-ku, Tokyo, Japan
| |
Collapse
|
7
|
Uchino H, Kazumata K, Ito M, Nakayama N, Kuroda S, Houkin K. Crossed cerebellar diaschisis as an indicator of severe cerebral hyperperfusion after direct bypass for moyamoya disease. Neurosurg Rev 2020; 44:599-605. [PMID: 32076897 DOI: 10.1007/s10143-020-01265-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/21/2020] [Accepted: 02/10/2020] [Indexed: 10/25/2022]
Abstract
Cerebral hyperperfusion (HP) complicates the postoperative course of patients with moyamoya disease (MMD) after direct revascularization surgery. Crossed cerebellar diaschisis (CCD) has been considered to be rarely associated with HP after revascularization surgery. This study aimed to describe the clinical features and factors associated with CCD secondary to cerebral HP after revascularization surgery for MMD. We analyzed 150 consecutive hemispheres including 101 in adults and 49 in pediatric patients who underwent combined direct and indirect bypass for MMD. Using single-photon emission computed tomography (SPECT), serial cerebral blood flow (CBF) was measured immediately after the surgery and on postoperative days 2 and 7. Pre- and postoperative voxel-based analysis of SPECT findings was performed to compare the changes in regional CBF. Multivariate logistic regression analysis was performed to test the effect of multiple variables on CCD. Asymptomatic and symptomatic HP was observed in 41.3% (62/150) and 16.7% (25/150) of the operated hemispheres, respectively. CCD was observed in 18.4% (16/87) of these hemispheres with radiological HP. Multivariate analysis revealed that the occurrence of CCD was significantly associated with symptomatic HP (p = 0.0015). Voxel-based analysis showed that the CBF increase in the operated frontal cortex, and the CBF reduction in the contralateral cerebellar hemisphere on day 7 were significantly larger in symptomatic HP than in asymptomatic HP (median 11.3% vs 7.5%; - 6.0% vs - 1.7%, respectively). CCD secondary to postoperative HP is more common than anticipated in MMD. CCD could potentially be used as an indicator of severe postoperative HP in patients with MMD.
Collapse
Affiliation(s)
- Haruto Uchino
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | - Ken Kazumata
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Masaki Ito
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Naoki Nakayama
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Satoshi Kuroda
- Department of Neurosurgery, University of Toyama, Toyama, Japan
| | - Kiyohiro Houkin
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| |
Collapse
|
8
|
Fan AP, Khalighi MM, Guo J, Ishii Y, Rosenberg J, Wardak M, Park JH, Shen B, Holley D, Gandhi H, Haywood T, Singh P, Steinberg GK, Chin FT, Zaharchuk G. Identifying Hypoperfusion in Moyamoya Disease With Arterial Spin Labeling and an [ 15O]-Water Positron Emission Tomography/Magnetic Resonance Imaging Normative Database. Stroke 2019; 50:373-380. [PMID: 30636572 DOI: 10.1161/strokeaha.118.023426] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Noninvasive imaging of brain perfusion has the potential to elucidate pathophysiological mechanisms underlying Moyamoya disease and enable clinical imaging of cerebral blood flow (CBF) to select revascularization therapies for patients. We used hybrid positron emission tomography (PET)/magnetic resonance imaging (MRI) technology to characterize the distribution of hypoperfusion in Moyamoya disease and its relationship to vessel stenosis severity, through comparisons with a normative perfusion database of healthy controls. Methods- To image CBF, we acquired [15O]-water PET as a reference and simultaneously acquired arterial spin labeling (ASL) MRI scans in 20 Moyamoya patients and 15 age-matched, healthy controls on a PET/MRI scanner. The ASL MRI scans included a standard single-delay ASL scan with postlabel delay of 2.0 s and a multidelay scan with 5 postlabel delays (0.7-3.0s) to estimate and account for arterial transit time in CBF quantification. The percent volume of hypoperfusion in patients (determined as the fifth percentile of CBF values in the healthy control database) was the outcome measure in a logistic regression model that included stenosis grade and location. Results- Logistic regression showed that anterior ( P<0.0001) and middle cerebral artery territory regions ( P=0.003) in Moyamoya patients were susceptible to hypoperfusion, whereas posterior regions were not. Cortical regions supplied by arteries with stenosis on MR angiography showed more hypoperfusion than normal arteries ( P=0.001), but the extent of hypoperfusion was not different between mild-moderate versus severe stenosis. Multidelay ASL did not perform differently from [15O]-water PET in detecting perfusion abnormalities, but standard ASL overestimated the extent of hypoperfusion in patients ( P=0.003). Conclusions- This simultaneous PET/MRI study supports the use of multidelay ASL MRI in clinical evaluation of Moyamoya disease in settings where nuclear medicine imaging is not available and application of a normative perfusion database to automatically identify abnormal CBF in patients.
Collapse
Affiliation(s)
- Audrey P Fan
- From the Department of Radiology (A.P.F., J.G., Y.I., J.R., M.W., J.H.P., B.S., D.H., H.G., T.H., P.S., F.T.C., G.Z.), Stanford University, CA
| | | | - Jia Guo
- From the Department of Radiology (A.P.F., J.G., Y.I., J.R., M.W., J.H.P., B.S., D.H., H.G., T.H., P.S., F.T.C., G.Z.), Stanford University, CA.,Department of Bioengineering, University of California Riverside (J.G.)
| | - Yosuke Ishii
- From the Department of Radiology (A.P.F., J.G., Y.I., J.R., M.W., J.H.P., B.S., D.H., H.G., T.H., P.S., F.T.C., G.Z.), Stanford University, CA.,Department of Neurosurgery, Tokyo Medical and Dental University, Japan (Y.I.)
| | - Jarrett Rosenberg
- From the Department of Radiology (A.P.F., J.G., Y.I., J.R., M.W., J.H.P., B.S., D.H., H.G., T.H., P.S., F.T.C., G.Z.), Stanford University, CA
| | - Mirwais Wardak
- From the Department of Radiology (A.P.F., J.G., Y.I., J.R., M.W., J.H.P., B.S., D.H., H.G., T.H., P.S., F.T.C., G.Z.), Stanford University, CA
| | - Jun Hyung Park
- From the Department of Radiology (A.P.F., J.G., Y.I., J.R., M.W., J.H.P., B.S., D.H., H.G., T.H., P.S., F.T.C., G.Z.), Stanford University, CA
| | - Bin Shen
- From the Department of Radiology (A.P.F., J.G., Y.I., J.R., M.W., J.H.P., B.S., D.H., H.G., T.H., P.S., F.T.C., G.Z.), Stanford University, CA
| | - Dawn Holley
- From the Department of Radiology (A.P.F., J.G., Y.I., J.R., M.W., J.H.P., B.S., D.H., H.G., T.H., P.S., F.T.C., G.Z.), Stanford University, CA
| | - Harsh Gandhi
- From the Department of Radiology (A.P.F., J.G., Y.I., J.R., M.W., J.H.P., B.S., D.H., H.G., T.H., P.S., F.T.C., G.Z.), Stanford University, CA
| | - Tom Haywood
- From the Department of Radiology (A.P.F., J.G., Y.I., J.R., M.W., J.H.P., B.S., D.H., H.G., T.H., P.S., F.T.C., G.Z.), Stanford University, CA
| | - Prachi Singh
- From the Department of Radiology (A.P.F., J.G., Y.I., J.R., M.W., J.H.P., B.S., D.H., H.G., T.H., P.S., F.T.C., G.Z.), Stanford University, CA
| | | | - Frederick T Chin
- From the Department of Radiology (A.P.F., J.G., Y.I., J.R., M.W., J.H.P., B.S., D.H., H.G., T.H., P.S., F.T.C., G.Z.), Stanford University, CA
| | - Greg Zaharchuk
- From the Department of Radiology (A.P.F., J.G., Y.I., J.R., M.W., J.H.P., B.S., D.H., H.G., T.H., P.S., F.T.C., G.Z.), Stanford University, CA
| |
Collapse
|
9
|
Kazumata K, Tha KK, Tokairin K, Ito M, Uchino H, Kawabori M, Sugiyama T. Brain Structure, Connectivity, and Cognitive Changes Following Revascularization Surgery in Adult Moyamoya Disease. Neurosurgery 2019; 85:E943-E952. [DOI: 10.1093/neuros/nyz176] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 01/23/2019] [Indexed: 11/13/2022] Open
Abstract
AbstractBACKGROUNDThe effect of the combined direct/indirect revascularization surgery in Moyamoya disease has not been evaluated sufficiently with regard to cognitive function, brain microstructure, and connectivity.OBJECTIVETo investigate structural and functional changes following revascularization surgery in patients with moyamoya disease (MMD) through a combined analysis of brain morphology, microstructure, connectivity, and neurobehavioral data.METHODSNeurobehavioral and neuroimaging examinations were performed in 25 adults with MMD prior to and >12 mo after revascularization surgery. Cognitive function was investigated using the Wechsler Adult Intelligence Scale-III, Trail-Making Test, Wisconsin Card Sorting Test, Continuous Performance Test, Stroop test, and Wechsler Memory Scale. We assessed white matter integrity using diffusion tensor imaging, brain morphometry using magnetization-prepared rapid gradient-echo sequences, and brain connectivity using resting-state functional magnetic resonance imaging (MRI).RESULTSCognitive examinations revealed significant changes in the full-scale intelligence quotient (IQ), performance IQ (PIQ), perceptual organization (PO), processing speed, and Stroop test scores after surgery (P < .05). Enlargement of the lateral ventricle, volume reductions in the corpus callosum and subcortical nuclei, and cortical thinning in the prefrontal cortex were also observed (P < .05). Fractional anisotropy in the white matter tracts, including the superior longitudinal fasciculus, increased 2 to 4 yr after surgery, relative to that observed in the presurgical state (P < .05). Resting-state brain connectivity was increased predominantly in the fronto-cerebellar circuit and was positively correlated with improvements in PIQ and PO (P < .05).CONCLUSIONRevascularization surgery may improve processing speed and attention in adult patients with MMD. Further, multimodal MRI may be useful for detecting subtle postsurgical brain structural changes, reorganization of white matter tracts, and brain connectivity alterations.
Collapse
Affiliation(s)
- Ken Kazumata
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Japan
| | - Khin Khin Tha
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Japan
| | - Kikutaro Tokairin
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Japan
| | - Masaki Ito
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Japan
| | - Haruto Uchino
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Japan
| | - Masahito Kawabori
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Japan
| | - Taku Sugiyama
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Japan
| |
Collapse
|
10
|
Kazumata K, Uchino H, Tokairin K, Ito M, Shiga T, Osanai T, Kawabori M. Cerebral Hyperperfusion Syndrome After Revascularization Surgery in Moyamoya Disease: Region-Symptom Mapping and Estimating a Critical Threshold. World Neurosurg 2018. [DOI: 10.1016/j.wneu.2018.02.190] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
11
|
Kazumata K, Tha KK, Uchino H, Ito M, Nakayama N, Abumiya T. Mapping altered brain connectivity and its clinical associations in adult moyamoya disease: A resting-state functional MRI study. PLoS One 2017; 12:e0182759. [PMID: 28783763 PMCID: PMC5544229 DOI: 10.1371/journal.pone.0182759] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 07/24/2017] [Indexed: 12/22/2022] Open
Abstract
Detection of subtle ischemic injuries in moyamoya disease may enable optimization of timing of revascularization surgery, and could potentially improve functional outcomes. Resting-state functional magnetic resonance imaging (rs-fMRI) is widely used to study functional organization of the brain, but it remains unclear whether rs-fMRI could elucidate distinct characteristics in moyamoya disease. Here, we aimed to determine changes in a conventional rs-fMRI measure and analyze any associations with clinical symptoms and cerebral hemodynamics. Thirty-one adults with moyamoya disease and 25 adult controls underwent rs-fMRI, in which we measured brain connectivity via temporal correlations of low-frequency BOLD signals. We identified the extent of between-group differences with multivoxel pattern analysis. Seed-based analysis was performed to determine associations with vascular lesions, symptoms, and regional cerebral blood flow (rCBF). There was significantly altered connectivity in the precentral gyrus, operculo-insular region, precuneus, cingulate cortex, and middle frontal gyrus in moyamoya disease. There was reduced connectivity in the left insula, left precuneus, right precentral, and right middle frontal regions, which form part of the salience, default mode, motor, and central executive networks, respectively. Patients with ischemic motor-related symptoms showed significantly decreased connectivity in precentral homotopic regions compared with those without, while there were no differences in vascular lesions or rCBF. Connectivity between the right occipital and left hippocampus was significantly associated with cognitive performance and posterior cerebral artery involvement. Our results demonstrate distinct alterations in the temporal correlations of low-frequency BOLD signals, predominantly in resting-state networks in moyamoya disease. Additionally, rs-fMRI measures were associated with ischemic motor-related symptoms and cognitive performance in the patients. Thus, rs-fMRI may offer a useful non-invasive method of acquiring additional information beyond cerebral perfusion as part of clinical investigations in patients with moyamoya disease.
Collapse
Affiliation(s)
- Ken Kazumata
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Kita, Sapporo, Japan
- * E-mail:
| | - Khin Khin Tha
- Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Kita, Sapporo, Japan
| | - Haruto Uchino
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Kita, Sapporo, Japan
| | - Masaki Ito
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Kita, Sapporo, Japan
| | - Naoki Nakayama
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Kita, Sapporo, Japan
| | - Takeo Abumiya
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Kita, Sapporo, Japan
| |
Collapse
|