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Lu G, Wang T, Sun X, Yang R, Luo J, Tong X, Gu Y, Wang J, Tong Z, Kuai D, Cai Y, Ren J, Wang D, Duan L, Maimaitili A, Hang C, Yu J, Ma Y, Liu S, Jiao L. Qualifying Event and Recurrence of Ischemic Stroke in Symptomatic Artery Occlusion: A Post Hoc Analysis of CMOSS. J Am Heart Assoc 2024; 13:e034056. [PMID: 38934799 PMCID: PMC11255723 DOI: 10.1161/jaha.123.034056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/30/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND The authors aimed to elucidate the relationship between latest ischemic event and the incidence of subsequent ischemic stroke in patients with symptomatic artery occlusion. METHODS AND RESULTS We analyzed the association between qualifying event-the latest ischemic event (transient ischemic attack [TIA] or stroke)-and the incidence of ipsilateral ischemic stroke in patients with symptomatic artery occlusion treated with medical therapy alone in CMOSS (Carotid or Middle Cerebral Artery Occlusion Surgery Study). The incidence of CMOSS primary outcomes, including any stroke or death within 30 days after randomization or ipsilateral ischemic stroke between 30 days and 2 years, between the bypass surgical and medical groups, stratified by qualifying events, was also compared. Of the 165 patients treated with medical therapy alone, 75 had a TIA and 90 had a stroke as their qualifying event. The incidence of ipsilateral ischemic stroke did not significantly differ between patients with a TIA and those with a stroke as their qualifying event (13.3% versus 6.7%, P=0.17). In multivariate analysis, the qualifying event was not associated with the incidence of ipsilateral ischemic stroke. There were no significant differences in the CMOSS primary outcomes between the surgical and medical groups, regardless of the qualifying event being TIA (10.1% versus 12.2%, P=0.86) or stroke (6.7% versus 8.9%, P=0.55). CONCLUSIONS Among patients with symptomatic artery occlusion and hemodynamic insufficiency, the risk of subsequent ipsilateral ischemic stroke does not appear to be lower in patients presenting with a TIA compared with those with a stroke. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT01758614.
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Affiliation(s)
- Guangdong Lu
- Department of Neurosurgery and Interventional NeuroradiologyXuanwu Hospital, China International Neuroscience Institute, Capital Medical University, National Center for Neurological DisordersBeijingChina
- Department of Interventional RadiologyThe First Affiliated Hospital With Nanjing Medical UniversityNanjingJiangsuChina
| | - Tao Wang
- Department of NeurosurgeryXuanwu Hospital, China International Neuroscience Institute, Capital Medical University, National Center for Neurological DisordersBeijingChina
| | - Xinyi Sun
- Department of NeurosurgeryXuanwu Hospital, China International Neuroscience Institute, Capital Medical University, National Center for Neurological DisordersBeijingChina
| | - Renjie Yang
- Department of NeurosurgeryXuanwu Hospital, China International Neuroscience Institute, Capital Medical University, National Center for Neurological DisordersBeijingChina
| | - Jichang Luo
- Department of NeurosurgeryXuanwu Hospital, China International Neuroscience Institute, Capital Medical University, National Center for Neurological DisordersBeijingChina
| | | | - Yuxiang Gu
- Department of Neurosurgery, Huashan HospitalFudan University, National Center for Neurological DisordersShanghaiChina
| | - Jiyue Wang
- Department of Neurosurgery, Liaocheng People’s HospitalShandong First Medical University and Shandong Academy of Medical SciencesLiaochengShandongChina
| | - Zhiyong Tong
- Department of NeurosurgeryThe First Hospital of China Medical UniversityShenyangLiaoningChina
| | - Dong Kuai
- Department of NeurosurgeryThe Affiliated Cardiovascular Hospital of Shanxi Medical University and Shanxi Cardiovascular HospitalTaiyuanShanxiChina
| | - Yiling Cai
- Department of NeurologyStrategic Support Force Medical CenterBeijingChina
| | - Jun Ren
- Department of NeurosurgeryThe Second Hospital of Lan Zhou UniversityLan ZhouChina
| | - Donghai Wang
- Department of NeurosurgeryQilu Hospital of Shandong University, Jinan, Qilu Hospital of Shandong University Dezhou HospitalDezhouChina
| | - Lian Duan
- Department of NeurosurgeryThe First Medical Center of Chinese People’s Liberation Army (PLA) General HospitalBeijingChina
| | - Aisha Maimaitili
- Department of NeurosurgeryThe First Affiliated Hospital of Xinjiang Medical UniversityXinjiangChina
| | - Chunhua Hang
- Department of Neurosurgery, Nanjing Drum Tower Hospital, Neurosurgical Institute of Nanjing UniversityNanjing University Medical SchoolNanjingChina
| | - Jiasheng Yu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Yan Ma
- Department of NeurosurgeryXuanwu Hospital, China International Neuroscience Institute, Capital Medical University, National Center for Neurological DisordersBeijingChina
| | - Sheng Liu
- Department of Interventional RadiologyThe First Affiliated Hospital With Nanjing Medical UniversityNanjingJiangsuChina
| | - Liqun Jiao
- Department of Neurosurgery and Interventional NeuroradiologyXuanwu Hospital, China International Neuroscience Institute, Capital Medical University, National Center for Neurological DisordersBeijingChina
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Chen JY, Ding YH, Li Y, Shi SS, Chen J, Tu XK. Assessment of bypass patency using transcranial Doppler sonography: correlations with computerized tomography angiography findings in patients with moyamoya disease. Neurosurg Rev 2023; 46:64. [PMID: 36877325 DOI: 10.1007/s10143-023-01970-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 02/08/2023] [Accepted: 02/25/2023] [Indexed: 03/07/2023]
Abstract
To explore the utility of transcranial Doppler (TCD) findings when assessing bypass patency in patients with Moyamoya disease (MMD). Computed tomography angiography (CTA) and TCD sonography (TCDS) were performed before and after surgery to evaluate bypass patency. The peak systolic flow velocity (PSV) of the superficial temporal artery (STA) and the pulsatility index (PI) were compared between the groups that achieved patency and not, and receiver operating characteristic (ROC) curve analyses were used to define the TCDS criteria revealing patency. This study included 35 hemispheres (15 women; mean age 47 years) with Moyamoya disease who underwent STA-middle carotid artery bypass in our institution between January 2022 and October 2022. The PSV first increased on postoperative days 4-5 and then decreased on postoperative days 6-7 and 7-8. Patients with transient neurological diseases (TNDs), compared to those without, evidenced a significantly lower PSV value (P < 0.05). Compared with the non-patency group, the PSV was higher (P < 0.001) in the patency group. The cutoff values reflecting patency with good sensitivity and specificity were PSV > 49.00; PSV ratio (postoperative/preoperative) > 1.218; PSV ratio (operation side/contralateral side) > 1.082; and PSV ratio (adjusted) > 1.202. In the patency group, the PSV and PI significantly increased (P < 0.001) and decreased (P < 0.001) respectively. Bypass patency can be noninvasively and accurately evaluated via TCDS, affording an objective basis for assessment of the effect of revascularization surgery on patients with MMD.
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Affiliation(s)
- Jing-Yi Chen
- Department of Neurosurgery, Fujian Medical University Union Hospital, Neurosurgery Research Institute of Fujian Province, 29# Xinquan Road, Fuzhou, 350001, Fujian, China
| | - Yi-Hang Ding
- Department of Neurosurgery, Fujian Medical University Union Hospital, Neurosurgery Research Institute of Fujian Province, 29# Xinquan Road, Fuzhou, 350001, Fujian, China
| | - Yang Li
- Department of Neurosurgery, Fujian Medical University Union Hospital, Neurosurgery Research Institute of Fujian Province, 29# Xinquan Road, Fuzhou, 350001, Fujian, China
| | - Song-Sheng Shi
- Department of Neurosurgery, Fujian Medical University Union Hospital, Neurosurgery Research Institute of Fujian Province, 29# Xinquan Road, Fuzhou, 350001, Fujian, China
| | - Jing Chen
- Department of Neurosurgery, Fujian Medical University Union Hospital, Neurosurgery Research Institute of Fujian Province, 29# Xinquan Road, Fuzhou, 350001, Fujian, China.
| | - Xian-Kun Tu
- Department of Neurosurgery, Fujian Medical University Union Hospital, Neurosurgery Research Institute of Fujian Province, 29# Xinquan Road, Fuzhou, 350001, Fujian, China.
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Yamashita K, Sugimori H, Nakamizo A, Amano T, Kuwashiro T, Watanabe T, Kawamata K, Furuya K, Harada S, Kamei R, Maehara J, Okada Y, Noguchi T. Different hemodynamics of basal ganglia between moyamoya and non-moyamoya diseases using intravoxel incoherent motion imaging and single-photon emission computed tomography. Acta Radiol 2023; 64:769-775. [PMID: 35466686 DOI: 10.1177/02841851221092895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Moyamoya disease (MMD) and non-MMD have different pathogenesis, clinical presentation, and treatment policy. PURPOSE To identify differences in hemodynamics between MMD and non-MMD using intravoxel incoherent motion (IVIM) magnetic resonance imaging (MRI) and single-photon emission computed tomography (SPECT). MATERIAL AND METHODS Patients who had undergone 99mTc-ECD or 123I-IMP SPECT, and IVIM imaging were retrospectively studied. IVIM imaging was acquired using six different b-values. Cerebral blood flow ratio (CBFR) in the basal ganglia was calculated using a standardized volume-of-interest template. The cerebellum was used as a reference region. IVIM perfusion fraction (f) was obtained using a two-step fitting algorithm. Elliptical regions of interest were placed in bilateral basal ganglia on the IVIM f map. Patients were classified into MMD and non-MMD groups. The correlation between CBFR and mean IVIM f (fmean) in the basal ganglia was evaluated using Spearman's rank correlation coefficient. RESULTS In total, 20 patients with MMD and 28 non-MMD patients were analyzed. No significant differences in fmean were observed among MMD, affected hemisphere with non-MMD (non-MMDaff), and unaffected hemispheres with non-MMD (non-MMDunaff). A negative correlation was seen between fmean and CBFR in the MMD group (r = -0.40, P = 0.0108), but not in the non-MMD group (non-MMDaff, r = 0.07, P = 0.69; non-MMDunaff, r = -0.22, P = 0.29). No significant differences were found among MMD and non-MMD patients, irrespective of SPECT tracers. CONCLUSION The combination of IVIM MRI and SPECT appears to allow non-invasive identification of differences in hemodynamics between MMD and non-MMD.
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Affiliation(s)
- Koji Yamashita
- Department of Radiology, Clinical Research Institute, 37085National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Hiroshi Sugimori
- Department of Cerebrovascular Medicine and Neurology, Clinical Research Institute, 37085National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Akira Nakamizo
- Department of Neurosurgery, Clinical Research Institute, 37085National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Toshiyuki Amano
- Department of Neurosurgery, Clinical Research Institute, 37085National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Takahiro Kuwashiro
- Department of Cerebrovascular Medicine and Neurology, Clinical Research Institute, 37085National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Takeharu Watanabe
- Department of Medical Technology, Division of Radiology, 37085National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Keisuke Kawamata
- Department of Medical Technology, Division of Radiology, 37085National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Kiyomi Furuya
- Department of Radiology, Clinical Research Institute, 37085National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Shino Harada
- Department of Radiology, Clinical Research Institute, 37085National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Ryotaro Kamei
- Department of Radiology, Clinical Research Institute, 37085National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Junki Maehara
- Department of Radiology, Clinical Research Institute, 37085National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Yasushi Okada
- Department of Cerebrovascular Medicine and Neurology, Clinical Research Institute, 37085National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Tomoyuki Noguchi
- Department of Radiology, Clinical Research Institute, 37085National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
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Velo M, Grasso G, Fujimura M, Torregrossa F, Longo M, Granata F, Pitrone A, Vinci SL, Ferraù L, La Spina P. Moyamoya Vasculopathy: Cause, Clinical Manifestations, Neuroradiologic Features, and Surgical Management. World Neurosurg 2022; 159:409-425. [PMID: 35255640 DOI: 10.1016/j.wneu.2021.11.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/03/2021] [Accepted: 11/05/2021] [Indexed: 11/17/2022]
Abstract
In moyamoya disease, the progressive occlusion of the distal portion of the internal carotid artery and its major branches is typically responsible for the formation of an extensive network of collateral vessels at the base of the brain. When moyamoya collateral network develops in association with various systemic or acquired diseases, the term moyamoya syndrome is used to denote this phenomenon. Sudden changes in the supraclinoid internal carotid artery and middle cerebral artery can be recognized with noninvasive neurovascular imaging techniques, which also allow a differential diagnosis with similar diseases such as degenerative steno-occlusive disease, cerebral vasculitis, and twig-like middle cerebral artery. Once the diagnosis is established, the definitive treatment for moyamoya disease is surgical revascularization, with the goal of increasing cerebral blood flow and preventing recurrent stroke. We provide a comprehensive review of the clinical and radiologic features in moyamoya vasculopathy along with its surgical management.
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Affiliation(s)
- Mariano Velo
- Neuroradiology Unit, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Giovanni Grasso
- Neurosurgical Unit, Department of Biomedicine, Neurosciences and Advance Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Miki Fujimura
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Fabio Torregrossa
- Neurosurgical Unit, Department of Biomedicine, Neurosciences and Advance Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Marcello Longo
- Neuroradiology Unit, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Francesca Granata
- Neuroradiology Unit, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy.
| | - Antonio Pitrone
- Neuroradiology Unit, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Sergio Lucio Vinci
- Neuroradiology Unit, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Ludovica Ferraù
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Paolino La Spina
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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Kuribara T, Akiyama Y, Mikami T, Komatsu K, Kimura Y, Takahashi Y, Sakashita K, Chiba R, Mikuni N. Macrohistory of Moyamoya Disease Analyzed Using Artificial Intelligence. Cerebrovasc Dis 2022; 51:413-426. [PMID: 35104814 DOI: 10.1159/000520099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 10/06/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Moyamoya disease is characterized by progressive stenotic changes in the terminal segment of the internal carotid artery and the development of abnormal vascular networks called moyamoya vessels. The objective of this review was to provide a holistic view of the epidemiology, etiology, clinical findings, treatment, and pathogenesis of moyamoya disease. A literature search was performed in PubMed using the term "moyamoya disease," for articles published until 2021. RESULTS Artificial intelligence (AI) clustering was used to classify the articles into 5 clusters: (1) pathophysiology (23.5%); (2) clinical background (37.3%); (3) imaging (13.2%); (4) treatment (17.3%); and (5) genetics (8.7%). Many articles in the "clinical background" cluster were published from the 1970s. However, in the "treatment" and "genetics" clusters, the articles were published from the 2010s through 2021. In 2011, it was confirmed that a gene called Ringin protein 213 (RNF213) is a susceptibility gene for moyamoya disease. Since then, tremendous progress in genomic, transcriptomic, and epigenetic profiling (e.g., methylation profiling) has resulted in new concepts for classifying moyamoya disease. Our literature survey revealed that the pathogenesis involves aberrations of multiple signaling pathways through genetic mutations and altered gene expression. CONCLUSION We analyzed the content vectors in abstracts using AI, and reviewed the pathophysiology, clinical background, radiological features, treatments, and genetic peculiarity of moyamoya disease.
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Affiliation(s)
| | - Yukinori Akiyama
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Takeshi Mikami
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Katsuya Komatsu
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Yusuke Kimura
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | | | - Kyoya Sakashita
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Ryohei Chiba
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Nobuhiro Mikuni
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
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Ren T, Sun S, Li B, Chen Y, Qu X, Li C, Deng X, Ni C. Study on the Correlation Between Ischemic Leukoaraiosis and Cerebral Large Artery Stenosis Using the Stages of the Preinfarction Period Based on the Result of Computed Tomography Perfusion. Neurologist 2021; 27:1-5. [PMID: 34842568 DOI: 10.1097/nrl.0000000000000350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE The influence of cerebral large artery stenosis (CLAS) on ischemic leukoaraiosis (LA) remains elusive. Based on the proposed stages of the preinfarction period, this study aimed to adopt the staging system to assess the correlation between ischemic LA and CLAS. MATERIALS AND METHODS Patients with unilateral CLAS ≥50% and without cerebral stroke were screened. The severity and distribution of stenosis were evaluated on computed tomography angiography images. The degree of regional cerebral perfusion was rated according to the stages of preinfarction period: 0=normal, 1=stage Ia, 2=stage Ib, 3=stage IIa, 4=stage IIb. Stage I included stage Ia and stage Ib. Stage II included stage IIa and stage IIb. LA was scored with Fazakas scale on T2-weighted image and/or fluid-attenuated inversion recovery sequences. RESULTS The cohort consisted of 212 patients (mean age, 66.89±11.39 y), including 145 (68.40%) males. CLAS severity and distribution did not differ between patients with and without LA (P>0.05). Normal, stage I, and stage II had significantly different incidences of LA and hemispheric LA scores in the left and right hemispheres (P<0.05). The degree of regional cerebral perfusion was independently associated with LA in the left (P=0.0094) and right hemispheres (P=0.0091). CONCLUSIONS Ischemic LA is not directly related to CLAS but is independently associated with the degree of CLAS-induced cerebral hypoperfusion. The stages of the preinfarction period are helpful in identifying people at high risk of LA progression.
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Affiliation(s)
- Taojie Ren
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou
- Department of Neurology, Yancheng City No. 1 People's Hospital, Yancheng, Jiangsu Province, People's Republic of China
| | - Shifu Sun
- Department of Neurology, Yancheng City No. 1 People's Hospital, Yancheng, Jiangsu Province, People's Republic of China
| | - Bo Li
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou
| | - Yuan Chen
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou
| | - Xiaofeng Qu
- Department of Neurology, Yancheng City No. 1 People's Hospital, Yancheng, Jiangsu Province, People's Republic of China
| | - Chunxing Li
- Department of Neurology, Yancheng City No. 1 People's Hospital, Yancheng, Jiangsu Province, People's Republic of China
| | - Xiaowen Deng
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou
| | - Caifang Ni
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou
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Chen DYT, Ishii Y, Fan AP, Guo J, Zhao MY, Steinberg GK, Zaharchuk G. Predicting PET Cerebrovascular Reserve with Deep Learning by Using Baseline MRI: A Pilot Investigation of a Drug-Free Brain Stress Test. Radiology 2020; 296:627-637. [PMID: 32662761 DOI: 10.1148/radiol.2020192793] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Cerebrovascular reserve (CVR) may be measured by using an acetazolamide test to clinically evaluate patients with cerebrovascular disease. However, acetazolamide use may be contraindicated and/or undesirable in certain clinical settings. Purpose To predict CVR images generated from acetazolamide vasodilation with a deep learning network by using only images before acetazolamide administration. Materials and Methods Simultaneous oxygen 15 (15O)-labeled water PET/MRI before and after acetazolamide injection were retrospectively analyzed for patients with Moyamoya disease and healthy control participants from April 2017 to May 2019. Inputs to deep learning models were perfusion-based images (arterial spin labeling [ASL]), structural scans (T2 fluid-attenuated inversion-recovery, T1), and brain location. Two models, that is, 15O-labeled water PET cerebral blood flow (CBF) and MRI (PET-plus-MRI model) before acetazolamide administration and only MRI (MRI-only model) before acetazolamide administration, were trained and tested with sixfold cross-validation. The models learned to predict a voxelwise relative CBF change (rΔCBF) map by using rΔCBF measured with PET due to acetazolamide as ground truth. Quantitative analysis included image quality metrics (peak signal-to-noise ratio, root mean square error, and structural similarity index), as well as comparison between the various methods by using correlation and Bland-Altman analyses. Identification of vascular territories with impaired rΔCBF was evaluated by using receiver operating characteristic metrics. Results Thirty-six participants were included: 24 patients with Moyamoya disease (mean age ± standard deviation, 41 years ± 12; 17 women) and 12 age-matched healthy control participants (mean age, 39 years ± 16; nine women). The rΔCBF maps predicted by both deep learning models demonstrated better image quality metrics than did ASL (all P < .001 in patients) and higher correlation coefficient with PET than with ASL (PET-plus-MRI model, 0.704; MRI-only model, 0.690 vs ASL, 0.432; both P < .001 in patients). Both models also achieved high diagnostic performance in identifying territories with impaired rΔCBF (area under receiver operating characteristic curve, 0.95 for PET-plus-MRI model [95% confidence interval: 0.90, 0.99] and 0.95 for MRI-only model [95% confidence interval: 0.91, 0.98]). Conclusion By using only images before acetazolamide administration, PET-plus-MRI and MRI-only deep learning models predicted cerebrovascular reserve images without the need for vasodilator injection. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
- David Y T Chen
- From the Department of Radiology, The Richard M. Lucas Center for Imaging, Stanford University, 1201 Welch Rd, Stanford, CA 94305 (D.Y.T.C., A.P.F., M.Y.Z., G.Z.); Department of Medical Imaging, Taipei Medical University-Shuan-Ho Hospital, New Taipei City, Taiwan (D.Y.T.C.); Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (D.Y.T.C.); Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan (Y.I.); Department of Bioengineering, University of California Riverside, Riverside, Calif (J.G.); and Department of Neurosurgery, Stanford University, Stanford, Calif (G.K.S.)
| | - Yosuke Ishii
- From the Department of Radiology, The Richard M. Lucas Center for Imaging, Stanford University, 1201 Welch Rd, Stanford, CA 94305 (D.Y.T.C., A.P.F., M.Y.Z., G.Z.); Department of Medical Imaging, Taipei Medical University-Shuan-Ho Hospital, New Taipei City, Taiwan (D.Y.T.C.); Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (D.Y.T.C.); Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan (Y.I.); Department of Bioengineering, University of California Riverside, Riverside, Calif (J.G.); and Department of Neurosurgery, Stanford University, Stanford, Calif (G.K.S.)
| | - Audrey P Fan
- From the Department of Radiology, The Richard M. Lucas Center for Imaging, Stanford University, 1201 Welch Rd, Stanford, CA 94305 (D.Y.T.C., A.P.F., M.Y.Z., G.Z.); Department of Medical Imaging, Taipei Medical University-Shuan-Ho Hospital, New Taipei City, Taiwan (D.Y.T.C.); Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (D.Y.T.C.); Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan (Y.I.); Department of Bioengineering, University of California Riverside, Riverside, Calif (J.G.); and Department of Neurosurgery, Stanford University, Stanford, Calif (G.K.S.)
| | - Jia Guo
- From the Department of Radiology, The Richard M. Lucas Center for Imaging, Stanford University, 1201 Welch Rd, Stanford, CA 94305 (D.Y.T.C., A.P.F., M.Y.Z., G.Z.); Department of Medical Imaging, Taipei Medical University-Shuan-Ho Hospital, New Taipei City, Taiwan (D.Y.T.C.); Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (D.Y.T.C.); Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan (Y.I.); Department of Bioengineering, University of California Riverside, Riverside, Calif (J.G.); and Department of Neurosurgery, Stanford University, Stanford, Calif (G.K.S.)
| | - Moss Y Zhao
- From the Department of Radiology, The Richard M. Lucas Center for Imaging, Stanford University, 1201 Welch Rd, Stanford, CA 94305 (D.Y.T.C., A.P.F., M.Y.Z., G.Z.); Department of Medical Imaging, Taipei Medical University-Shuan-Ho Hospital, New Taipei City, Taiwan (D.Y.T.C.); Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (D.Y.T.C.); Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan (Y.I.); Department of Bioengineering, University of California Riverside, Riverside, Calif (J.G.); and Department of Neurosurgery, Stanford University, Stanford, Calif (G.K.S.)
| | - Gary K Steinberg
- From the Department of Radiology, The Richard M. Lucas Center for Imaging, Stanford University, 1201 Welch Rd, Stanford, CA 94305 (D.Y.T.C., A.P.F., M.Y.Z., G.Z.); Department of Medical Imaging, Taipei Medical University-Shuan-Ho Hospital, New Taipei City, Taiwan (D.Y.T.C.); Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (D.Y.T.C.); Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan (Y.I.); Department of Bioengineering, University of California Riverside, Riverside, Calif (J.G.); and Department of Neurosurgery, Stanford University, Stanford, Calif (G.K.S.)
| | - Greg Zaharchuk
- From the Department of Radiology, The Richard M. Lucas Center for Imaging, Stanford University, 1201 Welch Rd, Stanford, CA 94305 (D.Y.T.C., A.P.F., M.Y.Z., G.Z.); Department of Medical Imaging, Taipei Medical University-Shuan-Ho Hospital, New Taipei City, Taiwan (D.Y.T.C.); Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (D.Y.T.C.); Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan (Y.I.); Department of Bioengineering, University of California Riverside, Riverside, Calif (J.G.); and Department of Neurosurgery, Stanford University, Stanford, Calif (G.K.S.)
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Ravindra VM, Kralik SF, Griauzde J, Gadgil N, LoPresti MA, Lam S. Preoperative computed tomography perfusion in pediatric moyamoya disease: a single-institution experience. J Neurosurg Pediatr 2020; 25:484-491. [PMID: 31978885 DOI: 10.3171/2019.10.peds19450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/25/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Moyamoya disease is a progressive occlusive arteriopathy for which surgical revascularization is indicated. In this retrospective study, the authors investigated the use of preoperative CT perfusion with the aim of establishing pathological data references. METHODS The authors reviewed the medical records of children with moyamoya disease treated surgically at one institution between 2016 and 2019. Preoperative CT perfusion studies were used to quantify mean transit time (MTT), cerebral blood volume (CBV), cerebral blood flow (CBF), and time to peak (TTP) for the anterior, middle, and posterior cerebral artery vascular territories for each patient. CT perfusion parameter ratios (diseased/healthy hemispheres) and absolute differences were compared between diseased and normal vascular territories (defined by catheter angiography studies). Sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values for CT perfusion parameters for severe angiographic moyamoya were calculated. RESULTS Nine children (89% female) had preoperative CT perfusion data; 5 of them had evidence of unilateral hemispheric disease and 4 had bilateral disease. The mean age at revascularization was 77 months (range 40-144 months). The etiology of disease was neurofibromatosis type 1 (3 patients), Down syndrome (2), primary moyamoya disease (2), cerebral proliferative angiopathy (1), and sickle cell disease (1). Five patients had undergone unilateral revascularization. Among these patients, pathological vascular territories demonstrated increased MTT in 66% of samples, increased TTP in 66%, decreased CBF in 47%, and increased CBV in 87%. Severe moyamoya (Suzuki stage ≥ 4) had diseased/healthy ratios ≥ 1 for MTT in 78% of cases, for TTP in 89%, for CBF in 67%, and for CBV in 89%. The MTT and TTP region of interest ratio ≥ 1 demonstrated 89% sensitivity, 67% specificity, 80% PPV, and 80% NPV for the prediction of severe angiographic moyamoya disease. CONCLUSIONS Pathological hemispheres in these children with moyamoya disease demonstrated increased MTT, TTP, and CBV and decreased CBF. The authors' results suggest that preoperative CT perfusion may, with high sensitivity, be useful in deciphering perfusion mismatch in brain tissue in children with moyamoya disease. More severe angiographic disease displays a more distinct correlation, allowing surgeons to recognize when to intervene in these patients.
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Affiliation(s)
| | - Stephen F Kralik
- 2Department of Pediatric Radiology, Baylor College of Medicine, Houston, Texas
| | - Julius Griauzde
- 3Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | | | | | - Sandi Lam
- 4Department of Neurosurgery, Northwestern University Feinberg School of Medicine; and
- 5Division of Pediatric Neurosurgery, Ann and Robert H Lurie Children's Hospital, Chicago, Illinois
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9
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Kang K, Ma N, Li J, Shen Y, Gu W, Ma G, Zhang D, Zhao X. Cerebral Hemodynamic Changes After Revascularization in Patients With Hemorrhagic Moyamoya Disease. Front Neurol 2020; 11:72. [PMID: 32117031 PMCID: PMC7026453 DOI: 10.3389/fneur.2020.00072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 01/21/2020] [Indexed: 01/29/2023] Open
Abstract
Objective: To explore the cerebral hemodynamic changes after revascularization in patients with hemorrhagic moyamoya disease (MMD). Materials and Methods: We retrospectively included 57 hemorrhagic MMD patients in a high-volume stroke center from January 2016 to December 2018. All subjects were evaluated with whole-brain CT perfusion (CTP) before and after surgical revascularization. Absolute and relative CTP values in the regions of cortical middle cerebral artery territory (CMT) and deep brain area (DBA) of hemorrhagic hemispheres were measured. Differences between pre- and post-operative CTP values were assessed comprehensively. The patients were categorized into subgroups based on revascularization subtypes and postoperative CTP intervals. Results: The relative cerebral blood volume (rCBV) in DBA and CMT significantly reduced in postoperative CTP (P < 0.05). The median and interquartile range of the proportion of rCBV decrease (rCBVc%) were 7.2% (2.3–13.2%). The rCBV reduction retained statistical significant in patients who received subtypes of revascularization, and in patients with variable intervals of follow-up (P < 0.05). There was no significant difference of rCBVc% between patients who received different revascularization and among patients with different postoperative CTP intervals (P > 0.05). The relative mean transit time (rMTT) and relative time to peak (rTTP) also showed downward trends, but without retainable statistical significance in stratified analysis. There was no significant change in relative cerebral blood flow (rCBF) (P > 0.05). Conclusion: In patients with hemorrhagic MMD, the CBV appeared to decrease and be relatively stable in the chronic phase after revascularization, with varying degrees of MTT and TTP shortening. However, there was no significant change in CBF.
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Affiliation(s)
- Kaijiang Kang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Ning Ma
- China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jinxin Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Yuan Shen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Weibin Gu
- China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Guofeng Ma
- China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dong Zhang
- China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
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10
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Current Open Surgical Indications for Revascularization in Cerebral Ischemia. ACTA NEUROCHIRURGICA. SUPPLEMENT 2020; 127:195-199. [PMID: 31407085 DOI: 10.1007/978-3-030-04615-6_31] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Cerebral revascularization was pioneered half a century ago. Gradual improvements in microsurgical instrumentation and training in microsurgical techniques have allowed significant changes that improved outcomes in neurosurgery, extrapolating this knowledge to other neurosurgical diseases (brain tumor, aneurysms, and skull base tumor surgery). But the popularity of cerebral bypass procedures was followed by their decline, given the lack of clear benefit of bypass surgery in chronic cerebrovascular ischemia after the EC-IC bypass studies. Over the last couple of decades, the formidable advance of neuro-endovascular techniques for revascularization has lessened the need for application of open cerebral revascularization procedures, either for flow augmentation or flow replacement. However, there is still a select group of patients with chronic cerebral ischemia, for whom open cerebral revascularization with flow augmentation is the only treatment option available, and this will be the objective of our current review.
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11
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Shulgina AA, Lukshin VA, Korshunov AE, Belousova OB, Pronin IN, Usachev DY. [Modern trends in diagnosis and surgical treatment of moyamoya disease]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2020; 84:90-103. [PMID: 32759932 DOI: 10.17116/neiro20208404190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This review is devoted to moyamoya disease. It is a rare chronic steno-occlusive cerebrovascular disease. However, moyamoya disease is increasingly diagnosed by neurosurgeons in our country. Unlike atherosclerotic lesions of cerebral arteries, pathogenesis and course of this disease are much more complex and variable. Therefore, specialists often have certain difficulties in diagnosis, management and treatment of these patients. To date, a large number of surgical interventions have been proposed for the treatment of moyamoya disease. Revascularization approaches include direct procedures (extra-intracranial microanastomoses), indirect methods (synangioses) and combined revascularization. The purpose of the review is to systematize current literature data on the pathogenesis, diagnosis, clinical patterns and surgical treatment of patients with moyamoya disease. results Outcomes of surgical revascularization and the role of its various components in combined approach are under particular attention.
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Affiliation(s)
| | - V A Lukshin
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | | | - I N Pronin
- Burdenko Neurosurgical Center, Moscow, Russia
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12
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Yin H, Liu X, Zhang D, Zhang Y, Wang R, Zhao M, Zhao J. A Novel Staging System to Evaluate Cerebral Hypoperfusion in Patients With Moyamoya Disease. Stroke 2019; 49:2837-2843. [PMID: 30571396 DOI: 10.1161/strokeaha.118.022628] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- The study goal was to evaluate cerebral perfusion in moyamoya patients with a novel staging system and investigate the association between differences of perfusion status and clinical outcomes in patients treated with revascularization. Methods- About 506 consecutive patients from 2009 to 2015 were enrolled. The perfusion status was evaluated by a staging system-the stage of preinfarction period based on the result of computed tomography perfusion. Hemisphere in different perfusion stage was compared between hemorrhagic patients (n=155) and ischemic patients (n=351). The modified Rankin Scale was applied to evaluate the prognosis of patients. Results- In the enrolled 506 patients: 229 hemispheres (22.6%) with normal perfusion, 72 hemispheres (7.1%) in stage I, 205 hemispheres (20.3%) in stage II, 308 hemispheres (30.4%) in stage III, and 198 hemispheres (19.6%) in stage IV. Significant difference was observed in stage distribution between hemorrhagic patients and ischemic patients ( P<0.01). The ratio of hemispheres with normal perfusion in hemorrhagic group is more than the ischemic group ( P<0.05; odds ratio, 1.440; 95% CI, 1.144-1.811). The ratio of hemispheres in stage III in ischemic group is more than the hemorrhagic group ( P<0.01; odds ratio, 0.618, 95% CI, 0.487-0.783). In the prognosis-related analysis, the stage I group has the highest improved ratio (73.9%) and the normal perfusion group has the lowest improved ratio (33.3%). The improved ratio has a decreasing tendency from stage I to stage IV. Conclusions- The novel preinfarction staging system is a valuable assessment tool to evaluate cerebral perfusion status in moyamoya patients and predict the efficacy of revascularization. Ischemic patients suffer more from hypoperfusion. Patients in stage I and stage II are more likely to obtain improvement after revascularization. This is a retrospective study.
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Affiliation(s)
- Hu Yin
- From the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.).,China National Clinical Research Center for Neurological Diseases, Beijing (NCRC-ND) (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.).,Center of Stroke, Beijing Institute for Brain Disorders (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.)
| | - Xingju Liu
- From the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.).,China National Clinical Research Center for Neurological Diseases, Beijing (NCRC-ND) (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.).,Center of Stroke, Beijing Institute for Brain Disorders (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.)
| | - Dong Zhang
- From the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.).,China National Clinical Research Center for Neurological Diseases, Beijing (NCRC-ND) (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.).,Center of Stroke, Beijing Institute for Brain Disorders (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.)
| | - Yan Zhang
- From the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.).,China National Clinical Research Center for Neurological Diseases, Beijing (NCRC-ND) (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.).,Center of Stroke, Beijing Institute for Brain Disorders (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.)
| | - Rong Wang
- From the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.).,China National Clinical Research Center for Neurological Diseases, Beijing (NCRC-ND) (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.).,Center of Stroke, Beijing Institute for Brain Disorders (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.)
| | - Meng Zhao
- From the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.).,China National Clinical Research Center for Neurological Diseases, Beijing (NCRC-ND) (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.).,Center of Stroke, Beijing Institute for Brain Disorders (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.)
| | - Jizong Zhao
- From the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.).,China National Clinical Research Center for Neurological Diseases, Beijing (NCRC-ND) (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.).,Center of Stroke, Beijing Institute for Brain Disorders (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.)
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13
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Zhang J, Xia C, Liu Y, Qian W, Peng W, Liu K, Li L, Zhao F, Li Z. Comparative study of MR mTI-ASL and DSC-PWI in evaluating cerebral hemodynamics of patients with Moyamoya disease. Medicine (Baltimore) 2018; 97:e12768. [PMID: 30313089 PMCID: PMC6203517 DOI: 10.1097/md.0000000000012768] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The aim of this study was to explore the correlation between multi-inversion time arterial spin labeling (mTI-ASL) and dynamic susceptibility contrast-enhanced perfusion weighted imaging (DSC-PWI) in assessment of hemodynamics of patients with Moyamoya disease (MMD).In this study, 24 MMD patients and 21 healthy subjects were enrolled between June 2017 and December 2017. The images of mTI-ASL and DSC-PWI in the week before revascularization surgery were retrospectively analyzed. The parameters of cerebral blood flow (CBF), time to peak (TTP), and bolus arrival time (BAT) were measured in regions of interest (ROIs) of lateral middle cerebral artery (MCA) territories, basal ganglia (BG), and cerebellum, and relative perfusion parameters (rCBF-ASL, rBAT-ASL, rCBF-DSC, and rTTP-DSC) were calculated by dividing by cerebellum value. One-way analysis of variance and Student-Newman-Keuls tests were performed to compare rCBF-ASL and rCBF-DSC in the MMD group and the control group. Unpaired t test was used to compare rBAT-ASL and rTTP-DSC in the MMD group and the control group. And we assessed the correlation between rCBF-ASL and rCBF-DSC and between rBAT-ASL and rTTP-DSC using Pearson correlation analysis.All the relative parameters were significantly different between the MMD group and the control group (all P<.05). Meanwhile, there was significant difference between rCBF-ASL and rCBF-DSC (P<.05), and there was strong correlation between rCBF-ASL and rCBF-DSC (r = 0.839, P<.001), and moderate correlation between rBAT-ASL and rTTP-DSC (r = 0.519, P<.001).Both mTI-ASL and DSC-PWI could be used to assess perfusion state in MMD patients before revascularization surgery effectively. As a noninvasive imaging technique, mTI-ASL could provide perfusion parameters without contrast medium injection, and the results were quite correlative with DSC-PWI.
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Affiliation(s)
| | | | - Yi Liu
- Department of Neurosurgery, Sichuan University West China Hospital, Chengdu City, China
| | - Weiqiang Qian
- Department of Neurosurgery, Sichuan University West China Hospital, Chengdu City, China
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14
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Karakama J, Nariai T, Hara S, Hayashi S, Sumita K, Inaji M, Tanaka Y, Wagatsuma K, Ishii K, Nemoto S, Maehara T. Unique Angiographic Appearances of Moyamoya Disease Detected with 3-Dimensional Rotational Digital Subtraction Angiography Imaging Showing the Hemodynamic Status. J Stroke Cerebrovasc Dis 2018; 27:2147-2157. [PMID: 29653803 DOI: 10.1016/j.jstrokecerebrovasdis.2018.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 02/08/2018] [Accepted: 03/13/2018] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND The aim of this study was to identify the unique morphological arterial features in patients with moyamoya disease on 3-dimensional rotational digital subtraction angiography. MATERIALS AND METHODS One hundred seven hemispheres of 58 consecutive patients with moyamoya disease that were analyzed with fused 3-dimensional images of internal carotid angiograms and vertebral angiograms that were marked with different colors were reviewed. Angiographic findings in the posterior watershed area were classified, and the utility of the classification was analyzed by comparing it with clinical presentations and quantitative hemodynamic parameters obtained with positron emission tomography. RESULTS Two unique angiographic appearances were identified. A vacant vessel appearance (no arterial inflow despite absence of cortical infarction) was observed mostly in transient ischemic attack hemispheres. In hemispheres with a vacant vessel appearance, cerebral blood flow was decreased, cerebral blood volume was increased, and mean transit time was prolonged significantly (P = .00017, P = .0061, and P = .00026, respectively). A cocktail vessel appearance (mixture of carotid and vertebral arterial flow) was most commonly observed in asymptomatic cases, as well as in ischemic hemispheres. Cerebral blood volume increased and mean transit time was prolonged significantly (P = .036 and P = .014, respectively) in hemispheres with a cocktail vessel appearance. The trend of progression in hemodynamic severity in the order of normal appearance, cocktail vessel appearance, and vacant vessel appearance in the watershed area was statistically significant. CONCLUSION Fused 3-dimensional digital subtraction angiography demonstrated unique angiographic features in the watershed area, and this represented the degree of cerebral hemodynamic impairment in moyamoya disease.
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Affiliation(s)
- Jun Karakama
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan; Department of Endovascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tadashi Nariai
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan; Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.
| | - Shoko Hara
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shihori Hayashi
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan; Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Kazutaka Sumita
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan; Department of Endovascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Motoki Inaji
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan; Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Yoji Tanaka
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kei Wagatsuma
- Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Kenji Ishii
- Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Shigeru Nemoto
- Department of Endovascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Taketoshi Maehara
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
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15
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Griffith B, Jain R. Perfusion Imaging in Neuro-Oncology: Basic Techniques and Clinical Applications. Magn Reson Imaging Clin N Am 2017; 24:765-779. [PMID: 27742116 DOI: 10.1016/j.mric.2016.07.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Perfusion imaging is a method for assessing the flow of blood occurring at the tissue level and can be accomplished by both CT and MR perfusion techniques. The use of perfusion imaging has increased substantially in the past decade, particularly in neuro-oncologic imaging, where it is has been used for brain tumor grading and directing biopsies or targeted therapy, as well as for the evaluation of treatment response and disease progression. This article discusses the basic principles and techniques of perfusion imaging, as well as its applications in neuro-oncology.
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Affiliation(s)
- Brent Griffith
- Department of Radiology, Henry Ford Health System, Detroit, MI, USA.
| | - Rajan Jain
- NYU School of Medicine, NYU Langone Medical Center, New York, NY, USA
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16
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Lin A, Rawal S, Agid R, Mandell DM. Cerebrovascular Imaging: Which Test is Best? Neurosurgery 2017; 83:5-18. [DOI: 10.1093/neuros/nyx325] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 05/12/2017] [Indexed: 11/12/2022] Open
Abstract
Abstract
Optimal diagnosis and characterization of cerebrovascular disease requires selection of the appropriate imaging exam for each clinical situation. In this review, we focus on intracranial arterial disease and discuss the techniques in current clinical use for imaging the blood vessel lumen and blood vessel wall, and for mapping cerebral hemodynamic impairment at the tissue level. We then discuss specific strategies for imaging intracranial aneurysms, arteriovenous malformations, dural arterial venous fistulas, and arterial steno-occlusive disease.
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Affiliation(s)
- Amy Lin
- Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital and the University of Toronto, Toronto, Ontario, Canada
| | - Sapna Rawal
- Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital and the University of Toronto, Toronto, Ontario, Canada
| | - Ronit Agid
- Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital and the University of Toronto, Toronto, Ontario, Canada
| | - Daniel M Mandell
- Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital and the University of Toronto, Toronto, Ontario, Canada
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17
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Ravi H, Liu P, Peng SL, Liu H, Lu H. Simultaneous multi-slice (SMS) acquisition enhances the sensitivity of hemodynamic mapping using gas challenges. NMR IN BIOMEDICINE 2016; 29:1511-1518. [PMID: 27598821 PMCID: PMC5123823 DOI: 10.1002/nbm.3600] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/29/2016] [Accepted: 07/18/2016] [Indexed: 06/06/2023]
Abstract
Hemodynamic mapping using gas inhalation has received increasing interest in recent years. Cerebrovascular reactivity (CVR), which reflects the ability of the brain vasculature to dilate in response to a vasoactive stimulus, can be measured by CO2 inhalation with continuous acquisition of blood oxygen level-dependent (BOLD) magnetic resonance images. Cerebral blood volume (CBV) can be measured by O2 inhalation. These hemodynamic mapping methods are appealing because of their absence of gadolinium contrast agent, their ability to assess both baseline perfusion and vascular reserve, and their utility in calibrating the functional magnetic resonance imaging (fMRI) signal. However, like other functional and physiological indices, a major drawback of these measurements is their poor sensitivity and reliability. Simultaneous multi-slice echo planar imaging (SMS EPI) is a fast imaging technology that allows the excitation and acquisition of multiple two-dimensional slices simultaneously, and has been shown to enhance the sensitivity of several MRI applications. To our knowledge, the benefit of SMS in gas inhalation imaging has not been investigated. In this work, we compared the sensitivity of CO2 and O2 inhalation data collected using SMS factor 2 (SMS2) and SMS factor 3 (SMS3) with those collected using conventional EPI (SMS1). We showed that the sensitivity of SMS scans was significantly (p = 0.01) higher than that of conventional EPI, although no difference was found between SMS2 and SMS3 (p = 0.3). On a voxel-wise level, approximately 20-30% of voxels in the brain showed a significant enhancement in sensitivity when using SMS compared with conventional EPI, with other voxels showing an increase, but not reaching statistical significance. When using SMS, the scan duration can be reduced by half, whilst maintaining the sensitivity of conventional EPI. The availability of a sensitive acquisition technique can further enhance the potential of gas inhalation MRI in clinical applications.
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Affiliation(s)
- Harshan Ravi
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
- Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA
| | - Peiying Liu
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
- Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Shin-Lei Peng
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
- Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan
| | - Hanli Liu
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA
| | - Hanzhang Lu
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA.
- Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX, USA.
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18
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Cheung AHK, Lam AKC, Ho WSW, Tsang CP, Tsang ACO, Lee R, Lui WM, Leung GKK. Surgical Outcome for Moyamoya Disease: Clinical and Perfusion Computed Tomography Correlation. World Neurosurg 2016; 98:81-88. [PMID: 27810451 DOI: 10.1016/j.wneu.2016.10.117] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 10/23/2016] [Accepted: 10/24/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To compare surgical outcome both radiologically and clinically after interventions for patients with Moyamoya disease. METHODS This retrospective observational study included 25 patients who were treated surgically for Moyamoya disease in the past 14 years. Clinical outcomes were analyzed by subgroups stratified by age, disease presentation, and surgical intervention. Serial postoperative brain computed tomography perfusion records were analyzed with respect to the cerebral blood flow and cerebrovascular reserve capacity (CVRC) of the middle cerebral artery territory. Changes in both the intervention (n = 23) and nonintervtion (n = 9) cerebral hemispheres were compared. RESULTS All children treated by synangiosis (n = 9), all adults receiving synangiosis (n = 5), and 88.9% of adults undergoing bypass (n = 9) had no neurologic deterioration, with a duration of at least 50.6 months, 85.7 months, and 27.7 months, respectively. Radiologically, CVRC improved more markedly after bypass surgery than synangiosis, particularly 12-24 months postoperatively (51.1% vs. -2.86%). The hemispheres that did not undergo intervention showed similar improvement in cerebral blood flow over time compared with the hemispheres that did undergo intervention, after surgery was performed. CONCLUSIONS Bypass surgery improved CVRC greater than synangiosis, which may correlate with decreased future stroke risks. The decision for bypass is to be balanced with a greater risk of postoperative neurologic deterioration in adults after this procedure. The hemisphere that did not undergo intervention also appeared to benefit from surgery performed on the contralateral brain.
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Affiliation(s)
- Alvin Ho-Kwan Cheung
- Divsion of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong
| | | | - Wai-Shing Wilson Ho
- Divsion of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong
| | - Chun-Pong Tsang
- Divsion of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong
| | - Anderson Chun-On Tsang
- Divsion of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong
| | - Raymond Lee
- Department of Radiology, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Wai-Man Lui
- Divsion of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong
| | - Gilberto Ka-Kit Leung
- Divsion of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong.
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Lin CF, Hsu SPC, Lin CJ, Guo WY, Liao CH, Chu WF, Hung SC, Shih YS, Lin YT. Prolonged Cerebral Circulation Time Is the Best Parameter for Predicting Vasospasm during Initial CT Perfusion in Subarachnoid Hemorrhagic Patients. PLoS One 2016; 11:e0151772. [PMID: 26986626 PMCID: PMC4795708 DOI: 10.1371/journal.pone.0151772] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 03/03/2016] [Indexed: 12/03/2022] Open
Abstract
Purpose We sought to imitate angiographic cerebral circulation time (CCT) and create a similar index from baseline CT perfusion (CTP) to better predict vasospasm in patients with subarachnoid hemorrhage (SAH). Methods Forty-one SAH patients with available DSA and CTP were retrospectively included. The vasospasm group was comprised of patients with deterioration in conscious functioning and newly developed luminal narrowing; remaining cases were classified as the control group. The angiography CCT (XA-CCT) was defined as the difference in TTP (time to peak) between the selected arterial ROIs and the superior sagittal sinus (SSS). Four arterial ROIs were selected to generate four corresponding XA-CCTs: the right and left anterior cerebral arteries (XA-CCTRA2 and XA-CCTLA2) and right- and left-middle cerebral arteries (XA-CCTRM2 and XA-CCTLM2). The CCTs from CTP (CT-CCT) were defined as the differences in TTP from the corresponding arterial ROIs and the SSS. Correlations of the different CCTs were calculated and diagnostic accuracy in predicting vasospasm was evaluated. Results Intra-class correlations ranged from 0.96 to 0.98. The correlations of XA-CCTRA2, XA-CCTRM2, XA-CCTLA2, and XA-CCTLM2 with the corresponding CT-CCTs were 0.64, 0.65, 0.53, and 0.68, respectively. All CCTs were significantly prolonged in the vasospasm group (5.8–6.4 s) except for XA-CCTLA2. CT-CCTA2 of 5.62 was the optimal cut-off value for detecting vasospasm with a sensitivity of 84.2% and specificity 82.4% Conclusion CT-CCTs can be used to interpret cerebral flow without deconvolution algorithms, and outperform both MTT and TTP in predicting vasospasm risk. This finding may help facilitate management of patients with SAH.
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Affiliation(s)
- Chun Fu Lin
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Sanford P. C. Hsu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chung Jung Lin
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wan Yuo Guo
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- * E-mail:
| | - Chih Hsiang Liao
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei Fa Chu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Sheng Che Hung
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yang Shin Shih
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yen Tzu Lin
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Prediction of cerebral hyperperfusion syndrome after carotid artery stenting by CT perfusion imaging with acetazolamide challenge. Neuroradiology 2015; 58:253-9. [DOI: 10.1007/s00234-015-1623-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 11/17/2015] [Indexed: 11/26/2022]
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Griffith B, Jain R. Perfusion imaging in neuro-oncology: basic techniques and clinical applications. Radiol Clin North Am 2015; 53:497-511. [PMID: 25953286 DOI: 10.1016/j.rcl.2015.01.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Perfusion imaging is a method for assessing the flow of blood occurring at the tissue level and can be accomplished by both CT and MR perfusion techniques. The use of perfusion imaging has increased substantially in the past decade, particularly in neuro-oncologic imaging, where it is has been used for brain tumor grading and directing biopsies or targeted therapy, as well as for the evaluation of treatment response and disease progression. This article discusses the basic principles and techniques of perfusion imaging, as well as its applications in neuro-oncology.
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Affiliation(s)
- Brent Griffith
- Department of Radiology, Henry Ford Health System, Detroit, MI, USA.
| | - Rajan Jain
- NYU School of Medicine, NYU Langone Medical Center, New York, NY, USA
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Chen Y, Xu W, Guo X, Shi Z, Sun Z, Gao L, Jin F, Wang J, Chen W, Yang Y. CT perfusion assessment of Moyamoya syndrome before and after direct revascularization (superficial temporal artery to middle cerebral artery bypass). Eur Radiol 2015; 26:254-61. [PMID: 25925360 DOI: 10.1007/s00330-015-3802-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 03/22/2015] [Accepted: 04/14/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the utility of CT perfusion (CTP) for the assessment of superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis in patients with Moyamoya syndrome (MMS). SUBJECTS AND METHODS Twenty-four consecutive MMS patients, who underwent unilateral STA-MCA bypass surgery, received CTP before and after surgery. The relative perfusion parameter values of surgical hemispheres before treatment were compared with post-treatment values. All patients underwent CT angiography (CTA) before and after surgery in order to confirm the patency of bypass. RESULTS The follow-up CTA after surgery clearly demonstrated 20 (20/24, 83.3 %) bypass arteries, whereas four (16.7 %) bypass arteries were occluded or very small. Postoperative rMTT and rTTP values (P < 0.05) of the surgical side were significantly lower than pre-operation. In patients (n = 20) with bypass patency, postoperative rCBF, rMTT and rTTP values (P < 0.05) of the surgical side were significantly improved. However, the differences of all parameters were not significant (P > 0.05) in the patients (n = 4) without bypass patency after revascularization. CONCLUSION This study demonstrates that CTP can provide a crucial quantitative assessment of cerebral haemodynamic changes in MMS before and after STA-MCA anastomosis. KEY POINTS Twenty-four MMS patients undergoing STA-MCA bypass received CTP pre- and post-surgery. Cerebral haemodynamics improved on the surgical side post-surgery on CTP maps. rCBF might have a better correlation with patency of the bypass artery. CTP can evaluate cerebral perfusion changes in MMS patients after cerebral revascularization.
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Affiliation(s)
- Yueqin Chen
- Department of Radiology, the Affiliated Hospital of Qingdao University, Qingdao, 266003, China
- CT Department, the Affiliated Hospital of Jining Medical College, Jining, 272029, China
| | - Wenjian Xu
- Department of Radiology, the Affiliated Hospital of Qingdao University, Qingdao, 266003, China.
| | - Xiang Guo
- CT Department, the Affiliated Hospital of Jining Medical College, Jining, 272029, China
| | - Zhitao Shi
- CT Department, the Affiliated Hospital of Jining Medical College, Jining, 272029, China
| | - Zhanguo Sun
- CT Department, the Affiliated Hospital of Jining Medical College, Jining, 272029, China
| | - Lingyun Gao
- MR Department, the Affiliated Hospital of Jining Medical College, Jining, 272029, China
| | - Feng Jin
- Department of Neurosurgery, the Affiliated Hospital of Jining Medical College, Jining, 272029, China
| | - Jiehuan Wang
- CT Department, the Affiliated Hospital of Jining Medical College, Jining, 272029, China
| | - Weijian Chen
- Department of Radiology, the first Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Yunjun Yang
- Department of Radiology, the first Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
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Tong E, Wintermark M. CTA-enhanced perfusion CT: an original method to perform ultra-low-dose CTA-enhanced perfusion CT. Neuroradiology 2014; 56:955-64. [DOI: 10.1007/s00234-014-1416-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 07/23/2014] [Indexed: 10/25/2022]
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Kronenburg A, Braun KPJ, van der Zwan A, Klijn CJM. Recent advances in moyamoya disease: pathophysiology and treatment. Curr Neurol Neurosci Rep 2014; 14:423. [PMID: 24310442 DOI: 10.1007/s11910-013-0423-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Moyamoya disease is a progressive intracranial arteriopathy characterized by bilateral stenosis of the distal portion of the internal carotid artery and the proximal anterior and middle cerebral arteries, resulting in transient ischemic attacks or strokes. The pathogenesis of moyamoya disease remains unresolved, but recent advances have suggested exciting new insights into a genetic contribution as well as into other pathophysiological mechanisms. Treatment that may halt progression of the disease or even reverse the intracranial arteriopathy is yet to be found. There are strong indications that neurosurgical intervention, through direct, indirect, or combined revascularization surgery, can reduce the risk of ischemic stroke and possibly also cognitive dysfunction by improving cerebral perfusion, although randomized clinical trials have not been performed. Many questions regarding the indication for and timing of surgery remain unanswered. In this review, we discuss recent developments in the pathogenesis and treatment of moyamoya disease.
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Affiliation(s)
- Annick Kronenburg
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, UMC Utrecht, Postbus 85500, 3508 GA, Utrecht, The Netherlands,
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Lin CJ, Chang FC, Tsai FY, Guo WY, Hung SC, Chen DYT, Lin CH, Chang CY. Stenotic transverse sinus predisposes to poststenting hyperperfusion syndrome as evidenced by quantitative analysis of peritherapeutic cerebral circulation time. AJNR Am J Neuroradiol 2014; 35:1132-6. [PMID: 24436346 DOI: 10.3174/ajnr.a3838] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Hyperperfusion syndrome is a devastating complication of carotid stent placement. The shortening of cerebral circulation time after stent placement is seen as a good indicator of the development of hyperperfusion syndrome. The purpose of our study was to evaluate whether patients with ipsilateral transverse sinus stenosis are prone to having shortened cerebral circulation time after stent placement, subsequently leading to the possible development of hyperperfusion syndrome. MATERIALS AND METHODS Forty-nine patients with >70% unilateral carotid stenosis undergoing stent placement were recruited for analysis. Group A consisted of patients with a stenotic ipsilateral transverse sinus >50% greater than the diameter of the contralateral transverse sinus; the remaining patients were in group B. Quantitative DSA was used to calculate cerebral circulation time. Cerebral circulation time was defined as the time difference between the relative time to maximal intensity of ROIs in the proximal internal carotid artery and the internal jugular vein. ΔCCT was defined as cerebral circulation time before stent placement minus cerebral circulation time after stent placement. ΔCCT, white matter hyperintensity signals, and sulcal effacement in MR imaging were compared between the 2 groups. RESULTS ΔCCT was significantly shorter in group A (0.65 ± 1.3) than in group B (-0.12 ± 1.4). Three patients had white matter hyperintensity signals in group A, and 1 developed hyperperfusion syndrome. Group B showed no MR imaging signs of hyperperfusion syndrome. CONCLUSIONS Ipsilateral hypoplastic transverse sinus was associated with prolonged cerebral circulation time before stent placement and greatly shortened cerebral circulation time after stent placement. Inadequate venous drainage might play a role in impaired cerebral autoregulation and might influence the development of poststenting hyperperfusion syndrome.
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Affiliation(s)
- C-J Lin
- From the Department of Radiology (C.-J.L., F.-C.C., W.-Y.G., S.-C.H., C.-Y.C.), Taipei Veterans General Hospital, Taipei, TaiwanSchool of Medicine (C.-J.L., F.-C.C., W.-Y.G., S.-C.H., C.-Y.C.), National Yang Ming University, Taipei, Taiwan
| | - F-C Chang
- From the Department of Radiology (C.-J.L., F.-C.C., W.-Y.G., S.-C.H., C.-Y.C.), Taipei Veterans General Hospital, Taipei, TaiwanSchool of Medicine (C.-J.L., F.-C.C., W.-Y.G., S.-C.H., C.-Y.C.), National Yang Ming University, Taipei, Taiwan
| | - F-Y Tsai
- Imaging Research Center (F.-Y.T., D.Y.-T.C.), Taipei Medical University, Taipei, Taiwan
| | - W-Y Guo
- From the Department of Radiology (C.-J.L., F.-C.C., W.-Y.G., S.-C.H., C.-Y.C.), Taipei Veterans General Hospital, Taipei, TaiwanSchool of Medicine (C.-J.L., F.-C.C., W.-Y.G., S.-C.H., C.-Y.C.), National Yang Ming University, Taipei, Taiwan
| | - S-C Hung
- From the Department of Radiology (C.-J.L., F.-C.C., W.-Y.G., S.-C.H., C.-Y.C.), Taipei Veterans General Hospital, Taipei, TaiwanSchool of Medicine (C.-J.L., F.-C.C., W.-Y.G., S.-C.H., C.-Y.C.), National Yang Ming University, Taipei, Taiwan
| | - D Y-T Chen
- Imaging Research Center (F.-Y.T., D.Y.-T.C.), Taipei Medical University, Taipei, TaiwanDepartment of Medical Imaging (D.Y.-T.C.), Shuang-Ho Hospital, New Taipei City, Taiwan
| | - C-H Lin
- Graduate Institute of Epidemiology and Preventive Medicine (C.-H.L.), National Taiwan University, Taipei, Taiwan
| | - C-Y Chang
- From the Department of Radiology (C.-J.L., F.-C.C., W.-Y.G., S.-C.H., C.-Y.C.), Taipei Veterans General Hospital, Taipei, TaiwanSchool of Medicine (C.-J.L., F.-C.C., W.-Y.G., S.-C.H., C.-Y.C.), National Yang Ming University, Taipei, Taiwan
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Huang APH, Tsai JC, Kuo LT, Lee CW, Lai HS, Tsai LK, Huang SJ, Chen CM, Chen YS, Chuang HY, Wintermark M. Clinical application of perfusion computed tomography in neurosurgery. J Neurosurg 2013; 120:473-88. [PMID: 24266541 DOI: 10.3171/2013.10.jns13103] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECT Currently, perfusion CT (PCT) is a valuable imaging technique that has been successfully applied to the clinical management of patients with ischemic stroke and aneurysmal subarachnoid hemorrhage (SAH). However, recent literature and the authors' experience have shown that PCT has many more important clinical applications in a variety of neurosurgical conditions. Therefore, the authors share their experiences of its application in various diseases of the cerebrovascular, neurotraumatology, and neurooncology fields and review the pertinent literature regarding expanding PCT applications for neurosurgical conditions, including pitfalls and future developments. METHODS A pertinent literature search was conducted of English-language articles describing original research, case series, and case reports from 1990 to 2011 involving PCT and with relevance and applicability to neurosurgical disorders. RESULTS In the cerebrovascular field, PCT is already in use as a diagnostic tool for patients suspected of having an ischemic stroke. Perfusion CT can be used to identify and define the extent of the infarct core and ischemic penumbra core, and thus aid patient selection for acute reperfusion therapy. For patients with aneurysmal SAH, PCT provides assessment of early brain injury, cerebral ischemia, and infarction, in addition to vasospasm. It may also be used to aid case selection for aggressive treatment of patients with poor SAH grade. In terms of oncological applications, PCT can be used as an imaging biomarker to assess angiogenesis and response to antiangiogenetic treatments, differentiate between glioma grades, and distinguish recurrent tumor from radiation necrosis. In the setting of traumatic brain injury, PCT can detect and delineate contusions at an early stage. In patients with mild head injury, PCT results have been shown to correlate with the severity and duration of postconcussion syndrome. In patients with moderate or severe head injury, PCT results have been shown to correlate with patients' functional outcome. CONCLUSIONS Perfusion CT provides quantitative and qualitative data that can add diagnostic and prognostic value in a number of neurosurgical disorders, and also help with clinical decision making. With emerging new technical developments in PCT, such as characterization of blood-brain barrier permeability and whole-brain PCT, this technique is expected to provide more and more insight into the pathophysiology of many neurosurgical conditions.
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Dai DW, Zhao WY, Zhang YW, Yang ZG, Li Q, Xu B, Ma XL, Tian B, Liu JM. Role of CT perfusion imaging in evaluating the effects of multiple burr hole surgery on adult ischemic Moyamoya disease. Neuroradiology 2013; 55:1431-8. [PMID: 24153446 PMCID: PMC3835952 DOI: 10.1007/s00234-013-1291-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 10/09/2013] [Indexed: 11/18/2022]
Abstract
Introduction To evaluate the effects of the multiple burr hole (MBH) revascularization on ischemic type adult Moyamoya disease (MMD) by computed tomography perfusion (CTP). Methods Eighty-six ischemic MMD patients received CTP 1 week before and 3 weeks after MBH operation. Fifty-seven patients received it again at 6 month and underwent digital subtraction angiography (DSA) and mRS follow-up. Cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), time to peak (TTP), and relative values of ischemic symptomatic hemispheres were measured. Differences in pre- and post-surgery perfusion CT values were assessed. Results There were significant differences of CBF, TTP, and relative time to peak (rTTP) in ischemic hemisphere between 1 week before and 3 weeks after surgery, and no significant difference in relative cerebral blood flow (rCBF), CBV, relative cerebral blood volume (rCBV), MTT, relative mean transit time (rMTT). According to whether there was symptom improvement or not on 3 weeks after MBH, the rTTP value was not statistically significant in the patients whose symptoms were not improved at all on 3 weeks after operation. Six-month follow-up showed that CBF, rCBF, and rCBV values were significantly higher than those before operation. Postoperative MTT, TTP, rMTT, and rTTP values were significantly lower than those before operation. Conclusion CTP is a sensitive method to obtain functional imaging of cerebral microcirculation, which can be a noninvasive assessment of the abnormalities of intracranial arteries and cerebral perfusion changes in MMD before and after surgery. CBF and TTP map, especially the relative values of TTP, seems to have the capability of being quite sensitive to the presence of altered brain perfusion at early time after indirect revascularization. Electronic supplementary material The online version of this article (doi:10.1007/s00234-013-1291-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dong Wei Dai
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, No. 168 Changhai Road, Yangpu District, Shanghai, 200433, People's Republic of China
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Zhang J, Wang J, Geng D, Li Y, Song D, Gu Y. Whole-brain CT perfusion and CT angiography assessment of Moyamoya disease before and after surgical revascularization: preliminary study with 256-slice CT. PLoS One 2013; 8:e57595. [PMID: 23451248 PMCID: PMC3579776 DOI: 10.1371/journal.pone.0057595] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 01/24/2013] [Indexed: 11/18/2022] Open
Abstract
Background/Aims The 256-slice CT enables the entire brain to be scanned in a single examination. We evaluated the application of 256-slice whole-brain CT perfusion (CTP) in determining graft patency as well as investigating cerebral hemodynamic changes in Moyamoya disease before and after surgical revascularization. Methods Thirty-nine cases of Moyamoya disease were evaluated before and after surgical revascularization with 256-slice CT. Whole-brain perfusion images and dynamic 3D CT angiographic images generated from perfusion source data were obtained in all patients. Cerebral blood flow (CBF), cerebral blood volume (CBV), time to peak (TTP) and mean transit time (MTT) of one hemisphere in the region of middle cerebral artery (MCA) distribution and contralateral mirroring areas were measured. Relative CTP values (rCBF, rCBV, rTTP, rMTT) were also obtained. Differences in pre- and post- operation perfusion CT values were assessed with paired t test or matched-pairs signed-ranks test. Results Preoperative CBF, MTT and TTP of potential surgical side were significantly different from those of contralateral side (P<0.01 for all). All graft patencies were displayed using the 3D-CTA images. Postoperative CBF, rCBF and rCBV values of surgical side in the region of MCA were significantly higher than those before operation (P<0.01 for all). Postoperative MTT, TTP, rMTT and rTTP values of the surgical side in the region of MCA were significantly lower than those before operation (P<0.05 for all). Conclusion The 256-slice whole-brain CTP can be used to evaluate cerebral hemodynamic changes in Moyamoya disease before and after surgery and the 3D-CTA is useful for assessing the abnormalities of intracranial arteries and graft patencies.
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Affiliation(s)
- Jun Zhang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jianhong Wang
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Daoying Geng
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
- * E-mail:
| | - Yuxin Li
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Donglei Song
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuxiang Gu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
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Sun W, Yuan C, Liu W, Li Y, Huang Z, Zhu W, Li M, Xu G, Liu X. Asymptomatic Cerebral Microbleeds in Adult Patients with Moyamoya Disease: A Prospective Cohort Study with 2 Years of Follow-Up. Cerebrovasc Dis 2013; 35:469-75. [DOI: 10.1159/000350203] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 02/20/2013] [Indexed: 11/19/2022] Open
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Chin SC, Chang CH, Chang TY, Huang KL, Wu TC, Lin JR, Chang YJ, Lee TH. Brain computed tomography perfusion may help to detect hemodynamic reconstitution and predict intracerebral hemorrhage after carotid stenting. J Vasc Surg 2012; 56:1281-90. [DOI: 10.1016/j.jvs.2012.04.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 04/16/2012] [Accepted: 04/17/2012] [Indexed: 10/28/2022]
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Moyamoya disease: evaluation of postoperative revascularization using multiphase selective arterial spin labeling MRI. J Comput Assist Tomogr 2012; 36:143-9. [PMID: 22261785 DOI: 10.1097/rct.0b013e31824150dd] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE The purpose of this study was to evaluate cerebral blood flow through the bypass in operated patients with Moyamoya disease using multiphase selective arterial spin labeling (ASL) technique. MATERIALS AND METHODS Fifteen surgically treated cerebral hemispheres from 11 patients with Moyamoya disease were included. Selective ASL examinations were performed during the early postoperative period (mean, 5.5 days) on 4 hemispheres and late postoperative period (mean, 332.7 days) on 15 hemispheres. The labeling slab was positioned at the bypassed external carotid artery and 5 slices in each of the 10 sequential phases were acquired using a 3-T scanner. RESULTS Two of 4 early postoperative ASL examinations and all late postoperative ASL examinations demonstrated blood flow through the bypass. The remaining 2 early postoperative ASL examinations showed absence of blood flow; however, blood flow improved on follow-up examinations. CONCLUSION Multiphase selective ASL technique can provide information about the dynamics of postoperative blood flow through the bypass in Moyamoya disease.
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Mogensen MA, Karzmark P, Zeifert PD, Rosenberg J, Marks M, Steinberg GK, Dorfman LJ. Neuroradiologic correlates of cognitive impairment in adult Moyamoya disease. AJNR Am J Neuroradiol 2011; 33:721-5. [PMID: 22173751 DOI: 10.3174/ajnr.a2852] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE MMD has been shown to result in impairment of executive functioning in adults. The purpose of this study was to correlate presurgical neuropsychological assessments with the severity of primary MMD as measured by CBF and CVR and with secondary damage from MMD as estimated by cortical stroke and WMD. MATERIALS AND METHODS A retrospective analysis of 31 adult patients with MMD was performed. Xe-CT was used to obtain CBF and CVR, and MRI was reviewed to grade cortical stroke and WMD. Two tests of executive functioning (FAS and TMT-B) were correlated with imaging findings. A multiple regression analysis was performed. RESULTS There was a significant overall positive relationship between mean CBF and FAS (P = .038) and TMT-B scores (P = .014). A significant negative relationship was present between the WMD score and the FAS (P = .009) and TMT-B scores (P = .015). Per-region analysis demonstrated that FAS and TMT-B scores were significantly decreased by the presence of a posterior stroke (P < .0001 and P = .001) or WMD (P = .006 and P = .004). All patients with posterior parieto-occipital WMD or stroke also had secondary disease in the anterior regions. CONCLUSIONS Impaired executive functioning in adults with MMD is most strongly associated secondary damage in the form of WMD or cortical stroke. The effect is most profound with parieto-occipital lobe involvement, likely a reflection of overall disease severity. Increasing global WMD burden may be a better indicator of cognitive decline than cortical infarction. Patients with higher baseline CBF seem to have better cognitive functioning.
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Affiliation(s)
- M A Mogensen
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Acetazolamide-challenged perfusion magnetic resonance imaging for assessment of cerebrovascular reserve capacity in patients with symptomatic middle cerebral artery stenosis: comparison with technetium-99m-hexamethylpropyleneamine oxime single-photon emission computed tomography. Clin Imaging 2011; 35:413-20. [DOI: 10.1016/j.clinimag.2011.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2010] [Accepted: 11/16/2010] [Indexed: 11/20/2022]
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Han JS, Abou-Hamden A, Mandell DM, Poublanc J, Crawley AP, Fisher JA, Mikulis DJ, Tymianski M. Impact of Extracranial–Intracranial Bypass on Cerebrovascular Reactivity and Clinical Outcome in Patients With Symptomatic Moyamoya Vasculopathy. Stroke 2011; 42:3047-54. [DOI: 10.1161/strokeaha.111.615955] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jay S. Han
- From the Department of Anesthesia (J.S.H., J.A.F.), University of Toronto and University Health Network, Toronto, Canada; the Department of Physiology (J.S.H., J.A.F., M.T.), University of Toronto, Toronto, Canada; the Division of Neurosurgery (A.A., M.T.), Department of Surgery (M.T.), University Health Network, Toronto, Canada; and the Division of Neuroradiology (D.M.M., J.P., A.P.C., D.J.M.), Department of Medical Imaging, University Health Network and the University of Toronto, Toronto, Canada
| | - Amal Abou-Hamden
- From the Department of Anesthesia (J.S.H., J.A.F.), University of Toronto and University Health Network, Toronto, Canada; the Department of Physiology (J.S.H., J.A.F., M.T.), University of Toronto, Toronto, Canada; the Division of Neurosurgery (A.A., M.T.), Department of Surgery (M.T.), University Health Network, Toronto, Canada; and the Division of Neuroradiology (D.M.M., J.P., A.P.C., D.J.M.), Department of Medical Imaging, University Health Network and the University of Toronto, Toronto, Canada
| | - Daniel M. Mandell
- From the Department of Anesthesia (J.S.H., J.A.F.), University of Toronto and University Health Network, Toronto, Canada; the Department of Physiology (J.S.H., J.A.F., M.T.), University of Toronto, Toronto, Canada; the Division of Neurosurgery (A.A., M.T.), Department of Surgery (M.T.), University Health Network, Toronto, Canada; and the Division of Neuroradiology (D.M.M., J.P., A.P.C., D.J.M.), Department of Medical Imaging, University Health Network and the University of Toronto, Toronto, Canada
| | - Julien Poublanc
- From the Department of Anesthesia (J.S.H., J.A.F.), University of Toronto and University Health Network, Toronto, Canada; the Department of Physiology (J.S.H., J.A.F., M.T.), University of Toronto, Toronto, Canada; the Division of Neurosurgery (A.A., M.T.), Department of Surgery (M.T.), University Health Network, Toronto, Canada; and the Division of Neuroradiology (D.M.M., J.P., A.P.C., D.J.M.), Department of Medical Imaging, University Health Network and the University of Toronto, Toronto, Canada
| | - Adrian P. Crawley
- From the Department of Anesthesia (J.S.H., J.A.F.), University of Toronto and University Health Network, Toronto, Canada; the Department of Physiology (J.S.H., J.A.F., M.T.), University of Toronto, Toronto, Canada; the Division of Neurosurgery (A.A., M.T.), Department of Surgery (M.T.), University Health Network, Toronto, Canada; and the Division of Neuroradiology (D.M.M., J.P., A.P.C., D.J.M.), Department of Medical Imaging, University Health Network and the University of Toronto, Toronto, Canada
| | - Joseph A. Fisher
- From the Department of Anesthesia (J.S.H., J.A.F.), University of Toronto and University Health Network, Toronto, Canada; the Department of Physiology (J.S.H., J.A.F., M.T.), University of Toronto, Toronto, Canada; the Division of Neurosurgery (A.A., M.T.), Department of Surgery (M.T.), University Health Network, Toronto, Canada; and the Division of Neuroradiology (D.M.M., J.P., A.P.C., D.J.M.), Department of Medical Imaging, University Health Network and the University of Toronto, Toronto, Canada
| | - David J. Mikulis
- From the Department of Anesthesia (J.S.H., J.A.F.), University of Toronto and University Health Network, Toronto, Canada; the Department of Physiology (J.S.H., J.A.F., M.T.), University of Toronto, Toronto, Canada; the Division of Neurosurgery (A.A., M.T.), Department of Surgery (M.T.), University Health Network, Toronto, Canada; and the Division of Neuroradiology (D.M.M., J.P., A.P.C., D.J.M.), Department of Medical Imaging, University Health Network and the University of Toronto, Toronto, Canada
| | - Michael Tymianski
- From the Department of Anesthesia (J.S.H., J.A.F.), University of Toronto and University Health Network, Toronto, Canada; the Department of Physiology (J.S.H., J.A.F., M.T.), University of Toronto, Toronto, Canada; the Division of Neurosurgery (A.A., M.T.), Department of Surgery (M.T.), University Health Network, Toronto, Canada; and the Division of Neuroradiology (D.M.M., J.P., A.P.C., D.J.M.), Department of Medical Imaging, University Health Network and the University of Toronto, Toronto, Canada
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Choi HS, Kim DS, Shim KW, Kim J, Kim ES, Lee SK. Focal time-to-peak changes on perfusion MRI in children with Moyamoya disease: correlation with conventional angiography. Acta Radiol 2011; 52:675-9. [PMID: 21525108 DOI: 10.1258/ar.2011.100495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Moyamoya disease is a chronic progressive steno-occlusion of the distal internal carotid arteries with unknown etiology. As the classical presentation of childhood Moyamoya disease is ischemic stroke, cerebral hemodynamic evaluation is important for patient selection for surgery to prevent recurrent ischemic attacks. Perfusion MR imaging has been applied to evaluate cerebral hemodynamics. PURPOSE To correlate the 'basal time-to-peak preservation sign', 'auto-synangiosis sign', and 'posterior involvement sign' on time-to-peak map of perfusion MRI with catheter angiography. MATERIAL AND METHODS Thirty-four children (6.91 ± 3.08 years) with Moyamoya disease who underwent both perfusion-weighted MRI and catheter angiography were enrolled in this study. Given catheter angiography as a reference standard, basal time-to-peak preservation sign, auto-synangiosis sign, and posterior involvement sign were evaluated on time-to-peak maps. RESULTS The basal time-to-peak preservation sign was accurate for the diagnosis of childhood Moyamoya disease; both sensitivity and specificity were 100%. The auto-synangiosis sign showed lower sensitivity (65%), however, with an acceptable specificity (98%). The posterior involvement sign showed lower sensitivity (61%) but had an acceptable specificity (96%). CONCLUSION The basal time-to-peak preservation sign may be a universal finding in childhood Moyamoya disease. The auto-synangiosis and posterior involvement sign may be useful in determining transdural collateral status and posterior circulation involvement in childhood Moyamoya disease.
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Affiliation(s)
- Hyun Seok Choi
- Department of Radiology
- Department of Radiology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Dong-Seok Kim
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul
| | - Kyu-Won Shim
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul
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Currie S, Raghavan A, Batty R, Connolly DJA, Griffiths PD. Childhood moyamoya disease and moyamoya syndrome: a pictorial review. Pediatr Neurol 2011; 44:401-13. [PMID: 21555050 DOI: 10.1016/j.pediatrneurol.2011.02.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 11/24/2010] [Accepted: 02/10/2011] [Indexed: 10/18/2022]
Abstract
Moyamoya disease is an uncommon chronic cerebrovasculopathy, characterized by progressive stenosis of the terminal portion of the internal carotid artery and its main branches, in association with the development of compensatory collateral vessels at the base of the brain. The etiology is unknown, and was originally considered exclusive to East Asia, with particular prevalence in Japan. Moyamoya disease is increasingly diagnosed throughout the world, and represents an important cause of childhood stroke in Western countries. In some cases, similar angiographic features are evident in children with other medical conditions, such as sickle cell disease and Down syndrome. In these instances, the term "moyamoya syndrome" is used. Diagnosing the vasculopathy, excluding possible associated conditions, and planning treatment and follow-up imaging comprise important aspects of clinical management. We review the key imaging features of childhood moyamoya disease and syndrome, present examples of its associations, and discuss new neuroradiologic methods that may be useful in management.
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Affiliation(s)
- Stuart Currie
- Leeds and West Yorkshire Radiology Academy, Leeds General Infirmary, Leeds University Teaching Hospitals, National Health Service Trust, Leeds, United Kingdom.
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Langner S, Fleck S, Seipel R, Schroeder HWS, Hosten N, Kirsch M. Perfusion CT scanning and CT angiography in the evaluation of extracranial-intracranial bypass grafts. J Neurosurg 2010; 114:978-83. [PMID: 20617876 DOI: 10.3171/2010.6.jns10117] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Extracranial-intracranial (EC-IC) bypass surgery remains an important treatment alternative for patients with occlusive cerebrovascular disease. The aim of the present study was to use perfusion CT and CT angiography (CTA) to evaluate cerebral hemodynamics and bypass patency in patients with occlusive cerebrovascular disease before and after EC-IC bypass surgery. METHODS Ten patients underwent perfusion CT and CTA before and after bypass surgery. Preoperative and postoperative digital subtraction angiography served as the diagnostic gold standard. An artery bypass was established from the superficial temporal artery to a cortical branch of the middle cerebral artery. Perfusion CT scanning was performed at the level of the basal ganglia. Color-coded perfusion maps of cerebral blood volume, cerebral blood flow, and time to peak were calculated. RESULTS Preoperative perfusion CT showed significant prolonged time to peak and reduced cerebral blood flow of the affected hemisphere. Postoperative neurological deterioration did not develop in any patient. Computed tomography angiography provided adequate evaluation of the anastomoses as well as the course and caliber of the bypass and confirmed bypass patency in all patients. Postoperative perfusion CT showed improved cerebral hemodynamics with a return to nearly normal perfusion parameters. CONCLUSIONS Computed tomography angiography is a noninvasive and reliable tool for evaluating patients with EC-IC bypass. Perfusion CT allows monitoring of hemodynamic changes after bypass surgery. The combination of both modalities enables noninvasive anatomical and functional analysis of superficial temporal artery-middle cerebral artery anastomoses using a single CT protocol. Hemodynamic evaluation of patients with occlusive cerebrovascular disease before and after surgery may improve the prediction of outcome and may help identify patients in whom a bypass procedure can be performed.
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Affiliation(s)
- Soenke Langner
- Institute for Diagnostic Radiology and Neuroradiology, Ernst-Moritz-Arndt-University Greifswald, Germany.
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Lui YW, Tang ER, Allmendinger AM, Spektor V. Evaluation of CT perfusion in the setting of cerebral ischemia: patterns and pitfalls. AJNR Am J Neuroradiol 2010; 31:1552-63. [PMID: 20190208 DOI: 10.3174/ajnr.a2026] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
CTP has a growing role in evaluating stroke. It can be performed immediately following NCCT and has advantages of accessibility and speed. Differentiation of salvageable ischemic penumbra from unsalvageable core infarct may help identify patients most likely to benefit from thrombectomy or thrombolysis. Still, CTP interpretation can be complex. We review normal and ischemic perfusion patterns followed by an illustrative series of technical/diagnostic challenges of CTP interpretation in the setting of acute stroke syndromes.
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Affiliation(s)
- Y W Lui
- Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210th St., Bronx, NY 10467, USA.
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Patient selection for revascularization procedures in adult Moyamoya disease based on dynamic perfusion computerized tomography with acetazolamide challenge (PCTA). Neurosurg Rev 2010; 33:225-32; discussion 232-3. [DOI: 10.1007/s10143-010-0237-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Revised: 09/17/2009] [Accepted: 09/18/2009] [Indexed: 10/19/2022]
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Lee M, Zaharchuk G, Guzman R, Achrol A, Bell-Stephens T, Steinberg GK. Quantitative hemodynamic studies in moyamoya disease: a review. Neurosurg Focus 2009; 26:E5. [PMID: 19335131 DOI: 10.3171/2009.1.focus08300] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Moyamoya disease is characterized by a chronic stenoocclusive vasculopathy affecting the terminal internal carotid arteries. The clinical presentation and outcome of moyamoya disease remain varied based on angiographic studies alone, and much work has been done to study cerebral hemodynamics in this group of patients. The ability to measure cerebral blood flow (CBF) accurately continues to improve with time, and with it a better understanding of the pathophysiological mechanisms in patients with moyamoya disease. The main imaging techniques used to evaluate cerebral hemodynamics include PET, SPECT, xenon-enhanced CT, dynamic perfusion CT, MR imaging with dynamic susceptibility contrast and with arterial spin labeling, and Doppler ultrasonography. More invasive techniques include intraoperative ultrasonography. The authors review the current knowledge of CBF in this group of patients and the role each main quantitative method has played in evaluating them, both in the disease state and after surgical intervention.
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Affiliation(s)
- Marco Lee
- Department of Neurosurgery, Stanford Stroke Center, Stanford, California, USA.
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Vagal AS, Leach JL, Fernandez-Ulloa M, Zuccarello M. The acetazolamide challenge: techniques and applications in the evaluation of chronic cerebral ischemia. AJNR Am J Neuroradiol 2009; 30:876-84. [PMID: 19246526 DOI: 10.3174/ajnr.a1538] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The acetazolamide (ACZ) challenge test is a useful clinical tool and a reliable predictor of critically reduced perfusion. In patients with chronic steno-occlusive disease, the ability to maintain normal cerebral blood flow by reducing vascular resistance secondary to autoregulatory vasodilation is compromised. Identification of the presence and degree of autoregulatory vasodilation (reflecting the cerebrovascular reserve) is a significant prognostic factor in patients with chronic cerebrovascular disease. The pharmacologic challenge of a vasodilatory stimulus such as ACZ can also be used to optimize the treatment strategies for these patients. The pathophysiology, methods, and clinical applications of the ACZ challenge test are discussed in this article.
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Affiliation(s)
- A S Vagal
- Department of Radiology, Section of Neuroradiology, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267-0762, USA.
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