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Radiology. 2018 Aug;288(2):565-572. doi: 10.1148/radiol.2018170509. Epub 2018 May 1.

Monitoring Cerebral Perfusion Changes after Revascularization in Patients with Moyamoya Disease by Using Arterial Spin-labeling MR Imaging.

Author information

1
From the Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (S.L., T.J.Y., R.E.Y., K.M.K., S.H.C., J.H.K., C.H.S., M.H.H.); Department of Radiology (S.L., T.J.Y., R.E.Y., K.M.K., S.H.C., J.H.K., C.H.S., M.H.H.), Clinical Research Center for Stroke, Clinical Research Institute (B.W.Y.), Department of Neurology (B.W.Y.), and Department of Neurosurgery (J.E.K.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 03080, Republic of Korea.

Abstract

Purpose To determine whether arterial spin-labeling (ASL) magnetic resonance (MR) imaging could be used to identify changes in cerebral blood flow (CBF), collateral blood flow, and anastomosis site patency after revascularization in patients with moyamoya disease. Materials and Methods This retrospective study was conducted in 145 patients with moyamoya disease who underwent middle cerebral artery (MCA)-superficial temporal artery anastomosis. Preoperative, early postoperative, and late postoperative ASL and digital subtraction angiography images were analyzed. In the MCA territory, absolute CBF (hereafter, CBFMCA) and normalized CBF values adjusted to nonanastomosis side (hereafter, nCBFMCA) and to cerebellum (hereafter, nCBFCbll) were calculated. Collateral grading in the MCA territory was assessed according to Alberta Stroke Program Early CT Score methodology, and anastomosis site patency were also assessed. Changes in CBF were compared by using one-way analysis of variance with Bonferroni correction for multiple comparisons. Intermodality agreement was determined by κ statistics. Results Significant increases in CBFMCA, nCBFMCA, and nCBFCbll were found after revascularization (preoperative and postoperative values of CBFMCA, 35.2 mL/100 g per minute ± 7.8 [mean ± standard deviation] and 51.5 mL/100 g per minute ± 12.0; nCBFMCA, 0.73 mL/100 g per minute ± 0.14 and 1.01 mL/100 g per minute ± 0.18; nCBFCbll, 0.74 mL/100 g per minute ± 0.12 and 1.12 mL/100 g per minute ± 0.16; all P < .001). Agreements for collateral grading and anastomosis patency between ASL MR imaging and digital subtraction angiography were moderate to good, with weighted κ values of 0.77 (95% confidence interval: 0.73, 0.81) and 0.57 (95% confidence interval: 0.37, 0.76), respectively. Conclusion ASL MR imaging can be used to identify perfusion changes in patients with moyamoya disease after revascularization as a noninvasive monitoring tool.

PMID:
29714677
DOI:
10.1148/radiol.2018170509
[Indexed for MEDLINE]

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