Evaluation of Cerebral Hemodynamics with Perfusion MRI in Childhood Moyamoya Disease

Abstract

The purpose of our study was to evaluate the role of perfusion MRI and to compare the findings with those of conventional imaging in childhood moyamoya disease (MMD). Perfusion MRI was performed preoperatively on 13 cases of childhood MMD. Based on the perfusion MRI findings, patients were classified into four groups: those with normal regional cerebral blood volume (rCBV) and time to peak (TTP) (group 1, n = 2); those with normal rCBV and delayed TTP (group 2, n = 1); those with increased rCBV and delayed TTP (group 3, n = 5), and those with decreased rCBV and delayed TTP (group 4, n = 5). Lesion volume as determined using the rCBV map was compared with that on MRI and single photon emission computerized tomography (SPECT). The characteristics of groups 1, 2 and 3 were a high frequency of transient ischemic attacks, normal finding on MRI, early angiographic stages, decreased reserve on SPECT and favorable operative outcome. In group 3, angiography revealed abundant collateral channels. In group 4, all cases had infarction on MRI and abnormal perfusion on SPECT. Angiographic stages tended to have progressed, and operative outcome was less favorable. Perfusion MRI documented hemodynamic asymmetries in the five cases with normal MRI. Perfusion MRI is suggested to have a sensitivity intermediate between rest and acetazolamide SPECTs. We conclude that perfusion MRI may be a valuable tool for characterizing and monitoring ischemia in MMD. Perfusion MRI provides additional functional information not available from conventional MRI and has a potential role comparable to SPECT in the evaluation of MMD.

Changes in Integrity of Normal-Appearing White Matter in Patients with Moyamoya Disease: A Diffusion Tensor Imaging Study

“…3,[14][15][16] TTP images are simple to use for the assessment of collateral status, development of neovascularization after encephaloduroarteriosyangiosis, and general perfusion status. In addition, the ischemic hemisphere usually shows an increased rCBV due to compensatory vasodilation and delayed TTP due to proximal vessel stenosis.…”

Quantitative Assessment of Neovascularization after Indirect Bypass Surgery: Color-Coded Digital Subtraction Angiography in Pediatric Moyamoya Disease

“…Noninvasive imaging modalities such as perfusion MR imaging, single-photon emission CT, and positron-emission tomography can demonstrate secondary hemodynamic changes. [1][2][3][4]12,[21][22][23][24][25][26][27] However, these methods show only overall cerebral perfusion changes and cannot directly visualize fine parenchymal neovascularization itself following the operation.…”

“…1,2,5-9 Indirect bypass surgery using the parietal branch of the superficial temporal artery, encephaloduroarteriosynangiosis (EDAS), is preferred in pediatric patients with MMD because of the simple technique and the lower risk of temporary ischemia during the operation. 5,[10][11][12] Additional bifrontal encephalogaleo(periosteal)synangiosis can be performed to reinforce the anterior circulation. After bypass surgery, it is essential to evaluate the degree of neovascularization via the external carotid artery (ECA) system and subsequent changes occurring in the ICAs.…”

Postoperative epidural hematoma covering the galeal flap in pediatric patients with moyamoya disease: clinical manifestation, risk factors, and outcomes

“…Thus, this surgical approach may be a more effective modality for the treatment of MMD. 12,14,15 Postoperative EDH is a common complication of revascularization surgery for MMD. Palmer et al 19 reported an overall incidence rate of 1.1% for postoperative hematomas requiring surgical evacuation after craniotomies in general, and EDH accounted for 33% of these hematomas.…”