CT perfusion assessment of Moyamoya syndrome before and after direct revascularization (superficial temporal artery to middle cerebral artery bypass)

• Published in: European radiology Vol. 26; no. 1; pp. 254 - 261
• Main Authors: Chen, Yueqin, Xu, Wenjian, Guo, Xiang, Shi, Zhitao, Sun, Zhanguo, Gao, Lingyun, Jin, Feng, Wang, Jiehuan, Chen, Weijian, Yang, Yunjun
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.01.2016; Springer Nature B.V
• Subjects: Adult; Cerebral Revascularization - methods; Cerebrovascular Circulation; Diagnostic Radiology; Female; Heart surgery; Hemodynamics; Hospitals; Humans; Imaging; Internal Medicine; Interventional Radiology; Ischemia; Male; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Middle Cerebral Artery - diagnostic imaging; Moyamoya Disease - diagnostic imaging; Moyamoya Disease - surgery; Neuro; Neuroradiology; Perfusion; Postoperative Period; Radiology; Temporal Arteries - diagnostic imaging; Tomography; Tomography, X-Ray Computed - methods; Ultrasound; China; Moyamoya syndrome; Cerebral revascularization; Angiography; Perfusion; Multidetector computed tomography
• ISSN: 0938-7994; 1432-1084; 1432-1084
• DOI: 10.1007/s00330-015-3802-4

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