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Open Access 01-12-2023 | Computed Tomography | Original Article

Evaluation of surgical revascularization procedure outcomes for adult Moyamoya disease: a computed tomography perfusion-based study

Authors: Xuexia Yuan, Hao Yu, Zhanguo Sun, Jiaxing Wu, Lingyun Gao, Zhen Chong, Feng Jin, Yueqin Chen, Deguo Liu

Published in: Insights into Imaging | Issue 1/2023

Abstract

Background

The effectiveness of surgical interventions, whether direct or indirect, for Moyamoya disease (MMD) remains controversial. This study aims to investigate CT perfusion (CTP) as an objective method to evaluate the outcomes of different surgical modalities for adult MMD.

Methods

The clinical and imaging data of 41 patients who underwent superficial temporal artery-middle cerebral artery (STA-MCA) bypass and 43 who received encephaloduroarteriosynangiosis (EDAS) were retrospectively analyzed. Intra- and intergroup differences in the Modified Rankin Scale (mRS) score, the change in clinical symptoms, collateral grade, and CTP parameters pre- and postoperatively were compared.

Results

The overall level of the change in clinical symptoms in the STA-MCA group was higher than in the EDAS group (p < 0.05). In the operative area, the relative cerebral blood flow (rCBF) was significantly higher whereas the relative time to peak (rTTP) and the relative mean transit time (rMTT) were significantly lower in the STA-MCA and EDAS groups postoperatively than preoperatively (all p < 0.05). In the ipsilateral frontal lobe and basal ganglia, the postoperative rCBF was significantly higher, and the rTTP was significantly lower than the preoperative in the STA-MCA group (all p < 0.05). The postoperative rCBF improvement was higher in each brain area for STA-MCA than in the EDAS group (all p < 0.05).

Conclusion

Highlighting the utility of CTP, this study demonstrates its effectiveness in assessing postoperative cerebral hemodynamic changes in adult MMD patients. STA-MCA yielded a larger postoperative perfusion area and greater improvement compared to EDAS, suggesting CTP’s potential to elucidate symptom variation between two surgical revascularization procedures.

Critical relevance statement

We analyzed computed tomography perfusion parameters in pre- and postoperative adult Moyamoya disease patients undergoing superficial temporal artery-middle cerebral artery bypass and encephaloduroarteriosynangiosis. Our findings suggest computed tomography perfusion’s potential in objectively elucidating symptom variations between these surgical revascularization approaches for MMD.

Key points

• Postoperative perfusion improvement is only confined to the operative area after EDAS.

• Besides the operative area, postoperative perfusion in the ipsilateral frontal lobe and basal ganglia was also improved after STA-MCA.

• The degree of perfusion improvement in each brain area in the STA-MCA group was generally greater than that in the EDAS group.

Graphical Abstract

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Title: Evaluation of surgical revascularization procedure outcomes for adult Moyamoya disease: a computed tomography perfusion-based study
Authors: Xuexia Yuan
Hao Yu
Zhanguo Sun
Jiaxing Wu
Lingyun Gao
Zhen Chong
Feng Jin
Yueqin Chen
Deguo Liu
Publication date: 01-12-2023
Publisher: Springer Vienna
Keywords: Computed Tomography
Computed Tomography
Published in: Insights into Imaging / Issue 1/2023
Electronic ISSN: 1869-4101
DOI: https://doi.org/10.1186/s13244-023-01519-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Evaluation of surgical revascularization procedure outcomes for adult Moyamoya disease: a computed tomography perfusion-based study

Abstract

Background

Methods

Results

Conclusion

Critical relevance statement

Key points

Graphical Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Critical relevance statement

Key points

Graphical Abstract

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