Characteristics of cerebral hemodynamics assessed by CT perfusion in moyamoya disease

Sasagawa, Ayaka; Mikami, Takeshi; Hirano, Tôru; Akiyama, Yukinori; Mikuni, Nobuhiro

doi:10.1016/j.jocn.2017.09.020

Cited by 24 publications

(11 citation statements)

References 24 publications

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“…In the preoperative period, a CT perfusion scan displays regions of the salvageable ischemic brain, which contain an arterial territory that could be amenable to reperfusion with either a direct or indirect revascularization method. In cases of direct revascularization, the effectiveness of the surgery can be assessed based on the characteristics of cerebral hemodynamics on postop CT perfusion imaging [33]. The use of transcranial Doppler (TCD) can be employed to evaluate the mean arterial velocity and resistance index before and after surgery for a comparison of the effectiveness of revascularization [34].…”

Section: Suzuki Stage III Sub-stages Angiographic Appearancementioning

confidence: 99%

Moyamoya: An Update and Review

Berry¹,

Cortez²,

Toor³

et al. 2020

Cureus

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This article is a clinical review of Moyamoya disease (MMD) and Moyamoya syndrome (MMS). We review the incidence, epidemiology, pathology, historical context, clinical and radiographic findings, diagnostic imaging modalities, radiographic grading systems, the effectiveness of medical, interventional, and surgical treatment, and some of the nuances of surgical treatment options. This article will help pediatricians, neurologists, neurosurgeons, and other clinical practitioners who are involved in caring for patients with this rare clinical entity. MMD is an intrinsic primary disease process that causes bilateral progressive stenosis of the anterior intracranial circulation with the involvement of the proximal portions of the intracranial internal carotid artery (ICA) extending to involve the proximal portions of the anterior cerebral artery (ACA) and middle cerebral artery (MCA); posterior circulation involvement is very rare. This causes a compensatory response where large numbers of smaller vessels such as the lenticulostriate arteries begin to enlarge and proliferate, which gives the angiographic appearance of a "Puff of Smoke", which is translated into Japanese as "Moyamoya”. MMS is a secondary process that occurs in response to another underlying pathological process that causes stenosis of intracranial blood vessels, such as radiation. For example, an external source of radiation causes stenosis of the ICA with a compensatory response of smaller blood vessels, which then enlarge and proliferate in response and has the same "Puff of Smoke" appearance on the diagnostic cerebral angiogram (DCA). Histological findings include an irregular internal elastic lamina with luminal narrowing, hyperplasia of the tunica media, and intimal thickening with vacuolar degeneration in smooth muscle cells in the tunica media. Compensation for diminishing blood supply occurs through angiogenesis, which causes the proliferation and enlargement of smaller collateral blood vessels to increase blood supply to under-perfused areas of the brain. MMD is rare in the United States, with just 0.086 newly diagnosed cases per 100,000 individuals per year, which is approximately one per million new cases annually. Risk factors for MMD include Eastern Asian ancestry and predisposing conditions such as neurofibromatosis and Down's syndrome. Clinically, patients often present with stroke signs and symptoms from cerebral ischemia. The proliferation of collateral blood vessels within the basal ganglia can produce movement disorders. Catheter-based DCA is the current gold standard for obtaining a diagnosis. CT perfusion allows preoperative identification of ischemic vascular territories, which may be amenable to surgical intervention. MRI enables rapid detection of acute ischemic stroke using diffusion-weighted Imaging (DWI) and apparent diffusion coefficient (ADC) sequences to assess for any diffusion restriction. Non-contrast CT of the head is used to rule out acute hemorrhage in the presentation...

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Section: Suzuki Stage III Sub-stages Angiographic Appearancementioning

confidence: 99%

Moyamoya: An Update and Review

Berry¹,

Cortez²,

Toor³

et al. 2020

Cureus

View full text Add to dashboard Cite

show abstract

“…However, with the establishment of artificial collateral vessels and the regression of original collateral vessels, how the cerebral hemodynamics changes in hemorrhagic MMD after surgical revascularization is still unclear. CTP, as a reliable and readily accessible technique method, has been widely used in cerebral hemodynamic evaluation of MMD in clinical practice (22)(23)(24)(25). In this study, we found that in adult patients with hemorrhagic MMD, the most significant hemodynamic change after revascularization surgery was CBV reduction, accompanied by varying degrees of MTT and TTP shortening.…”

Section: Discussionmentioning

confidence: 68%

Cerebral Hemodynamic Changes After Revascularization in Patients With Hemorrhagic Moyamoya Disease

Kang

et al. 2020

Front. Neurol.

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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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“…During this specific phase of hemodynamic improvement, increased cerebral perfusion pressure can result in reduced MTT and TTP with or without vasodilatation. Nevertheless, in the absence of cerebral autoregulation induced by chronic cerebral hypoperfusion, CBV may remain within the previous range [ 20 ]. We hypothesize that CBF, as a subordinate sensitive parameter to changed brain perfusion, might have a better correlation with patency of the bypass artery [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Assessment of Single-Barrel Superficial Temporal Artery-Middle Cerebral Artery Bypass in Treatment for Adult Patients with Ischemic-Type Moyamoya Disease

Tao

Liu

et al. 2018

Med Sci Monit

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BackgroundMoyamoya disease (MMD) is an idiopathic disease caused by progressive steno-occlusion of the distal internal carotid artery. Ideal surgical treatment for adult patients with ischemic-type MMD has not been achieved. The aim of this study was to evaluate the efficacy of single-barrel superficial temporal artery-middle cerebral artery (STA-MCA) bypass in treatment for adult patients with ischemic-type MMD by analyzing clinical and radiological data retrospectively.Material/MethodsThe present study included 37 patients with non-hemorrhagic MMD, including 21 women and 16 men (21~55 years old, mean age 38.1 years). The bypass surgery was performed on 56 sides in the 37 patients. The clinical charts, angiographic revascularization, and hemodynamic changes were reviewed at 6–60 months after surgery.ResultsAmong the 37 patients, the clinical symptoms and signs of 32 patients were improved or stabilized. Five patients had complications, including 2 cases of acute cerebral infarction, 1 case of epidural hematoma, and 1 case of transient speech disturbance, and 1 patient died. Follow-up computed tomography perfusion (CTP) revealed that cerebral blood flow (CBF) was markedly improved after surgery (P<0.05). Time to peek (TTP) and mean transit time (MTT) were significantly decreased after surgery (P<0.05). No significant change in cerebral blood volume (CBV) was found after surgery (P>0.05). Postoperative patency was clearly verified in 52 bypasses (92.8%) of 56 bypasses on follow-up DSA imaging.ConclusionsSingle-barrel STA-MCA bypass can be considered as an effective surgical treatment, which exhibits satisfactory clinical efficacy in ischemic-type MMD patients.

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Characteristics of cerebral hemodynamics assessed by CT perfusion in moyamoya disease

Cited by 24 publications

References 24 publications

Moyamoya: An Update and Review

Moyamoya: An Update and Review

Cerebral Hemodynamic Changes After Revascularization in Patients With Hemorrhagic Moyamoya Disease

Assessment of Single-Barrel Superficial Temporal Artery-Middle Cerebral Artery Bypass in Treatment for Adult Patients with Ischemic-Type Moyamoya Disease

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