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Encephaloduroarteriosynangiosis (EDAS) treatment of moyamoya syndrome: evaluation by computed tomography perfusion imaging

  • Computed Tomography
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Abstract

Objective

To explore the value of computed tomography perfusion (CTP) imaging for evaluating the efficacy of encephaloduroarteriosynangiosis (EDAS) treatment of moyamoya syndrome (MMS).

Methods

Forty-three patients with MMS (48 hemispheres) who received EDAS treatment were examined using CTP and DSA before and after surgery. CTP of the ipsilateral cortex, contralateral mirror area, and pons region were measured, and the relative cerebral blood flow (rCBF) and volume (rCBV), mean transit time (rMTT), and time-to-peak (rTTP) were calculated. Based on postoperative DSA, 48 hemispheres were apportioned to two groups based on rich (grades 2, 3) or poor (grades 0, 1) collateral vessel formation, and the pre- and post-operative differences in perfusion changes were compared. The association between clinical outcome, CTP, and the degree of DSA collateral vessels was explored.

Results

rCBF and rMTT significantly improved in both the poor and rich collateral vessel formation groups (n = 21 and 27, respectively), while rTTP significantly improved only in the latter. Postoperative CTP improved in the rich and the grade 1 collateral vessel groups (p < 0.01). The clinical improvement was consistent with the improvement of CTP (p = 0.07), but less consistent with the degree of collateral angiogenesis (p = 0.003).

Conclusion

CTP can quantitatively evaluate the improvement of brain tissue perfusion in the operated area after EDAS. Brain tissue perfusion in operated areas improved regardless of postoperative rich or poor collateral vessel formation observed via DSA. A significant improvement in rTTP in the operated area may indicate the formation of abundant collateral vessels.

Key Points

• CTP showed that brain tissue perfusion in the operated area after EDAS improved regardless of rich or poor collateral vessel formation observed via DSA.

• Significant improvement of rTTP in the operated area may indicate the formation of abundant collateral vessels.

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Abbreviations

CBF:

Cerebral blood flow

CBV:

Cerebral blood volume

CTP:

Computed tomography perfusion

DSA:

Digital subtraction angiography

EDAS:

Encephaloduroarteriosynangiosis

MCA:

Middle cerebral artery

MMS:

Moyamoya syndrome

mRS:

Modified Rankin scale

MTT:

Mean transit time

ROC:

Receiver operating characteristic

TTP:

Time-to-peak

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Funding

This study was supported by the Shandong Provincial Development Program of Medical Science and Technology (No. 2016WS0185), and the Jining Key Research and Development Program (No. 2017SMNS012).

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Authors and Affiliations

  1. Department of Radiology, The Affiliated Hospital of Jining Medical University, Jining, China

    Xiang Guo, Xuexia Yuan, Lingyun Gao, Yueqin Chen, Hao Yu, Zhen Chong, Zhanguo Sun & Deguo Liu

  2. Department of Medical Imaging, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China

    Weijian Chen & Yunjun Yang

  3. Department of Neurosurgery, The Affiliated Hospital of Jining Medical University, Jining, China

    Feng Jin

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  1. Xiang Guo
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Correspondence to Deguo Liu.

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Guo, X., Yuan, X., Gao, L. et al. Encephaloduroarteriosynangiosis (EDAS) treatment of moyamoya syndrome: evaluation by computed tomography perfusion imaging. Eur Radiol 31, 8364–8373 (2021). https://doi.org/10.1007/s00330-021-07960-4

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  • DOI: https://doi.org/10.1007/s00330-021-07960-4

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