So Young, Lee Ho-Young, Kim Seung-Ki, Lee Jae Sung, Wang Kyu-Chang, Cho Byung-Kyu, Kang Eunjoo, Lee Dong Soo
Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul 110-744, Korea.
Stroke. 2005 Jul;36(7):1485-9. doi: 10.1161/01.STR.0000170709.95185.b1. Epub 2005 Jun 9.
We evaluated whether basal/acetazolamide stress brain perfusion SPECT performed after revascularization surgery can predict the further clinical outcome of patients with pediatric moyamoya disease.
A total of 77 (31 males, 46 females, age 6.6+/-3.2 years) patients with postoperative pediatric moyamoya disease who underwent basal/acetazolamide stress brain perfusion SPECT 6 to 12 months after revascularization surgery and who were followed-up >12 months after SPECT were included. Mean follow-up period after SPECT was 36+/-19 months. Sixty-two patients underwent bilateral ribbon encephaloduroarteriosynangiosis (EDAS), 14 bilateral EDAS, and 1 unilateral EDAS. Ordinal logistic regression analysis using 5 independent variables (infarction on preoperative MRI, age at the first operation, highest Suzuki stage on cerebral angiography, and regional cerebrovascular reserve on postoperative SPECT) against postoperative clinical outcomes was performed.
Fifty-one patients had preserved reserve on postoperative SPECT and their clinical outcomes were excellent (30), good (15), fair (4), and poor (2); 26 patients had decreased reserve (excellent, 1; good, 7; fair, 14; poor, 4). On ordinal logistic regression analysis, age at the first operation (P=0.033) and reserve on postoperative SPECT (P<0.001) were statistically significant.
Basal/acetazolamide stress brain perfusion SPECT performed at 6 to 12 months after the indirect bypass operation could predict the further clinical outcome of pediatric patients with moyamoya disease. Patients with decreased cerebrovascular reserve will have remaining neurological deficit and ischemic attacks on follow-up.
我们评估了血管重建术后进行的基础/乙酰唑胺负荷脑灌注单光子发射计算机断层扫描（SPECT）能否预测小儿烟雾病患者的进一步临床结局。
纳入77例（男31例，女46例，年龄6.6±3.2岁）小儿烟雾病术后患者，这些患者在血管重建术后6至12个月接受了基础/乙酰唑胺负荷脑灌注SPECT检查，且在SPECT检查后随访时间超过12个月。SPECT检查后的平均随访期为36±19个月。62例行双侧带状脑硬脑膜动脉血管融合术（EDAS），14例行双侧EDAS，1例行单侧EDAS。使用5个独立变量（术前MRI上的梗死、首次手术时的年龄、脑血管造影上的最高铃木分期以及术后SPECT上的局部脑血管储备）对术后临床结局进行有序逻辑回归分析。
51例患者术后SPECT显示储备良好，其临床结局为优（30例）、良（15例）、中（4例）和差（2例）；26例患者储备降低（优，1例；良，7例；中，14例；差，4例）。在有序逻辑回归分析中，首次手术时的年龄（P = 0.033）和术后SPECT上的储备（P < 0.001）具有统计学意义。
间接搭桥手术后6至12个月进行的基础/乙酰唑胺负荷脑灌注SPECT可以预测小儿烟雾病患者的进一步临床结局。脑血管储备降低的患者在随访中会有残留神经功能缺损和缺血性发作。
