Sato K, Yamada M, Kuroda H, Yamamoto D, Asano Y, Inoue Y, Fujii K, Kumabe T
From the Departments of Neurosurgery (K.S., M.Y., H.K., D.Y., K.F., T.K.)
From the Departments of Neurosurgery (K.S., M.Y., H.K., D.Y., K.F., T.K.).
AJNR Am J Neuroradiol. 2016 Jul;37(7):1244-8. doi: 10.3174/ajnr.A4715. Epub 2016 Mar 3.
Cerebral hyperperfusion syndrome is a potential complication of superficial temporal artery-MCA anastomosis for Moyamoya disease. In this study, we evaluated whether TOF-MRA could assess cerebral hyperperfusion syndrome after superficial temporal artery-MCA anastomosis for this disease.
This retrospective study included patients with Moyamoya disease who underwent superficial temporal artery-MCA single anastomosis. TOF-MRA and SPECT were performed before and 1-6 days after anastomosis. Bilateral ROIs on the source image of TOF-MRA were manually placed directly on the parietal branch of the superficial temporal artery just after branching the frontal branch of the superficial temporal artery and on the contralateral superficial temporal artery on the same axial image, respectively. The change ratio of the maximum signal intensity of the superficial temporal artery on TOF-MRA was calculated by using the following formula: (Postoperative Ipsilateral/Postoperative Contralateral)/(Preoperative Ipsilateral/Preoperative Contralateral).
Of 23 patients (26 sides) who underwent the operation, 5 sides showed cerebral hyperperfusion syndrome postoperatively. There was a significant difference in the change ratio of signal intensity on TOF-MRA observed between the cerebral hyperperfusion syndrome and non-cerebral hyperperfusion syndrome groups (cerebral hyperperfusion syndrome group: 1.88 ± 0.32; non-cerebral hyperperfusion syndrome group: 1.03 ± 0.20; P = .0009). The minimum ratio value for the cerebral hyperperfusion syndrome group was 1.63, and the maximum ratio value for the non-cerebral hyperperfusion syndrome group was 1.30. Thus, no overlap was observed between the 2 groups for the change ratio of signal intensity on TOF-MRA.
Diagnosis of cerebral hyperperfusion syndrome is indicated by an increase in the change ratio of signal intensity on TOF-MRA by more than approximately 1.5 times the preoperative levels.
脑过度灌注综合征是烟雾病颞浅动脉-大脑中动脉吻合术的一种潜在并发症。在本研究中，我们评估了时间飞跃法磁共振血管造影（TOF-MRA）能否评估烟雾病颞浅动脉-大脑中动脉吻合术后的脑过度灌注综合征。
这项回顾性研究纳入了接受颞浅动脉-大脑中动脉单吻合术的烟雾病患者。在吻合术前及术后1 - 6天进行TOF-MRA和单光子发射计算机断层扫描（SPECT）。TOF-MRA源图像上的双侧感兴趣区（ROIs）分别直接手动放置在颞浅动脉额支分出后的颞浅动脉顶支以及同一轴位图像上的对侧颞浅动脉上。TOF-MRA上颞浅动脉最大信号强度的变化率采用以下公式计算：（术后同侧/术后对侧）/（术前同侧/术前对侧）。
在接受手术的23例患者（26侧）中，5侧术后出现脑过度灌注综合征。脑过度灌注综合征组与非脑过度灌注综合征组在TOF-MRA上观察到的信号强度变化率存在显著差异（脑过度灌注综合征组：1.88±0.32；非脑过度灌注综合征组：1.03±0.20；P = 0.0009）。脑过度灌注综合征组的最小比值为1.63，非脑过度灌注综合征组的最大比值为1.30。因此，两组在TOF-MRA信号强度变化率上未观察到重叠。
TOF-MRA信号强度变化率增加超过术前水平约1.5倍提示脑过度灌注综合征。
