Shiba Masato, Toma Naoki, Tanioka Satoru, Yasuda Ryuta, Sakaida Hiroshi, Suzuki Hidenori
Department of Neurosurgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
Department of Neurosurgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
Clin Neurol Neurosurg. 2018 Apr;167:70-75. doi: 10.1016/j.clineuro.2018.02.019. Epub 2018 Feb 12.
Transient neurological events (TNEs) are frequently observed after revascularization surgery for moyamoya disease (MMD). Recently, two signs on fluid-attenuated inversion recovery magnetic resonance images, a cortical hyperintensity belt (CHB) sign possibly reflecting vasogenic edema and a transient subcortical low intensity (SCLI) sign possibly reflecting cytotoxic edema, were reported associated with TNEs. The purpose of this study was to create a SCLI score and to investigate the significance of the score in TNEs.
The authors retrospectively analyzed 18 cerebral hemispheres in 16 consecutive patients with revascularization surgery for MMD. The SCLI sign was defined as a transient SCLI in surgically treated hemispheres, and blindly graded as the SCLI score (0-4) based on the extent. The relationships among SCLI, CHB signs and TNEs were evaluated.
Postoperative TNEs, SCLI and CHB signs were detected in 8 (44.4%), 9 (50.0%) and 12 (66.7%) hemispheres, respectively. Patients with SCLI and CHB signs had a significantly higher TNE occurrence rate than those without these signs (p = 0.015, and p = 0.013, respectively). Patients with TNEs showed significantly higher SCLI scores than those without TNEs (p = 0.009), while the difference of CHB scores did not reach significance between patients with and without TNEs. For the occurrence of postoperative TNEs, SCLI score with a cut-off value of 1.0 resulted in a specificity of 80.0% and a sensitivity of 87.5%.
The novel SCLI score may be useful for diagnosing TNEs after revascularization surgery for MMD, although both vasogenic and cytotoxic edema may be involved in postoperative TNEs.
烟雾病（MMD）血管重建术后常观察到短暂性神经事件（TNE）。最近，在液体衰减反转恢复磁共振图像上有两个征象被报道与TNE相关，一个可能反映血管源性水肿的皮质高信号带（CHB）征象，以及一个可能反映细胞毒性水肿的短暂性皮质下低信号（SCLI）征象。本研究的目的是创建一个SCLI评分，并研究该评分在TNE中的意义。
作者回顾性分析了连续16例接受MMD血管重建手术患者的18个脑半球。SCLI征象定义为手术治疗半球的短暂性SCLI，并根据范围盲目分级为SCLI评分（0 - 4分）。评估SCLI、CHB征象与TNE之间的关系。
术后分别在8个（44.4%）、9个（50.0%）和12个（66.7%）脑半球检测到TNE、SCLI和CHB征象。有SCLI和CHB征象的患者TNE发生率显著高于无这些征象的患者（分别为p = 0.015和p = 0.013）。有TNE的患者SCLI评分显著高于无TNE的患者（p = 0.009），而有TNE和无TNE患者的CHB评分差异无统计学意义。对于术后TNE的发生，截断值为1.0的SCLI评分特异性为80.0%，敏感性为87.5%。
新的SCLI评分可能有助于诊断MMD血管重建术后的TNE，尽管血管源性和细胞毒性水肿可能都与术后TNE有关。
