Department of Radiology, Gyeongsang National University Changwon Hospital, Changwon, Korea.
Department of Radiology, Seoul National University Hospital, Seoul, Korea.
Korean J Radiol. 2019 Jun;20(6):985-996. doi: 10.3348/kjr.2018.0651.
To determine the correlation between cerebral blood flow (CBF) on arterial spin labeling (ASL) MRI and the degree of postoperative revascularization assessed on digital subtraction angiography in children with moyamoya disease (MMD).
Twenty-one children (9 boys and 12 girls; mean age, 8.4 ± 3.6 years; age range, 3-16 years) with MMD who underwent both pseudocontinuous ASL MRI at 1.5T and catheter angiography before and after superficial temporal artery encephaloduroarteriosynangiosis were included in this retrospective study. The degree of revascularization in the middle cerebral artery (MCA) territory was evaluated on external carotid angiography and was graded on a 3-point scale. On ASL CBF maps, regions of interest were manually drawn over the MCA territory of the operated side at the level of the centrum semi-ovale and over the cerebellum. The normalized CBF (nCBF) was calculated by dividing the CBF of the MCA territory by the CBF of the cerebellum. Changes in nCBFs were calculated by subtracting the preoperative nCBF values from the postoperative nCBF values. The correlation between nCBF changes measured with ASL and the revascularization grade from direct angiography was evaluated.
The nCBF value on the operated side increased after the operation ( = 0.001). The higher the degree of revascularization, the greater the nCBF change was: poor revascularization (grade 1), -0.043 ± 0.212; fair revascularization (grade 2), 0.345 ± 0.176; good revascularization (grade 3), 0.453 ± 0.182 ( = 0.005, Jockheere-Terpstra test). The interobserver agreement was excellent for the measured CBF values of the three readers (0.91-0.97).
The nCBF values of the MCA territory obtained from ASL MRI increased after the revascularization procedure in children with MMD, and the degree of nCBF change showed a significant correlation with the degree of collateral formation evaluated via catheter angiography.
确定磁共振动脉自旋标记（ASL）成像上的脑血流（CBF）与烟雾病（MMD）患儿术后数字减影血管造影（DSA）评估的再通程度之间的相关性。
本回顾性研究纳入了 21 例 MMD 患儿（9 名男孩，12 名女孩；平均年龄 8.4 ± 3.6 岁；年龄范围 3-16 岁），这些患儿均在 1.5T 磁共振仪上接受了伪连续 ASL 成像，并在颞浅动脉大脑中动脉贴敷术前后进行了导管血管造影。通过颈外动脉血管造影评估大脑中动脉（MCA）区域的再通程度，并按 3 分制进行分级。在 ASL CBF 图上，在大脑半卵圆中心层面手动勾画 MCA 供血区的感兴趣区，同时在小脑勾画感兴趣区。通过将 MCA 供血区 CBF 除以小脑 CBF 计算得到标准化 CBF（nCBF）。通过从术前 nCBF 值中减去术后 nCBF 值计算 nCBF 的变化。评估 ASL 测量的 nCBF 变化与直接血管造影的再通分级之间的相关性。
术后患侧 nCBF 值增加（ = 0.001）。再通程度越高，nCBF 变化越大：再通不良（分级 1），-0.043 ± 0.212；再通中等（分级 2），0.345 ± 0.176；再通良好（分级 3），0.453 ± 0.182（ = 0.005，Jockheere-Terpstra 检验）。3 位观察者的 CBF 值测量具有极好的观察者间一致性（0.91-0.97）。
MMD 患儿血管重建术后，ASL MRI 获得的 MCA 供血区 nCBF 值增加，nCBF 变化程度与导管血管造影评估的侧支形成程度显著相关。
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