Takemoto Yushin, Kawano Takayuki, Ohmori Yuki, Kaku Yasuyuki, Uekawa Ken, Amadatsu Toshihiro, Hayashi Kenyu, Kitajima Mika, Mukasa Akitake
Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto City, Kumamoto, Japan.
Department of Neurosurgery, Kurume University School of Medicine, Kurume City, Fukuoka, Japan.
J Clin Neurosci. 2020 Apr;74:124-129. doi: 10.1016/j.jocn.2020.02.022. Epub 2020 Feb 16.
Transient neurological events (TNEs) are observed after direct bypass surgery in patients with moyamoya disease (MMD). Although a correlation between cortical hyperintensity belt signs (CHBs) and TNEs has been reported, the pathophysiology of CHBs is still unknown. The purpose of this study was to reveal the pathophysiology of CHBs by using dynamic susceptibility contrast-magnetic resonance imaging. Thirty patients with MMD were included in this study. We provided scores (0-2) for the existence of CHBs on postoperative FLAIR images. We placed the ROI for the presented area of CHBs in the images of cerebral blood flow, CBV, and MTT. We calculated the change of the hemodynamic parameters (increase ratio, IR) and analyzed the relationship between IRs, CHB scores, and TNEs. TNEs were observed in 15 cases (50%) and CHBs were detected in 28 cases (93%). TNEs showed significantly higher CHB scores than those without (p < 0.05). The group of CHB score 2 showed a significantly higher CBV IR than the group with of score 0 (p < 0.05). Patients with TNEs showed a significantly higher CBV IR than those without (p < 0.05). As for the cut-off level to predict an appearance of TNEs, the CBV IR was 1.36 by the Receiver Operating Characteristic analysis, and the sensitivity and specificity were 80% respectively. We hypothesize that the pathophysiology of the CHBs are vasogenic edemas because the postoperative CBV increase correlated with the CHBs.
在烟雾病（MMD）患者进行直接搭桥手术后可观察到短暂性神经事件（TNE）。尽管已有报道称皮质高信号带征（CHB）与TNE之间存在相关性，但CHB的病理生理学仍不清楚。本研究的目的是通过使用动态磁敏感对比磁共振成像来揭示CHB的病理生理学。本研究纳入了30例MMD患者。我们对术后液体衰减反转恢复（FLAIR）图像上CHB的存在情况进行评分（0 - 2分）。我们在脑血流量、脑血容量（CBV）和平均通过时间（MTT）图像中为CHB的显示区域设置感兴趣区（ROI）。我们计算了血流动力学参数的变化（增加率，IR），并分析了IR、CHB评分和TNE之间的关系。15例（50%）观察到TNE，28例（93%）检测到CHB。TNE患者的CHB评分显著高于无TNE患者（p < 0.05）。CHB评分为2分的组比评分为0分的组显示出显著更高的CBV IR（p < 0.05）。有TNE的患者比没有TNE的患者显示出显著更高的CBV IR（p < 0.05）。至于预测TNE出现的截断水平，通过受试者工作特征分析，CBV IR为1.36，敏感性和特异性均为80%。我们推测CHB的病理生理学是血管源性水肿，因为术后CBV增加与CHB相关。
