Takahashi Satoshi, Horiguchi Takashi
Department of Neurosurgery, Keio University, School of Medicine, Tokyo, Japan.
Department of Neurosurgery, Keio University, School of Medicine, Tokyo, Japan.
Clin Neurol Neurosurg. 2020 Oct;197:106090. doi: 10.1016/j.clineuro.2020.106090. Epub 2020 Jul 15.
The aim of this study was to clarify the relationship between ischaemic symptoms during the early postoperative period in patients with moyamoya disease and changes in the cerebellar asymmetry index (AI), a parameter used to quantitatively identify crossed cerebellar diaschisis (CCD).
We analysed the data of 18 patients with moyamoya disease who underwent quantitative IMP-cerebral blood flow SPECT at least once during the follow-up period. Cerebellar AI scores were calculated using the CBF of the cerebellum calculated automatically from multiple slices of SPECT images with automated ROI setup software and categorized and statistically examined according to the presence or absence of ischaemic symptoms.
The cerebellar AI calculated from SPECT performed in the patients who presented with ischaemic symptoms was 0.094 ± 0.023 (mean ± SD), which was significantly elevated compared to the value of 0.013 ± 0.025 (mean ± SD) calculated from SPECT performed when the patients did not present with ischaemic symptoms (p < 0.0001). Limiting the time of SPECT to calculate the cerebellar AI to be compared to the acute phase within 2 weeks after surgery did not change this trend, and again, the cerebellar AI was statistically significantly elevated in the presence of ischaemic symptoms (0.094 ± 0.023 (mean ± SD)) compared to the AI in the absence of ischaemic symptoms (0.000081 ± 0.026 (mean ± SD)) (p = 0.0003). In patients who underwent quantitative SPECT in the acute phase during the first postoperative week, the cerebellar AI values calculated from the results of SPECT performed during the preoperative period as well as multiple times during postoperative period were followed over time in each case. The cerebellar AI increased in patients who presented with symptoms of ischaemia postoperatively but then tended to decrease reversibly and approach zero with the disappearance of symptoms of ischaemia.
Since the cerebellar AI reflects the symptom of ischaemia in patients with moyamoya disease, especially in the early stage after revascularization surgery, and is a parameter that improves with symptom improvement, it seems to be useful for understanding the state of cerebral blood flow after bypass surgery in patients with moyamoya disease.
本研究旨在阐明烟雾病患者术后早期缺血症状与小脑不对称指数（AI）变化之间的关系，小脑不对称指数是用于定量识别交叉小脑去传入（CCD）的一个参数。
我们分析了18例烟雾病患者的数据，这些患者在随访期间至少接受了一次定量IMP-脑血流SPECT检查。使用自动ROI设置软件从SPECT图像的多个切片自动计算的小脑CBF来计算小脑AI评分，并根据是否存在缺血症状进行分类和统计学检验。
出现缺血症状的患者经SPECT计算的小脑AI为0.094±0.023（平均值±标准差），与未出现缺血症状时经SPECT计算的值0.013±0.025（平均值±标准差）相比显著升高（p<0.0001）。将计算小脑AI的SPECT时间限制在术后2周内与急性期进行比较，这一趋势并未改变，并且再次发现，存在缺血症状时小脑AI在统计学上显著升高（0.094±0.023（平均值±标准差）），与无缺血症状时的AI（0.000081±0.026（平均值±标准差））相比（p=0.0003）。在术后第一周急性期接受定量SPECT检查的患者中，对术前以及术后多次SPECT结果计算的小脑AI值在每个病例中进行了随时间的跟踪。术后出现缺血症状的患者小脑AI升高，但随后倾向于可逆性降低，并随着缺血症状的消失接近零。
由于小脑AI反映了烟雾病患者的缺血症状，尤其是在血运重建手术后的早期阶段，并且是一个随症状改善而改善的参数，因此它似乎有助于了解烟雾病患者搭桥手术后的脑血流状态。
