Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
China National Clinical Research Center for Neurological Diseases, Beijing, China.
Cerebrovasc Dis. 2021;50(2):147-155. doi: 10.1159/000511936. Epub 2021 Feb 8.
Infarction is one of the most common postoperative complications after surgical revascularization for moyamoya disease (MMD). Increased conspicuity of deep medullary veins (DMVs) on susceptibility-weighted imaging (SWI), known as "brush sign," could predict the severity of MMD. This study aimed to reveal the features of the "brush sign" in preoperative SWI and to verify its relationship to postoperative infarction.
Consecutive patients with MMD who had undergone cerebral revascularization surgery were included. Routine preoperative SWI was performed. The "brush sign" was defined according to the number of the conspicuous DMVs > 5 detected on SWI. Postoperative infarctions were defined as the high-intensity signal on postoperative DWI images, with or without neurologic deficits. The modified Rankin scale (mRS) was applied to evaluate the prognosis of patients.
In the enrolled 100 hemispheres, 35 were presented with the "brush sign." Patients with ischemic onset manifestation and previous infarction history tended to present with the "brush sign." Multivariate analysis showed that the "brush sign" (OR 13.669; 95% CI, 1.747-106.967, p = 0.013) and decreased rCBF (OR 6.050; 95% CI, 1.052-34.799, p = 0.044) were independent risk factors of postoperative infarction. Besides, the "brush sign" showed a significant correlation with a higher mRS score at discharge (p = 0.047).
The findings strongly suggest that the presence of the "brush sign" preoperatively can be a predictor of infarction after surgical revascularization for ischemic MMD. It may contribute to an improved surgical result through focused perioperative management based on appropriate surgical risk stratification.
在烟雾病（MMD）手术血运重建术后，梗死是最常见的术后并发症之一。磁敏感加权成像（SWI）上显示的深部髓静脉（DMV）显影增加，称为“毛刷征”，可预测 MMD 的严重程度。本研究旨在揭示术前 SWI 中“毛刷征”的特征，并验证其与术后梗死的关系。
纳入接受脑血运重建手术的 MMD 连续患者。进行常规术前 SWI。根据 SWI 上检测到的 >5 个明显 DMV 定义“毛刷征”。术后梗死定义为术后 DWI 图像上的高信号，伴有或不伴有神经功能缺损。采用改良 Rankin 量表（mRS）评估患者的预后。
在纳入的 100 个半脑中，35 个出现“毛刷征”。有缺血性发病表现和既往梗死史的患者倾向于出现“毛刷征”。多变量分析显示，“毛刷征”（OR 13.669；95%CI，1.747-106.967，p = 0.013）和 rCBF 降低（OR 6.050；95%CI，1.052-34.799，p = 0.044）是术后梗死的独立危险因素。此外，“毛刷征”与出院时更高的 mRS 评分显著相关（p = 0.047）。
这些发现强烈表明，术前存在“毛刷征”可能是缺血性 MMD 手术后梗死的预测因子。通过基于适当手术风险分层的集中围手术期管理，可能有助于改善手术结果。
