Zhang Kun, Ren Wei, Sun Yu-Xue, Wang Xin-Jun, Li Chao-Yue, Wang Zi-Liang, Li Tian-Xiao, Gao Bu-Lang
The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China.
Front Neurosci. 2022 Jun 14;16:922482. doi: 10.3389/fnins.2022.922482. eCollection 2022.
To investigate the characteristics of cerebral perfusion and hemodynamics of bypass grafting in the treatment of moyamoya disease (MMD) using the iFlow color-coded flow map in comparison with magnetic resonance imaging-perfusion-weighted imaging (MRI-PWI) and computational fluid dynamic (CFD) analysis.
Patients with MMD treated with bypass grafting who had undergone MRI PWI and digital subtraction angiography for iFlow color-coded map was retrospectively enrolled and CFD was performed for calculating the hemodynamic stresses around the bypass grafting.
Forty-five patients with unilateral MMD treated with bypass surgery were enrolled. The bypass surgery was successful in all patients, with no severe neurological complications during the periprocedural period. Followed up for 4-12 months (median 5.5), the neurological function was good in all patients. The cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), and time to peak (TTP) were significantly ( < 0.05) improved in the middle cerebral artery distribution area on the surgical side before and after vascular bypass, and the difference of TTP (s) measured from the proximal bifurcation of common carotid artery to the confluence of sinus was also significant ( < 0.05). A significant ( < 0.05) positive correlation existed in the perfusion parameters between the iFlow blood perfusion and the MRI-PWI perfusion, with -value for TTP of 0.765 ( < 0.01). The iFlow color-coded blood flow map showed warm color changes on the diseased side, similar to those on the contralateral side. In CFD analysis, the hemodynamic stresses were all improved, in and around the bypass grafting and distal vessels, which were beneficial to blood flow entering distal arterial branches.
The iFlow color-coded flow map can be used to analyze cerebral perfusion after bypass grafting for MMD, similar to MRI-PWI, and CFD can be used to analyze the hemodynamics after bypass grafting, revealing improved hemodynamics to promote blood flow entering distal arteries.
使用iFlow彩色编码血流图，与磁共振成像灌注加权成像（MRI-PWI）和计算流体动力学（CFD）分析相比较，研究烟雾病（MMD）旁路移植术治疗中的脑灌注和血流动力学特征。
回顾性纳入接受旁路移植术治疗的MMD患者，这些患者已接受MRI PWI和数字减影血管造影以获取iFlow彩色编码图，并进行CFD分析以计算旁路移植周围的血流动力学应力。
纳入45例接受旁路手术治疗的单侧MMD患者。所有患者的旁路手术均成功，围手术期无严重神经并发症。随访4至12个月（中位数5.5），所有患者神经功能良好。血管旁路前后，手术侧大脑中动脉分布区域的脑血流量（CBF）、脑血容量（CBV）、平均通过时间（MTT）和达峰时间（TTP）均显著改善（<0.05），从颈总动脉近端分叉至窦汇测量的TTP（秒）差异也显著（<0.05）。iFlow血流灌注与MRI-PWI灌注的灌注参数之间存在显著正相关（<0.05），TTP的r值为0.765（<0.01）。iFlow彩色编码血流图显示病变侧有暖色变化，与对侧相似。在CFD分析中，旁路移植及其周围和远端血管的血流动力学应力均得到改善，有利于血流进入远端动脉分支。
iFlow彩色编码血流图可用于分析MMD旁路移植术后的脑灌注，类似于MRI-PWI，CFD可用于分析旁路移植术后的血流动力学，揭示血流动力学改善以促进血流进入远端动脉。
