Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany.
Berlin Institute of Health, BIH Academy, (Junior) Clinician Scientist Program, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Neurosurg Rev. 2022 Dec 27;46(1):25. doi: 10.1007/s10143-022-01920-2.
The Berlin Grading System assesses clinical severity of moyamoya angiopathy (MMA) by combining MRI, DSA, and cerebrovascular reserve capacity (CVRC). Our aim was to validate this grading system using [O]HO PET for CVRC. We retrospectively identified bilateral MMA patients who underwent [O]HO PET examination and were treated surgically at our department. Each hemisphere was classified using the Suzuki and Berlin Grading System. Preoperative symptoms and perioperative ischemias were collected, and a logistic regression analysis was performed. A total of 100 hemispheres in 50 MMA patients (36 women, 14 men) were included. Using the Berlin Grading System, 2 (2.8%) of 71 symptomatic hemispheres were categorized as grade I, 14 (19.7%) as grade II, and 55 (77.5%) as grade III. The 29 asymptomatic hemispheres were characterized as grade I in 7 (24.1%) hemispheres, grade II in 12 (41.4%), and grade III in 10 (34.5%) hemispheres. Berlin grades were independent factors for identifying hemispheres as symptomatic and higher grades correlated with increasing proportion of symptomatic hemispheres (p < 0.01). The Suzuki grading did not correlate with preoperative symptoms (p = 0.26). Perioperative ischemic complications occurred in 8 of 88 operated hemispheres. Overall, complications did not occur in any of the grade I hemispheres, but in 9.1% (n = 2 of 22) and 9.8% (n = 6 of 61) of grade II and III hemispheres, respectively. In this study, we validated the Berlin Grading System with the use of [O]HO PET for CVRC as it could stratify preoperative symptomatology. Furthermore, we highlighted its relevance for predicting perioperative ischemic complications.
柏林分级系统通过结合 MRI、DSA 和脑血管储备能力（CVRC）来评估烟雾病（MMA）的临床严重程度。我们的目的是使用 [O]HO PET 评估 CVRC 来验证该分级系统。我们回顾性地确定了在我们科室接受 [O]HO PET 检查并接受手术治疗的双侧 MMA 患者。使用铃木和柏林分级系统对每个半球进行分类。收集了术前症状和围手术期缺血情况，并进行了逻辑回归分析。共纳入 50 例 MMA 患者（36 例女性，14 例男性）的 100 个半球。使用柏林分级系统，71 个有症状的半球中有 2 个（2.8%）为 I 级，14 个（19.7%）为 II 级，55 个（77.5%）为 III 级。29 个无症状的半球中有 7 个（24.1%）为 I 级，12 个（41.4%）为 II 级，10 个（34.5%）为 III 级。柏林分级是确定半球是否为症状性的独立因素，且较高的分级与症状性半球比例增加相关（p < 0.01）。铃木分级与术前症状不相关（p = 0.26）。88 个手术半球中有 8 个发生围手术期缺血性并发症。总体而言，任何 I 级半球都没有发生并发症，但在 II 级和 III 级半球中分别有 9.1%（n = 2/22）和 9.8%（n = 6/61）发生并发症。在这项研究中，我们使用 [O]HO PET 评估 CVRC 验证了柏林分级系统，因为它可以对术前症状进行分层。此外，我们强调了它对预测围手术期缺血性并发症的相关性。
