Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan.
Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan.
World Neurosurg. 2023 Jul;175:e1292-e1299. doi: 10.1016/j.wneu.2023.04.119. Epub 2023 May 4.
The evaluation of postsurgical neoangiogenesis in patients with moyamoya disease (MMD) is crucial for appropriate patient management. This study aimed to assess the visualization of neovascularization after bypass surgery using noncontrast-enhanced silent magnetic resonance angiography (MRA) with ultrashort echo time and arterial spin labeling.
After bypass surgery, 13 patients with MMD were followed up for >6 months between September 2019 and November 2022. They underwent silent MRA in the same session as time-of-flight magnetic resonance angiography (TOF-MRA) and digital subtraction angiography (DSA). Two observers independently rated the visualization of neovascularization in both types of MRA from 1 (not visible) to 4 (nearly equal to DSA), with reference to DSA images as the standard.
The mean scores were significantly higher for silent MRA compared with TOF-MRA (3.81 ± 0.48 and 1.92 ± 0.70, respectively) (P < 0.01). The intermodality agreements were 0.83 and 0.71 for silent MRA and TOF-MRA, respectively. TOF-MRA depicted the donor artery and recipient cortical artery after direct bypass surgery, although fine neovascularization developed after indirect bypass surgery was poorly visualized. Silent MRA could reveal the developed bypass flow signal and perfused middle cerebral artery territory, which was almost equal to the DSA images.
Silent MRA achieves better visualization of postsurgical revascularization in patients with MMD than TOF-MRA. Moreover, it may have the potential to provide visualization of the developed bypass flow equivalent to DSA.
评估烟雾病（MMD）患者手术后的新生血管对于适当的患者管理至关重要。本研究旨在使用超短回波时间和动脉自旋标记的无对比增强静默磁共振血管造影（MRA）评估旁路手术后的新生血管可视化。
在 2019 年 9 月至 2022 年 11 月期间，13 例 MMD 患者在旁路手术后进行了随访>6 个月。他们在同一时间段内进行了静默 MRA 和时飞磁共振血管造影（TOF-MRA）及数字减影血管造影（DSA）检查。两名观察者分别对两种 MRA 的新生血管可视化程度进行评分，从 1（不可见）到 4（几乎与 DSA 相等），以 DSA 图像为标准。
与 TOF-MRA 相比，静默 MRA 的平均评分显著更高（分别为 3.81±0.48 和 1.92±0.70）（P<0.01）。静默 MRA 和 TOF-MRA 的模态间一致性分别为 0.83 和 0.71。TOF-MRA 可以描绘直接旁路手术后的供体动脉和受区皮质动脉，尽管间接旁路手术后发育的精细新生血管显示不佳。静默 MRA 可以显示发育的旁路血流信号和灌注的大脑中动脉区域，几乎与 DSA 图像相等。
与 TOF-MRA 相比，静默 MRA 可更好地显示 MMD 患者手术后的再血管化情况。此外，它可能有潜力提供与 DSA 相当的发育旁路血流可视化。
