Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.
Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea.
Korean J Radiol. 2023 Aug;24(8):784-794. doi: 10.3348/kjr.2023.0035.
To determine whether dynamic susceptibility contrast-enhanced (DSC) perfusion magnetic resonance imaging (MRI) can be used to evaluate posterior cerebral circulation in pediatric patients with moyamoya disease (MMD) who underwent anterior revascularization.
This study retrospectively included 73 patients with MMD who underwent DSC perfusion MRI (age, 12.2 ± 6.1 years) between January 2016 and December 2020, owing to recent-onset clinical symptoms during the follow-up period after completion of anterior revascularization. DSC perfusion images were analyzed using a dedicated software package (NordicICE; Nordic NeuroLab) for the middle cerebral artery (MCA), posterior cerebral artery (PCA), and posterior border zone between the two regions (PCA-MCA). Patients were divided into two groups; the PCA stenosis group included 30 patients with newly confirmed PCA involvement, while the no PCA stenosis group included 43 patients without PCA involvement. The relationship between DSC perfusion parameters and PCA stenosis, as well as the performance of the parameters in discriminating between groups, were analyzed.
In the PCA stenosis group, the mean follow-up duration was 5.3 years after anterior revascularization, and visual disturbances were a common symptom. Normalized cerebral blood volume was increased, and both the normalized time-to-peak (nTTP) and mean transit time values were significantly delayed in the PCA stenosis group compared with those in the no PCA stenosis group in the PCA and PCA-MCA border zones. TTP (odds ratio [OR] = 6.745; 95% confidence interval [CI] = 2.665-17.074; < 0.001) and CBV (OR = 1.567; 95% CI = 1.021-2.406; = 0.040) were independently associated with PCA stenosis. TTP showed the highest receiver operating characteristic curve area in discriminating for PCA stenosis (0.895; 95% CI = 0.803-0.986).
nTTP can be used to effectively diagnose PCA stenosis. Therefore, DSC perfusion MRI may be a valuable tool for monitoring PCA stenosis in patients with MMD.
探讨动态磁敏感对比增强（DSC）灌注磁共振成像（MRI）能否用于评估接受颅内外血管搭桥术（EC-IC）后发生后部脑循环改变的烟雾病（MMD）患儿的后循环。
回顾性纳入 2016 年 1 月至 2020 年 12 月间因 EC-IC 术后随访期内出现新发临床症状而接受 DSC 灌注 MRI 检查的 73 例 MMD 患儿（年龄 12.2 ± 6.1 岁）。采用专用软件（NordicICE；Nordic NeuroLab）对大脑中动脉（MCA）、大脑后动脉（PCA）及二者之间的后界区（PCA-MCA）的 DSC 灌注图像进行分析。根据是否存在 PCA 狭窄，将患儿分为 PCA 狭窄组（30 例）和无 PCA 狭窄组（43 例）。分析 DSC 灌注参数与 PCA 狭窄的关系，以及各参数在组间鉴别中的效能。
在 PCA 狭窄组中，MCA-PCA 旁路术后平均随访时间为 5.3 年，视觉障碍为常见症状。与无 PCA 狭窄组相比，PCA 狭窄组的 PCA 和 PCA-MCA 交界区的脑血容量（CBV）标准化值增加，达峰时间（TTP）和平均通过时间（MTT）标准化值显著延长。TTP（比值比[OR] = 6.745；95%置信区间[CI] = 2.665-17.074； ＜0.001）和 CBV（OR = 1.567；95% CI = 1.021-2.406； = 0.040）与 PCA 狭窄独立相关。TTP 对 PCA 狭窄的鉴别效能最高（曲线下面积 0.895；95% CI = 0.803-0.986）。
MTT 可有效诊断 PCA 狭窄，DSC 灌注 MRI 可能是监测 MMD 患者 PCA 狭窄的一种有价值的工具。
