Li Juan, Meng Qinghu, Huang Ling, Pylypenko Dmytro, Zhong Hai
Department of Radiology, The Second Hospital of Shandong University, Ji Nan, Shandong Province, 250033, China.
Department of Neurosurgery, The Second Hospital of Shandong University, Ji Nan, Shandong Province, 250033, China.
Heliyon. 2024 Sep 3;10(17):e37368. doi: 10.1016/j.heliyon.2024.e37368. eCollection 2024 Sep 15.
To evaluate if pseudo-continuous arterial spin labeling (pcASL) and territorial ASL (tASL) can assess cerebral perfusion post-revascularization in Moyamoya disease and compare with digital subtraction angiography (DSA) outcomes.
Patients diagnosed with Moyamoya disease who underwent pcASL using two post-labeling delays (short ASL, 1,525 ms; delayed ASL, 2,525 ms), tASL, and DSA 3 months after surgery at a single institution were retrospectively evaluated. Manual delineation on pcASL cerebral blood flow (CBF) maps covered middle cerebral artery (MCA) territory on both sides, and cerebellum. Normalized CBF (nCBF) was calculated. Revascularization in the MCA territory was evaluated with external carotid angiography and tASL, graded on a three-point scale. Intermodality agreement was analyzed with weighted κ statistics. Correlation between pcASL-derived nCBF and tASL-measured revascularization, and revascularization grade from direct angiography, was determined. Diagnostic performance of pcASL and tASL was evaluated using DSA as a reference via receiver operating characteristic (ROC) curve analysis.
A total of 32 hemispheres from 31 patients were assessed. On the operated side, sASL and dASL had nCBF values of 1.00 ± 0.30 and 1.31 ± 0.31, respectively. Revascularization area grading showed substantial intermodality agreement (weighted κ = 0.68; 95 % CI: 0.49, 0.87). DSA revascularization moderately correlated with sASL and dASL nCBF values (r = 0.56 and 0.47) and strongly correlated with tASL revascularization area (r = 0.73). ROC analysis revealed that sASL and dASL nCBF values reflected revascularization (area under the curve (AUC) = 0.86 and 0.77) and tASL revascularization area (AUC = 0.91). Combined pcASL and tASL had an AUC of 0.93, comparable to tASL alone, improving diagnostic performance. The diagnostic accuracy of nCBF for sASL was 87.5 %, superior to 75 % for dASL. The diagnostic accuracy of tASL external carotid artery revascularization area was 87.5 %, with sensitivity and specificity of 88 % and 85.7 %, respectively.
The combination of pcASL and tASL outperformed pcASL alone in assessing cerebral perfusion post-Moyamoya disease revascularization.
评估伪连续动脉自旋标记（pcASL）和区域动脉自旋标记（tASL）能否评估烟雾病血管重建术后的脑灌注，并与数字减影血管造影（DSA）结果进行比较。
对在单一机构接受手术3个月后进行pcASL（使用两种标记后延迟时间，即短ASL为1525毫秒；延迟ASL为2525毫秒）、tASL和DSA检查的烟雾病患者进行回顾性评估。在pcASL脑血流量（CBF）图上手动勾勒双侧大脑中动脉（MCA）区域和小脑。计算标准化脑血流量（nCBF）。通过颈外动脉血管造影和tASL评估MCA区域的血管重建情况，并进行三分制分级。采用加权κ统计分析不同检查方法之间的一致性。确定pcASL衍生的nCBF与tASL测量的血管重建以及直接血管造影的血管重建分级之间的相关性。以DSA为参考，通过受试者操作特征（ROC）曲线分析评估pcASL和tASL的诊断性能。
共评估了31例患者的32个半球。在手术侧，短ASL和延迟ASL的nCBF值分别为1.00±0.30和1.31±0.31。血管重建区域分级显示不同检查方法之间具有高度一致性（加权κ=0.68；95%CI：0.49，0.87）。DSA血管重建与短ASL和延迟ASL的nCBF值中度相关（r=0.56和0.47），与tASL血管重建区域高度相关（r=0.73）。ROC分析显示，短ASL和延迟ASL的nCBF值可反映血管重建情况（曲线下面积[AUC]=0.86和0.77），tASL血管重建区域的AUC为0.91。pcASL和tASL联合使用的AUC为0.93，与单独使用tASL相当，提高了诊断性能。nCBF对短ASL的诊断准确性为87.5%，优于延迟ASL的75%。tASL颈外动脉血管重建区域的诊断准确性为87.5%，敏感性和特异性分别为88%和85.7%。
在评估烟雾病血管重建术后的脑灌注方面，pcASL和tASL联合使用的效果优于单独使用pcASL。
