Suzuki Tomoaki, Hasegawa Hitoshi, Fujiwara Hidemoto, Shibuya Kohei, Okamoto Kouichirou, Oishi Makoto
Department of Neurosurgery, Brain Research Institute, Niigata University, 1-757 Asahimachi-dori, Niigata, 951-8585, Japan.
Neuroradiology. 2025 Feb;67(2):321-329. doi: 10.1007/s00234-024-03486-w. Epub 2024 Oct 23.
To investigate postsurgical indirect cortical neoangiogenesis in patients with moyamoya disease (MMD) using silent magnetic resonance angiography (MRA).
We studied 44 patients with MMD (63 hemispheres) who were previously revascularized with combined bypass surgery (23 and 40 hemispheres in pediatric and adult patients, respectively). They underwent follow-up for postoperative bypass patency using time-of-flight (TOF)-MRA and silent MRA between January 2022 and December 2023. The mean duration from surgery to MRA was 8.5 years (range, 1.2-22.3 years). Two observers independently rated the revascularization as follows: 0 (near-complete signal loss or no signal); 1, poor (slightly visible donor arteries); 2, good (acceptable revascularization around the brain surface); and 3, excellent (good quality of revascularization with perfusion from the cortical surface into the middle cerebral artery).
Silent MRA visualized indirect bypass significantly better than TOF-MRA (2.6 ± 0.7 and 1.4 ± 0.8) (P < 0.01). In silent MRA, the mean score of indirect bypass was significantly higher than that of direct bypass (2.6 ± 0.7 and 1.7 ± 1.0; P < 0.01) and indicated good indirect bypass development in both children and adults (91.3% and 85.0%; score ≥ 2). Children exhibited a higher rate of excellent indirect bypass patency than adults (73.9% and 55.0%; score 3). Poor bypass development in indirect bypass (8 hemispheres, mean age: 35.5 ± 17.5 years, mean follow-up period: 11.3 years) was significantly observed in male patients (P < 0.01).
Silent MRA enables better precision in postsurgical visualization of indirect cortical neoangiogenesis during long-term follow-up and reveals indirect bypass development even in adult patients.
使用静音磁共振血管造影（MRA）研究烟雾病（MMD）患者术后的间接皮质新生血管形成情况。
我们研究了44例MMD患者（63个半球），这些患者之前分别接受了小儿（23个半球）和成人（40个半球）联合搭桥手术进行血运重建。在2022年1月至2023年12月期间，他们接受了时间飞跃（TOF）-MRA和静音MRA检查以评估术后搭桥通畅情况。从手术到MRA的平均时间为8.5年（范围1.2 - 22.3年）。两名观察者独立对血运重建情况进行如下评分：0（近乎完全信号丢失或无信号）；1，差（供体动脉隐约可见）；2，良好（脑表面周围血运重建可接受）；3，优秀（皮质表面向大脑中动脉灌注的血运重建质量良好）。
静音MRA对间接搭桥的可视化明显优于TOF-MRA（分别为2.6±0.7和1.4±0.8）（P < 0.01）。在静音MRA中，间接搭桥的平均评分显著高于直接搭桥（分别为2.6±0.7和1.7±1.0；P < 0.01），表明儿童和成人的间接搭桥发育均良好（分别为91.3%和85.0%；评分≥2）。儿童的间接搭桥通畅优秀率高于成人（分别为73.9%和55.0%；评分3）。在间接搭桥中，较差的搭桥发育（8个半球，平均年龄：35.5±17.5岁，平均随访期：11.3年）在男性患者中显著观察到（P < 0.01）。
静音MRA在长期随访中能够更精确地可视化术后间接皮质新生血管形成，并且即使在成年患者中也能显示间接搭桥发育情况。
