Hao Xiaojun, Zhang Chao, Yang Chen, Zhao Xintong, Zhou Yunfeng, Wang Juan
Department of Radiology, The First Affiliated Hospital of Wannan Medical College, Wuhu, PR China.
Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, PR China.
Insights Imaging. 2025 Jan 2;16(1):2. doi: 10.1186/s13244-024-01882-7.
To determine the value of preoperative CT perfusion (CTP) parameters for prediction of post-revascularization cerebral infarction (post-CI) in adults with moyamoya disease (MMD).
This retrospective study included 92 adults with MMD who underwent surgical revascularization. Preoperative quantitative CTP parameters, including cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), time to drain (TTD), and transit time to maximum of the residue function (Tmax), along with clinical data, were compared between the groups with and without post-CI. Predictors of post-CI were identified and assessed using multivariable logistic regression and receiver-operating characteristic curve analyses.
Post-CI occurred in 11 patients (12.0%). In univariate analysis, preoperative mean values for CBF, MTT, TTD, Tmax, initial presentation, infarction within the 2 months before surgery, surgical side, and modified Rankin Scale score on admission were associated with post-CI (all p < 0.05). Multivariable logistic regression revealed that the preoperative mean Tmax (OR 2.342, 95% CI: 1.267-4.330, p = 0.007) and infarction within the 2 months before surgery (OR 14.345, 95% CI: 2.108-97.638, p = 0.006) were independent predictors of post-CI. The preoperative mean Tmax produced the largest area under the curve (0.955, 95% CI: 0.914-0.997) with a cutoff of 3.590 s (sensitivity, 100%; specificity, 87.7%).
Adults with MMD are at risk of post-CI when the preoperative mean Tmax is > 3.590 s. Cerebral infarction during the 2 months before revascularization is also a risk factor for post-CI.
Post-CI is a serious complication for adults with MMD following surgical revascularization. The risk of post-CI can be predicted using preoperative CTP parameters, which will assist neurosurgeons with surgical decisions and implementing individualized prophylactic strategies.
Predicting the risk of post-CI in MMD patients is beneficial to their prognosis. The preoperative mean Tmax was an excellent perfusion parameter for predicting post-CI. Preoperative CTP evaluation can help clinicians make cautious surgical decisions.
确定术前CT灌注（CTP）参数对预测烟雾病（MMD）成年患者血管重建术后脑梗死（post-CI）的价值。
这项回顾性研究纳入了92例接受外科血管重建术的MMD成年患者。比较发生和未发生post-CI的两组患者术前的定量CTP参数，包括脑血流量（CBF）、脑血容量（CBV）、平均通过时间（MTT）、引流时间（TTD）以及残留函数最大值的通过时间（Tmax），并分析临床资料。采用多变量逻辑回归和受试者工作特征曲线分析来确定和评估post-CI的预测因素。
11例患者（12.0%）发生了post-CI。单因素分析显示，术前CBF、MTT、TTD、Tmax的平均值、初次就诊情况、术前2个月内的梗死情况、手术侧别以及入院时的改良Rankin量表评分与post-CI相关（均p < 0.05）。多变量逻辑回归显示，术前平均Tmax（比值比[OR] 2.342，95%置信区间[CI]：1.267 - 4.330，p = 0.007）和术前2个月内的梗死情况（OR 14.345，95% CI：2.108 - 97.638，p = 0.006）是post-CI的独立预测因素。术前平均Tmax的曲线下面积最大（0.955，95% CI：0.914 - 0.997），截断值为3.590秒（敏感性为100%；特异性为87.7%）。
术前平均Tmax > 3.590秒的MMD成年患者有发生post-CI的风险。血管重建术前2个月内的脑梗死也是post-CI的一个危险因素。
Post-CI是MMD成年患者外科血管重建术后的一种严重并发症。可使用术前CTP参数预测post-CI的风险，这将有助于神经外科医生做出手术决策并实施个体化的预防策略。
预测MMD患者post-CI的风险对其预后有益。术前平均Tmax是预测post-CI的一个优秀灌注参数。术前CTP评估有助于临床医生做出谨慎的手术决策。
