Devalckeneer Antoine, Haddad Geoffrey, Kuschcinski Gregory, Leclerc Xavier, Bourgeois Philippe, Delhem Nadira, Menovsky Tomas, Aboukaïs Rabih, Bretzner Martin
Neurosurgical Department, CHU Lille, Roger Salengro Hospital, Lille, F-59000, France.
University Lille, INSERM, U1189-ONCO-THAI-Image Assisted Laser Therapy for Oncology, Lille, OncoLille, F-59000, France.
Neurosurg Rev. 2025 May 27;48(1):447. doi: 10.1007/s10143-025-03618-7.
Extracranial-intracranial (EIC) bypasses are used to treat Moya-Moya syndrome and complex aneurysms. Evaluating bypass patency is vital. Current methods include intraoperative techniques like indocyanine angiography, micro-doppler probes, and postoperative non-invasive imaging. However, adjudicating the frequent discordant imaging results is done via conventional digital subtraction angiography (DSA) despite its associated risks. Our study aims to quantitatively evaluate bypass patency by introducing a novel biomarker, the virtual cut-flow index (VCFI) derived from 4D-PACK MRI imaging. We prospectively reviewed consecutive adult patients who underwent bypass surgery at our institution between January and October 2023. MR angiography was performed, employing 4D-PACK (four-dimensional pseudo-continuous arterial spin labeling (4D-pCASL)-based angiography using CENTRA-keyhole and view sharing) imaging. We measured arterial signal intensity using regions of interest (ROIs) placed on the superficial temporal artery (STA) and a branch of the middle cerebral artery (MCA) post-bypass. We modeled signal evolution using linear regression and extracted slope α coefficients and then calculated the virtual cut-flow index (VCFI) using the equation VCFI = αMCA/αSTA. We included 18 patients corresponding to 19 bypasses. The median VCI was significantly higher in patients with a patent bypass compared to those with an occluded bypass (87.33 vs. 19.87%; p < 0.05). The median αMCA coefficient was significantly higher in patients with a patent bypass compared to those with an occluded bypass (69.21 vs. 11.34; p < 0.05). The median αSTA coefficient was significantly higher in patients with a patent bypass compared to those with an occluded bypass (102.74 vs. 44.74; p < 0.05). We introduced a novel noninvasive biomarker, the virtual cut-flow index, as a new means to assess bypass patency. While DSA remains the gold standard, VCFI offers a promising avenue for quantitative evaluation, potentially enhancing postoperative monitoring and influencing surgical planning.
颅外-颅内（EIC）搭桥术用于治疗烟雾病和复杂动脉瘤。评估搭桥血管的通畅性至关重要。目前的方法包括术中技术，如吲哚菁绿血管造影、微型多普勒探头，以及术后的非侵入性成像。然而，尽管传统数字减影血管造影（DSA）存在相关风险，但对于频繁出现的不一致成像结果，仍通过它来判定。我们的研究旨在通过引入一种新的生物标志物——从4D-PACK MRI成像中得出的虚拟截流指数（VCFI），来定量评估搭桥血管的通畅性。我们前瞻性地回顾了2023年1月至10月在我们机构接受搭桥手术的连续成年患者。采用4D-PACK（基于四维伪连续动脉自旋标记（4D-pCASL）的血管造影，使用CENTRA锁孔技术和视图共享）成像进行磁共振血管造影。我们在搭桥术后，使用放置在颞浅动脉（STA）和大脑中动脉（MCA）一个分支上的感兴趣区域（ROI）测量动脉信号强度。我们使用线性回归对信号演变进行建模，提取斜率α系数，然后使用公式VCFI = αMCA/αSTA计算虚拟截流指数（VCFI）。我们纳入了18例患者，对应19次搭桥手术。与搭桥血管闭塞的患者相比，搭桥血管通畅的患者的VCI中位数显著更高（87.33%对19.87%；p < 0.05）。与搭桥血管闭塞的患者相比，搭桥血管通畅的患者的αMCA系数中位数显著更高（69.21对11.34；p < 0.05）。与搭桥血管闭塞的患者相比，搭桥血管通畅的患者的αSTA系数中位数显著更高（102.74对44.74；p < 0.05）。我们引入了一种新的非侵入性生物标志物——虚拟截流指数，作为评估搭桥血管通畅性的新方法。虽然DSA仍然是金标准，但VCFI为定量评估提供了一条有前景的途径，可能会加强术后监测并影响手术规划。
