Kaneko Koichiro, Maekawa Yui, Yamaguchi Koji, Chiba Kentaro, Tanifuji Mizuka, Yamamoto Atsushi, Nagao Michinobu, Sakai Shuji
Department of Diagnostic Imaging & Nuclear Medicine.
Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan.
Clin Nucl Med. 2025 Aug 1;50(8):e461-e468. doi: 10.1097/RLU.0000000000005929. Epub 2025 Jun 17.
To examine the relationship between postoperative cerebral hyperperfusion (CHP) and preoperative cerebral blood flow (CBF) SPECT findings in patients with moyamoya disease (MMD) or atherosclerotic occlusive cerebrovascular disease (AOCD).
We calculated the preoperative-postoperative CBF and postoperative increase rate (IR) in the frontal, temporal, and parietal lobes of 100 cerebral hemispheres and then compared the CHP patterns and severities among the patients with adult-onset MMD (AMMD), pediatric-onset MMD (PMMD), and AOCD. We investigated the associations among CHP, preoperative CBF, and cerebrovascular reactivity (CVR).
CHP (≥30% change in the IR) occurred in 27 hemispheres. The incidence of the frontal lobe-dominant pattern (19.0%) was significantly higher than those of the temporal and parietal lobe-dominant patterns (4.0% each, P < 0.001). Severe CHP (≥50% change) occurred more frequently in the AMMD group (2 patients suffered major complications) versus the patients with PMMD and AOCD (21.5% vs 2.9%, P = 0.01). In the combined patients with MMD, reduced preoperative CBF more accurately predicted the occurrence of mild/severe or severe CHP than CVR (AUCs: 0.84 vs 0.67; 0.81 vs 0.73), while neither preoperative CBF nor CVR was correlated with CHP in the AOCD group. As demonstrated by 13 SPECT studies conducted after postoperative day 2, CHP was promptly resolved in 12 hemispheres; 1 hemisphere progressed to severe CHP.
CHP in the frontal lobe occurred more often and with greater severity in patients with AMMD. Preoperative CBF reduction was more closely associated with CHP than CVR in patients with MMD. Nonactivated 99m Tc-ethyl cysteinate dimer SPECT was suitable for preoperative/postoperative CBF evaluations.
研究烟雾病（MMD）或动脉粥样硬化性闭塞性脑血管病（AOCD）患者术后脑血流灌注过度（CHP）与术前脑血流量（CBF）单光子发射计算机断层扫描（SPECT）结果之间的关系。
我们计算了100个脑半球额叶、颞叶和顶叶的术前术后脑血流量及术后增加率（IR），然后比较成人起病型烟雾病（AMMD）、儿童起病型烟雾病（PMMD）和AOCD患者的CHP模式和严重程度。我们研究了CHP、术前脑血流量和脑血管反应性（CVR）之间的关联。
27个半球出现CHP（IR变化≥30%）。额叶为主型模式的发生率（19.0%）显著高于颞叶和顶叶为主型模式（均为4.0%，P<0.001）。与PMMD和AOCD患者相比，严重CHP（变化≥50%）在AMMD组中更频繁出现（2例患者出现严重并发症）（21.5%对2.9%，P=0.01）。在合并烟雾病患者中，术前脑血流量降低比CVR更准确地预测轻度/重度或重度CHP的发生（曲线下面积：0.84对0.67；0.81对0.73），而在AOCD组中，术前脑血流量和CVR均与CHP无相关性。术后第2天之后进行的13项SPECT研究显示，12个半球的CHP迅速缓解；1个半球进展为严重CHP。
AMMD患者额叶CHP的发生更频繁且更严重。在烟雾病患者中，术前脑血流量降低比CVR与CHP的关联更密切。未激活的99m锝-乙基半胱氨酸二聚体SPECT适用于术前/术后脑血流量评估。
