Noninvasively Evaluating the Cerebral Blood Flow Changes After Surgery in Adult Moyamoya Patients Using 3D Pulsed Arterial Spin Labelling MRI.

PURPOSE: To explore the feasibility of phase contrast (PC) MRI and three-dimensional pulsed arterial spin labelling (3D PASL)-MRI in assessing cerebrovascular blood flow changes after surgical revascularization in patients with moyamoya disease (MMD).

METHODS

This study was a prospective study and comprised two sections. In the first section, 43 patients with MMD who never underwent any revascularization surgery and 19 healthy control volunteers were enrolled. In the second section, 51 patients with MMD who underwent revascularization surgery were included. PC-MRI and 3D PASL-MRI were performed. The average blood flow in the internal carotid (ICA), basilar (BA), superficial temporal (STA) arteries and cerebral blood flow (CBF) were compared between the MMD patients and control volunteers (first section) as well as before and after surgery (second section). Then, MMD patients were divided into haemorrhage and non-haemorrhage subgroups and the average blood flow and CBF before and after surgery were compared between the subgroups.

RESULTS

The average flow in the ICA, BA, STA was lower in the MMD patients than in the healthy control group (p = 0.000, p = 0.001, p = 0.001). The CBF of the seven clusters was higher in the healthy controls than in the MMD patients' groups. The average flow in the ICA, BA and STA was increased in MMD patients after combined surgery (p = 0.000, p = 0.002, p = 0.000). Fifteen clusters of elevated CBF and one of reduced CBF were postoperatively evident. Eight clusters of elevated CBF were compared with the preoperative status in the patients without haemorrhage. In the haemorrhage group, postoperative CBF did not significantly change after combined surgery (p > 0.05).

CONCLUSION

Both 3D PASL-MRI and PC-MRI can noninvasively evaluate CBF changes in patients with MMD after surgery. The CBF of the cerebral was significantly improved after surgery. Moreover, the improvement of CBF was more obvious in patients with non-hemorrhagic rather than hemorrhagic MMD.