Cerebral Blood Flow Improvement after Indirect Revascularization for Pediatric Moyamoya Disease: A Statistical Analysis of Arterial Spin-Labeling MRI

T. Blauwblomme, H. Lemaitre, O. Naggara, R. Calmon, M. Kossorotoff, M. Bourgeois, B. Mathon, S. Puget, M. Zerah, F. Brunelle, C. Sainte-Rose, N. Boddaert
AJNR Am J Neuroradiol. 2015-11-19; 37(4): 706-712
DOI: 10.3174/ajnr.A4592

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BACKGROUND AND PURPOSE: The severity of Moyamoya disease is generally scaled with
conventional angiography and nuclear medicine. Arterial spin-labeling MR imaging
is now acknowledged for the noninvasive quantification of cerebral blood flow.
This study aimed to analyze CBF modifications with statistical parametric mapping
of arterial spin-labeling MR imaging in children undergoing an operation for
Moyamoya disease.

MATERIALS AND METHODS: We included 15 children treated by indirect cerebral
revascularization with multiple burr-holes between 2011 and 2013. Arterial
spin-labeling MR imaging and T1 sequences were then analyzed under SPM8,
according to the general linear model, before and after the operation (3 and 12
months). Voxel-based analysis was performed at the group level, comparing all
diseased hemispheres with all normal hemispheres and, at the individual level,
comparing each patient with a control group.

RESULTS: Group analysis showed statistically significant preoperative
hypoperfusion in the MCA territory in the Moyamoya hemispheres and a significant
increase of cerebral perfusion in the same territory after revascularization (P <
.05 family-wise error-corrected). Before the operation, individual analysis
showed significant hypoperfusion for each patient co-localized with the
angiographic defect on DSA. All except 1 patient had improvement of CBF after
revascularization, correlated with their clinical status.

CONCLUSIONS: SPM analysis of arterial spin-labeling MR imaging offers a
noninvasive evaluation of preoperative cerebral hemodynamic impairment and an
objective assessment of postoperative improvement in children with Moyamoya

© 2016 by American Journal of Neuroradiology.


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