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Guida L, Beccaria K, Benichi S, Kossorotof M, Naggara O, Bourgeois M, Bourdeaut F, Abbou S, Dangouloff-Ros V, Boddaert N, Blauwblomme T. Laser interstitial thermal therapy is effective and safe for the treatment of brain tumors in NF1 patients after cerebral revascularization for moyamoya angiopathy: a report on two cases. Front Neurol 2023; 14:1291207. [PMID: 38145120 PMCID: PMC10748471 DOI: 10.3389/fneur.2023.1291207] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/13/2023] [Indexed: 12/26/2023] Open
Abstract
Background The co-occurrence of moyamoya vasculopathy and extra-optic pathway tumors is rare in neurofibromatosis type 1 (NF1), with only four cases described in the literature. Brain surgery in these patients may be challenging because of the risk of brain infarction after skin and dural incision. Given its percutaneous and minimally invasive nature, laser interstitial thermal therapy (LITT) is an ideal option for the treatment of brain tumors in these patients. Here, we report on two patients with NF1 and moyamoya syndrome (MMS) treated for a brain glioma with LITT, after cerebral revascularization. Cases The first patient, with familial NF1, underwent bilateral indirect revascularization with multiple burr holes (MBH) for symptomatic MMS. Two years later, she was diagnosed with a left temporal tumor, with evidence of radiologic progression over 10 months. The second patient, also with familial NF1, developed unilateral MMS when he was 6 years old and was treated with MBH. At the age of 15 years, MRI showed a right cingular lesion, growing on serial MRIs. Both patients underwent LITT with no perioperative complications; they are progression free at 10 and 12 months, respectively, and the tumors have decreased in volume. Discussion While the association of extra-optic neoplasm and moyamoya angiopathy is seldom reported in NF1, tumor treatment is challenging in terms of both avoiding stroke and achieving oncological control. Here, we show in 2 cases, that LITT could be a safe and effective option in these rare conditions.
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Affiliation(s)
- Lelio Guida
- Department of Pediatric Neurosurgery, APHP, Hôpital Necker Enfants Malades, Paris, France
- Université de Paris Cité, Paris, France
| | - Kevin Beccaria
- Department of Pediatric Neurosurgery, APHP, Hôpital Necker Enfants Malades, Paris, France
- Université de Paris Cité, Paris, France
| | - Sandro Benichi
- Department of Pediatric Neurosurgery, APHP, Hôpital Necker Enfants Malades, Paris, France
- Université de Paris Cité, Paris, France
| | - Manoelle Kossorotof
- Université de Paris Cité, Paris, France
- Department of Pediatric Neurology, Hôpital Necker Enfants Malades, Paris, France
| | - Olivier Naggara
- Université de Paris Cité, Paris, France
- Department of Radiology, GHU Sainte-Anne, Paris, France
| | - Marie Bourgeois
- Department of Pediatric Neurosurgery, APHP, Hôpital Necker Enfants Malades, Paris, France
| | - Franck Bourdeaut
- Université de Paris Cité, Paris, France
- Department of Pediatric Oncology, Institut Curie, Paris, France
| | - Samuel Abbou
- Université de Paris Cité, Paris, France
- Department of Pediatric Oncology, Institut Gustave Roussy, Villejuif, France
| | - Volodia Dangouloff-Ros
- Department of Pediatric Radiology, APHP, Hôpital Necker Enfants Malades, Paris, France
- Université Paris Cité, UMR 1163, Institut Imagine, Paris, France
| | - Nathalie Boddaert
- Department of Pediatric Radiology, APHP, Hôpital Necker Enfants Malades, Paris, France
- Université Paris Cité, UMR 1163, Institut Imagine, Paris, France
| | - Thomas Blauwblomme
- Department of Pediatric Neurosurgery, APHP, Hôpital Necker Enfants Malades, Paris, France
- Université de Paris Cité, Paris, France
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Soler-Rico M, Di Santo M, Vaz G, Joris V, Fomekong E, Guillaume S, Van Boven M, Raftopoulos C. How to reduce the complication rate of multiple burr holes surgery in moyamoya angiopathy. Acta Neurochir (Wien) 2023; 165:3613-3622. [PMID: 37993630 DOI: 10.1007/s00701-023-05876-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/16/2023] [Indexed: 11/24/2023]
Abstract
PURPOSE This study is aimed at analyzing clinical outcome, absence of stroke recurrence, revascularization, and complications and long-term follow-up in the surgical treatment of moyamoya angiopathy (MMA) using the multiple burr holes (MBH) technique with dura opening and arachnoid preservation as a single procedure. To the best of our knowledge, this is the first to describe an MBH technique with arachnoid preservation. METHOD We retrospectively reviewed all patients operated from June 2001 to March 2021, for a symptomatic and progressive MMA operated with opening of the dura but arachnoid preservation. Clinical examinations were obtained in all patients, and radiological monitoring was performed by cerebral 3D-magnetic resonance angiography (MRA) with perfusion or single-photon emission computed tomography (SPECT) with acetazolamide. RESULTS In total, 21 consecutive patients (6 children and 15 adults) were included with a mean age of 7.4 years in the pediatric group and 36.9 years in the adult group. Initial presentation was permanent ischemic stroke in 15 cases, transient ischemic attack (TIA) in 5 cases, and cerebral hemorrhage in one case. The MBH with dura opening and arachnoid preservation was performed bilaterally in 9 cases (43%) and unilaterally in 12 cases (57%). One patient died due to intraoperative bilateral ischemic stroke. Of the 20 other patients, 30% demonstrated clinical stability and 70% showed partial or complete recovery. Although one patient experienced a perioperative stroke, we did not observe any pseudomeningocele or postoperative ischemic stroke (IS) recurrence in all surviving cases during the average follow-up period of 55.5 months (range: 1-195). These outcomes emphasize the importance of preoperative monitoring to ensure the effectiveness and safety of the intervention. Postoperative angiography studies showed revascularization in 96.3% of treated hemispheres (100% in the adult group vs 80% in the pediatric group). CONCLUSIONS Our results on this small cohort suggest that the MBH technique with opening of the dura and arachnoids preservation can prevent recurrent strokes and reduce the risk of pseudomeningocele.
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Affiliation(s)
- M Soler-Rico
- Neurosurgery Department, St-Luc Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - M Di Santo
- Neurosurgery Department, St-Luc Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - G Vaz
- Neurosurgery Department, St-Luc Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - V Joris
- Neurosurgery Department, St-Luc Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - E Fomekong
- Neurosurgery Department, St-Luc Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - S Guillaume
- Medical Imaging Department, St-Luc Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - M Van Boven
- Anesthesiology Department, St-Luc Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - C Raftopoulos
- Neurosurgery Department, St-Luc Hospital, Université Catholique de Louvain, Brussels, Belgium.
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Transient ischemic attack after indirect revascularization surgery for pediatric patients with moyamoya disease: A retrospective study of intraoperative blood pressure. Anaesth Crit Care Pain Med 2023; 42:101168. [PMID: 36309164 DOI: 10.1016/j.accpm.2022.101168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 09/29/2022] [Accepted: 10/18/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study aimed to investigate the association between intraoperative blood pressure and postoperative transient ischemic attacks (TIAs) in pediatric patients with moyamoya disease after indirect revascularization surgery. METHODS We retrospectively reviewed the medical records of patients with moyamoya disease younger than 15 years who underwent indirect revascularizations under general anesthesia from 2013 to 2019. Perioperative clinical factors and intraoperative blood pressure data were collected and analyzed. Univariate and multivariable mixed-effect logistic regressions were used to identify predictors of postoperative TIA and symptom progression. RESULTS Among 444 hemispheres in 296 pediatric patients, 70 cases (16%) experienced postoperative TIAs within 2 weeks after surgery, and 34 cases (7.7%) developed postoperative symptom progression. Baseline mean blood pressure (MBP) (adjusted odds ratio, 1.261; 95% confidence interval, 1.037-1.528; P < 0.001), Average mean arterial pressure (MAP) (adjusted odds ratio, 1.137; 95% confidence interval, 1.052-1.228; P = 0.006), and Ipsilateral magnetic resonance angiography (MRA) score (adjusted odds ratio, 1.464; 95% confidence interval, 0.886-2.419; P = 0.012) were statistically significant risk factors for postoperative TIA. Average real variability of MAP (ARV-MAP), which were measures of intraoperative MAP variability (adjusted odds ratio, 4.731; 95% confidence interval, 1.419-15.257; P = 0.003) and maximum MAP declination (MaxD-MAP) (adjusted odds ratio, 1.271; 95% confidence interval, 1.013-1.520; P = 0.010) were statistically significant risk factors for postoperative symptom progression. CONCLUSION Higher pre-induction baseline blood pressure and ipsilateral MRA score were independent risk factors predicting postoperative TIA in pediatric patients with moyamoya disease after indirect revascularization. The high variability and drastic decline in intraoperative MAP showed predictive value in postoperative symptom progression.
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Alcolumbre Tobelem FL, de Andrade GALR, Paschoal JKSF, de Oliveira Cardoso MDS, Sarmento Trindade SM, Paschoal EHA, Paschoal-Jr FM, Bor-Seng-Shu E. Cerebral Vasculopathy in Children With Sickle Cell Disease in an Amazonian Population. J Child Neurol 2022; 37:8830738221100088. [PMID: 35611504 DOI: 10.1177/08830738221100088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Sickle cell disease is the most prevalent hereditary disease in the country. The aim of this study was to use transcranial Doppler as a screening method for identifying cerebral vasculopathy in children with sickle cell disease. Methods: An epidemiologic, descriptive, and cross-sectional study was conducted. Patients aged 2-16 years with sickle cell disease and followed at a neurology referral service between January 2014 and March 2020 underwent transcranial Doppler and complementary examinations to screen for cerebral vasculopathy. Results: Screening and confirmatory examinations diagnosed 14 of 164 patients (8.5%) with cerebral vasculopathy. Regarding stroke risk, as measured by cerebral blood flow velocity, 2 of 14 patients (14.2%) were classified as conditional risk (170-199 cm/s) and 12 of 14 (85.7%) as high risk of stroke. Conclusion: Complementary examinations should be performed in all patients with changes on transcranial Doppler to confirm cerebral vasculopathy. Further studies, particularly genetic, are needed to better understand the relationship between sickle cell disease and cerebral vasculopathy.
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Affiliation(s)
| | | | - Joelma Karin Sagica Fernandes Paschoal
- Amazônia Neurovascular Research Group, Federal University of Pará, Belém, Brazil
- Department of Neurology, Federal University of Pará Medical School, Belém, Brazil
| | - Maria do Socorro de Oliveira Cardoso
- Department of Hematology, Federal University of Pará Medical School, Belém, Brazil
- Foundation Center of Hematology and Hemotherapy of Pará (HEMOPA), Belém, Brazil
| | | | - Eric Homero Albuquerque Paschoal
- Amazônia Neurovascular Research Group, Federal University of Pará, Belém, Brazil
- Department of Neurosurgery, Federal University of Pará, Belém, Brazil
| | - Fernando M Paschoal-Jr
- Amazônia Neurovascular Research Group, Federal University of Pará, Belém, Brazil
- Department of Neurology, Federal University of Pará Medical School, Belém, Brazil
| | - Edson Bor-Seng-Shu
- Laboratory for Neurosonology and Cerebral Hemodynamics, Division of Neurological Surgery, Hospital das Clinicas, São Paulo University Medical School, São Paulo, Brazil
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Rao VL, Prolo LM, Santoro JD, Zhang M, Quon JL, Jin M, Iyer A, Yedavalli V, Lober RM, Steinberg GK, Yeom KW, Grant GA. Acetazolamide-Challenged Arterial Spin Labeling Detects Augmented Cerebrovascular Reserve After Surgery for Moyamoya. Stroke 2021; 53:1354-1362. [PMID: 34865510 DOI: 10.1161/strokeaha.121.036616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Cerebrovascular reserve (CVR) inversely correlates with stroke risk in children with Moyamoya disease and may be improved by revascularization surgery. We hypothesized that acetazolamide-challenged arterial spin labeling MR perfusion quantifies augmentation of CVR achieved by revascularization and correlates with currently accepted angiographic scoring criteria. METHODS We retrospectively identified pediatric patients with Moyamoya disease or syndrome who received cerebral revascularization at ≤18 years of age between 2012 and 2019 at our institution. Using acetazolamide-challenged arterial spin labeling, we compared postoperative CVR to corresponding preoperative values and to postoperative perfusion outcomes classified by Matsushima grading. RESULTS In this cohort, 32 patients (17 males) with Moyamoya underwent 29 direct and 16 indirect extracranial-intracranial bypasses at a median 9.7 years of age (interquartile range, 7.6-15.7). Following revascularization, median CVR increased within the ipsilateral middle cerebral artery territory (6.9 mL/100 g per minute preoperatively versus 16.5 mL/100 g per minute postoperatively, P<0.01). No differences were observed in the ipsilateral anterior cerebral artery (P=0.13) and posterior cerebral artery (P=0.48) territories. Postoperative CVR was higher in the ipsilateral middle cerebral artery territories of patients who achieved Matsushima grade A perfusion, in comparison to those with grades B or C (25.8 versus 17.5 mL, P=0.02). The method of bypass (direct or indirect) did not alter relative increases in CVR (8 versus 3.8 mL/100 g per minute, P=0.7). CONCLUSIONS Acetazolamide-challenged arterial spin labeling noninvasively quantifies augmentation of CVR following surgery for Moyamoya disease and syndrome.
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Affiliation(s)
| | - Laura M Prolo
- Department of Neurosurgery, Stanford University School of Medicine, CA. (L.M.P., M.Z., J.L.Q., A.I., G.K.S., G.A.G.)
| | - Jonathan D Santoro
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, CA (J.D.S.).,Department of Neurology, Keck School of Medicine at the University of Southern California, Los Angeles (J.D.S.)
| | - Michael Zhang
- Department of Neurosurgery, Stanford University School of Medicine, CA. (L.M.P., M.Z., J.L.Q., A.I., G.K.S., G.A.G.)
| | - Jennifer L Quon
- Department of Neurosurgery, Stanford University School of Medicine, CA. (L.M.P., M.Z., J.L.Q., A.I., G.K.S., G.A.G.)
| | - Michael Jin
- Stanford University School of Medicine, CA (V.L.R., M.J.)
| | - Aditya Iyer
- Department of Neurosurgery, Stanford University School of Medicine, CA. (L.M.P., M.Z., J.L.Q., A.I., G.K.S., G.A.G.)
| | - Vivek Yedavalli
- Johns Hopkins Hospital, Department of Radiological Sciences, Baltimore, MD (V.Y.)
| | - Robert M Lober
- Dayton Children's Hospital Division of Neurosurgery and Wright State University Boonshoft School of Medicine Department of Pediatrics, Dayton, OH (R.M.L.)
| | - Gary K Steinberg
- Department of Neurosurgery, Stanford University School of Medicine, CA. (L.M.P., M.Z., J.L.Q., A.I., G.K.S., G.A.G.)
| | - Kristen W Yeom
- Department of Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, CA. (K.W.Y.)
| | - Gerald A Grant
- Department of Neurosurgery, Stanford University School of Medicine, CA. (L.M.P., M.Z., J.L.Q., A.I., G.K.S., G.A.G.)
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Kossorotoff M, Blauwblomme T. Refining revascularization surgery indications for paediatric moyamoya angiopathy: Age also matters. Eur J Paediatr Neurol 2021; 35:A1. [PMID: 34838447 DOI: 10.1016/j.ejpn.2021.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Manoelle Kossorotoff
- French Centre for Paediatric Stroke, Paediatric Neurology Department, APHP University Hospital Necker-Enfants Malades, Paris, France.
| | - Thomas Blauwblomme
- French Centre for Paediatric Stroke, Paediatric Neurosurgery Department, APHP University Hospital Necker-Enfants Malades, Paris, France; University of Paris, Paris, France
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Imaging methods for surgical revascularization in patients with moyamoya disease: an updated review. Neurosurg Rev 2021; 45:343-356. [PMID: 34417671 PMCID: PMC8827314 DOI: 10.1007/s10143-021-01596-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 06/20/2021] [Accepted: 06/24/2021] [Indexed: 02/08/2023]
Abstract
Neuroimaging is crucial in moyamoya disease (MMD) for neurosurgeons, during pre-surgical planning and intraoperative navigation not only to maximize the success rate of surgery, but also to minimize postsurgical neurological deficits in patients. This is a review of recent literatures which updates the clinical use of imaging methods in the morphological and hemodynamic assessment of surgical revascularization in patients with MMD. We aimed to assist surgeons in assessing the status of moyamoya vessels, selecting bypass arteries, and monitoring postoperative cerebral perfusion through the latest imaging technology.
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8
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Clinical Management of Moyamoya Patients. J Clin Med 2021; 10:jcm10163628. [PMID: 34441923 PMCID: PMC8397113 DOI: 10.3390/jcm10163628] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 01/01/2023] Open
Abstract
Moyamoya angiopathy (MMA) is a peculiar cerebrovascular condition characterized by progressive steno-occlusion of the terminal part of the internal carotid arteries (ICAs) and their proximal branches, associated with the development of a network of fragile collateral vessels at the base of the brain. The diagnosis is essentially made by radiological angiographic techniques. MMA is often idiopathic (moyamoya disease-MMD); conversely, it can be associated with acquired or hereditary conditions (moyamoya Syndrome-MMS); however, the pathophysiology underlying either MMD or MMS has not been fully elucidated to date, and this poor knowledge reflects uncertainties and heterogeneity in patient management. MMD and MMS also have similar clinical expressions, including, above all, ischemic and hemorrhagic strokes, then headaches, seizures, cognitive impairment, and movement disorders. The available treatment strategies are currently shared between idiopathic MMD and MMS, including pharmacological and surgical stroke prevention treatments and symptomatic drugs. No pharmacological treatment able to reverse the progressive disappearance of the ICAs has been found to date in both idiopathic and syndromic cases. Antithrombotic agents are usually prescribed in ischemic MMA, although the coexisting hemorrhagic risk should be considered. Surgical revascularization techniques, which are currently the best available treatment in symptomatic MMA, are associated with good long-term outcomes and reduced ischemic and hemorrhagic risks. Given the lack of dedicated randomized clinical trials, current treatment is mainly based on observational studies and physicians’ and surgeons’ expertise.
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Hoffmann AC, Ruel Y, Gnirs K, Papageorgiou S, Zilberstein L, Nahmani S, Boddaert N, Gaillot H. Brain perfusion magnetic resonance imaging using pseudocontinuous arterial spin labeling in 314 dogs and cats. J Vet Intern Med 2021; 35:2327-2341. [PMID: 34291497 PMCID: PMC8478041 DOI: 10.1111/jvim.16215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/17/2021] [Accepted: 06/22/2021] [Indexed: 11/30/2022] Open
Abstract
Background Arterial spin labeling (ASL) is a noninvasive brain perfusion magnetic resonance imaging (MRI) technique that has not been assessed in clinical veterinary medicine. Hypothesis/Objectives To test the feasibility of ASL using a 1.5 Tesla scanner and provide recommendations for optimal quantification of cerebral blood flow (CBF) in dogs and cats. Animals Three hundred fourteen prospectively selected client‐owned dogs and cats. Methods Each animal underwent brain MRI including morphological sequences and ≥1 ASL sequences using different sites of blood labeling and postlabeling delays (PLD). Calculated ASL success rates were compared. The CBF was quantified in animals that had morphologically normal brain MRI results and parameters of ASL optimization were investigated. Results Arterial spin labeling was easily implemented with an overall success rate of 95% in animals with normal brain MRI. Technical recommendations included (a) positioning of the imaging slab at the foramen magnum and (b) selected PLD of 1025 ms in cats and dogs <7 kg, 1525 ms in dogs 7 to 38 kg, and 2025 ms in dogs >38 kg. In 37 dogs, median optimal CBF in the cortex and thalamic nuclei were 114 and 95 mL/100 g/min, respectively. In 28 cats, median CBF in the cortex and thalamic nuclei were 113 and 114 mL/100 g/min, respectively. Conclusions and Clinical Importance Our survey of brain perfusion ASL‐MRI demonstrated the feasibility of ASL at 1.5 Tesla, suggested technical recommendations and provided CBF values that should be helpful in the characterization of various brain diseases in dogs and cats.
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Affiliation(s)
- Anne-Cécile Hoffmann
- Unit of Diagnostic Imaging, ADVETIA Veterinary Referral Hospital, Vélizy-Villacoublay, France
| | - Yannick Ruel
- Unit of Diagnostic Imaging, ADVETIA Veterinary Referral Hospital, Vélizy-Villacoublay, France
| | - Kirsten Gnirs
- Unit of Neurology, ADVETIA Veterinary Referral Hospital, Vélizy-Villacoublay, France
| | - Stella Papageorgiou
- Unit of Neurology, ADVETIA Veterinary Referral Hospital, Vélizy-Villacoublay, France
| | - Luca Zilberstein
- Unit of Anesthesiology-Analgesia, ADVETIA Veterinary Referral Hospital, Vélizy-Villacoublay, France
| | - Sarah Nahmani
- Paediatric Radiology Department, AP-HP, Hôpital Necker Enfants Malades, Université de Paris, Paris, France
| | - Nathalie Boddaert
- Paediatric Radiology Department, AP-HP, Hôpital Necker Enfants Malades, Université de Paris, Paris, France.,Universié de Paris, Institut Imagine INSERM U1163, Paris, France
| | - Hugues Gaillot
- Unit of Diagnostic Imaging, ADVETIA Veterinary Referral Hospital, Vélizy-Villacoublay, France
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Loiselet K, Ruzzenente B, Roux CJ, Barcia G, Pennisi A, Desguerre I, Rötig A, Munnich A, Boddaert N. Cerebral blood flow and acute episodes of Leigh syndrome in neurometabolic disorders. Dev Med Child Neurol 2021; 63:705-711. [PMID: 33511646 DOI: 10.1111/dmcn.14814] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2020] [Indexed: 11/29/2022]
Abstract
AIM To investigate cerebral blood flow (CBF) in acute episodes of Leigh syndrome compared with basal state in patients carrying pathogenic mitochondrial disease gene variants responsible for neurometabolic disorders. METHOD Arterial spin labelling (ASL) magnetic resonance imaging (MRI) sequences were used to measure CBF in 27 patients with mitochondrial respiratory chain enzyme deficiencies, ascribed to pathogenic variants of reported disease genes who were undergoing either urgent neuroimaging for acute episodes of Leigh syndrome (Group I: 15 MRI, seven females, eight males; mean age 7y; range 7mo-14y) or routine brain MRI (Group II: 15 MRI, eight females, seven males; mean age 5y 2mo; range 2mo-12y). RESULTS Patients displayed markedly increased CBF in the striatum (2.8-fold greater, p<0.001 [1.05-2.53]) during acute episodes of Leigh syndrome compared to basal conditions. Detection of elevated CBF preceded identification of structural MRI lesions in four out of 15 cases. INTERPRETATION Our results suggest that increased CBF is an overt hallmark of Leigh syndrome episodes and ASL MRI sequences should facilitate early diagnosis of acute episodes of Leigh syndrome, especially during the first attack in young children, when structural MRI is insufficiently informative.
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Affiliation(s)
- Klervie Loiselet
- Department of Pediatric Radiology, Hôpital Necker-Enfants Malades, Paris, France
| | - Benedetta Ruzzenente
- Department of Genetics, Hôpital Necker-Enfants Malades, Paris, France.,AP-HP, IMAGINE Institute, INSERM UMR 1163, Université de Paris, Paris, France
| | - Charles-Joris Roux
- Department of Pediatric Radiology, Hôpital Necker-Enfants Malades, Paris, France
| | - Giulia Barcia
- Department of Genetics, Hôpital Necker-Enfants Malades, Paris, France
| | | | - Isabelle Desguerre
- Department of Neurology and Metabolism, Hôpital Necker-Enfants Malades, Paris, France
| | - Agnès Rötig
- AP-HP, IMAGINE Institute, INSERM UMR 1163, Université de Paris, Paris, France
| | - Arnold Munnich
- Department of Genetics, Hôpital Necker-Enfants Malades, Paris, France.,AP-HP, IMAGINE Institute, INSERM UMR 1163, Université de Paris, Paris, France
| | - Nathalie Boddaert
- Department of Pediatric Radiology, Hôpital Necker-Enfants Malades, Paris, France.,AP-HP, IMAGINE Institute, INSERM UMR 1163, Université de Paris, Paris, France
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PHACES Syndrome and Associated Anomalies: Risk Associated With Small and Large Facial Hemangiomas. AJR Am J Roentgenol 2021; 217:507-514. [PMID: 34036811 DOI: 10.2214/ajr.20.23488] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. PHACES syndrome includes posterior fossa malformations, hemangioma, arterial anomalies, coarctation of the aorta and cardiac defects, eye abnormalities, and sternal defect with or without supraumbilical raphe. Usually, brain imaging is performed when facial hemangiomas are larger than 5 cm. Data on associated anomalies regardless of hemangioma size are sparse. The objective of this study was to determine, first, the prevalence of PHACES-like associated anomalies in a large sample of infants with all sizes of segmental facial or periorbital focal infantile hemangioma and, second, whether the cutaneous localization of the hemangioma correlates with the type of anomalies present. MATERIALS AND METHODS. The records of all patients of a vascular anomalies practice who had a diagnosis of segmental facial or periorbital focal infantile hemangioma and who had clinical photographs and brain MRI available were reviewed. The clinical photographs were reviewed to determine the localization by segment and lateralization. MRI was reviewed by two experienced pediatric radiologists. If present, cardiovascular anomalies, sternal defects, and eye anomalies were recorded. The criteria for definite and possible PHACES were used. RESULTS. The study included 122 children (90 girls, 32 boys; mean age, 16.6 months). Forty-five (36.9%) children had a facial infantile hemangioma larger than 5 cm. Twenty-two patients (18.0%) had PHACES or possible PHACES syndrome. Cerebrovascular structural anomalies were seen in 14 of 22 and brain anomalies in 6 of 22 patients with PHACES syndrome but in none and one of the patients in the group without PHACES (p < .001). Cardiovascular anomalies were seen in six patients and ocular anomalies in eight patients. All but one of them had PHACES syndrome. CONCLUSION. Clinical concern about associated extracutaneous anomalies is warranted for all children with facial segmental or periorbital focal infantile hemangiomas, including those with small hemangiomas. Further studies are needed to correlate cerebrovascular anomalies with the clinical evolution of hemangiomas and their effects on cerebral perfusion.
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12
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Blauwblomme T, Demertzi A, Tacchela J, Fillon L, Bourgeois M, Losito E, Eisermann M, Marinazzo D, Raimondo F, Alcauter S, Van De Steen F, Colenbier N, Laureys S, Dangouloff‐Ros V, Naccache L, Boddaert N, Nabbout R. Complete hemispherotomy leads to lateralized functional organization and lower level of consciousness in the isolated hemisphere. Epilepsia Open 2020; 5:537-549. [PMID: 33336125 PMCID: PMC7733653 DOI: 10.1002/epi4.12433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/18/2020] [Accepted: 08/22/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To quantify whole-brain functional organization after complete hemispherotomy, characterizing unexplored plasticity pathways and the conscious level of the dissected hemispheres. METHODS Evaluation with multimodal magnetic resonance imaging in two pediatric patients undergoing right hemispherotomy including complete callosotomy with a perithalamic section. Regional cerebral blood flow and fMRI network connectivity assessed the functional integrity of both hemispheres after surgery. The level of consciousness was tested by means of a support vector machine classifier which compared the intrinsic organization of the dissected hemispheres with those of patients suffering from disorders of consciousness. RESULTS After hemispherotomy, both patients showed typical daily functionality. We found no interhemispheric transfer of functional connectivity in either patient as predicted by the operation. The healthy left hemispheres displayed focal blood hyperperfusion in motor and limbic areas, with preserved network-level organization. Unexpectedly, the disconnected right hemispheres showed sustained network organization despite low regional cerebral blood flow. Subcortically, functional connectivity was increased in the left thalamo-cortical loop and between the cerebelli. One patient further showed unusual ipsilateral right cerebello-cortical connectivity, which was explained by the mediation of the vascular system. The healthy left hemisphere had higher probability to be classified as in a minimally conscious state compared to the isolated right hemisphere. SIGNIFICANCE Complete hemispherotomy leads to a lateralized whole-brain organization, with the remaining hemisphere claiming most of the brain's energetic reserves supported by subcortical structures. Our results further underline the contribution of nonneuronal vascular signals on contralateral connectivity, shedding light on the nature of network organization in the isolated tissue. The disconnected hemisphere is characterized by a level of consciousness which is necessary but insufficient for conscious processing, paving the way for more specific inquiries about its role in awareness in the absence of behavioral output.
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Affiliation(s)
- Thomas Blauwblomme
- Assistance Publique Hôpitaux de ParisHôpital Necker‐Enfants MaladesParisFrance
- Université de ParisParisFrance
- INSERM U1163Institut ImagineParisFrance
| | - Athena Demertzi
- GIGA‐Consciousness, Physiology of Cognition Research LabGIGA InstituteUniversity of LiègeLiègeBelgium
- INSERMU1127ParisFrance
- Institut du Cerveau et de la Moelle EpinièreHôpital Pitié‐SalpêtrièreParisFrance
| | | | | | - Marie Bourgeois
- Assistance Publique Hôpitaux de ParisHôpital Necker‐Enfants MaladesParisFrance
| | - Emma Losito
- Assistance Publique Hôpitaux de ParisHôpital Necker‐Enfants MaladesParisFrance
| | - Monika Eisermann
- Assistance Publique Hôpitaux de ParisHôpital Necker‐Enfants MaladesParisFrance
| | - Daniele Marinazzo
- Department of Data AnalysisFaculty of Psychological and Educational SciencesUniversity of GhentGhentBelgium
| | - Federico Raimondo
- Institut du Cerveau et de la Moelle EpinièreHôpital Pitié‐SalpêtrièreParisFrance
- GIGA‐Consciousness, Coma Science GroupGIGA InstituteUniversity of LiègeLiègeBelgium
| | - Sarael Alcauter
- Instituto de NeurobiologíaUniversidad Nacional Autónoma de MéxicoQuerétaroMéxico
| | - Frederik Van De Steen
- GIGA‐Consciousness, Physiology of Cognition Research LabGIGA InstituteUniversity of LiègeLiègeBelgium
| | - Nigel Colenbier
- GIGA‐Consciousness, Physiology of Cognition Research LabGIGA InstituteUniversity of LiègeLiègeBelgium
| | - Steven Laureys
- GIGA‐Consciousness, Coma Science GroupGIGA InstituteUniversity of LiègeLiègeBelgium
| | - Volodia Dangouloff‐Ros
- Assistance Publique Hôpitaux de ParisHôpital Necker‐Enfants MaladesParisFrance
- Université de ParisParisFrance
- INSERM U1163Institut ImagineParisFrance
| | - Lionel Naccache
- INSERMU1127ParisFrance
- Institut du Cerveau et de la Moelle EpinièreHôpital Pitié‐SalpêtrièreParisFrance
| | - Nathalie Boddaert
- Assistance Publique Hôpitaux de ParisHôpital Necker‐Enfants MaladesParisFrance
- Université de ParisParisFrance
- INSERM U1163Institut ImagineParisFrance
| | - Rima Nabbout
- Assistance Publique Hôpitaux de ParisHôpital Necker‐Enfants MaladesParisFrance
- Université de ParisParisFrance
- INSERM U1163Institut ImagineParisFrance
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13
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Clinical Prediction of Surgical Revascularization Outcome in Moyamoya Disease Via Transcranial Color Sonography. J Stroke Cerebrovasc Dis 2020; 29:105154. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.105154] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/12/2020] [Indexed: 11/22/2022] Open
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14
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Ha JY, Choi YH, Lee S, Cho YJ, Cheon JE, Kim IO, Kim WS. Arterial Spin Labeling MRI for Quantitative Assessment of Cerebral Perfusion Before and After Cerebral Revascularization in Children with Moyamoya Disease. Korean J Radiol 2020; 20:985-996. [PMID: 31132824 PMCID: PMC6536794 DOI: 10.3348/kjr.2018.0651] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 03/13/2019] [Indexed: 01/03/2023] Open
Affiliation(s)
- Ji Young Ha
- Department of Radiology, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Young Hun Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
| | - Seunghyun Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Yeon Jin Cho
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Eun Cheon
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - In One Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Woo Sun Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
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15
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Spatial coefficient of variation applied to arterial spin labeling MRI may contribute to predict surgical revascularization outcomes in pediatric moyamoya vasculopathy. Neuroradiology 2020; 62:1003-1015. [DOI: 10.1007/s00234-020-02446-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 04/20/2020] [Indexed: 10/24/2022]
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16
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Fahlström M, Lewén A, Enblad P, Larsson EM, Wikström J. High Intravascular Signal Arterial Transit Time Artifacts Have Negligible Effects on Cerebral Blood Flow and Cerebrovascular Reserve Capacity Measurement Using Single Postlabel Delay Arterial Spin-Labeling in Patients with Moyamoya Disease. AJNR Am J Neuroradiol 2020; 41:430-436. [PMID: 32115416 DOI: 10.3174/ajnr.a6411] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 12/24/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Arterial spin-labeling-derived CBF values may be affected by arterial transit time artefacts. Thus, our aim was to assess to what extent arterial spin-labeling-derived CBF and cerebrovascular reserve capacity values in major vascular regions are overestimated due to the arterial transit time artifacts in patients with Moyamoya disease. MATERIALS AND METHODS Eight patients with Moyamoya disease were included before or after revascularization surgery. CBF maps were acquired using a 3D pseudocontinuous arterial spin-labeling sequence, before and 5, 15, and 25 minutes after an IV acetazolamide injection and were registered to each patient's 3D-T1-weighted images. Vascular regions were defined by spatial normalization to a Montreal Neurological Institute-based vascular regional template. The arterial transit time artifacts were defined as voxels with high signal intensity corresponding to the right tail of the histogram for a given vascular region, with the cutoff selected by visual inspection. Arterial transit time artifact maps were created and applied as masks to exclude arterial transit time artifacts on CBF maps, to create corrected CBF maps. The cerebrovascular reserve capacity was calculated as CBF after acetazolamide injection relative to CBF at baseline for corrected and uncorrected CBF values, respectively. RESULTS A total of 16 examinations were analyzed. Arterial transit time artifacts were present mostly in the MCA, whereas the posterior cerebral artery was generally unaffected. The largest differences between corrected and uncorrected CBF and cerebrovascular reserve capacity values, reported as patient group average ratio and percentage point difference, respectively, were 0.978 (95% CI, 0.968-0.988) and 1.8 percentage points (95% CI, 0.3-3.2 percentage points). Both were found in the left MCA, 15 and 5 minutes post-acetazolamide injection, respectively. CONCLUSIONS Arterial transit time artifacts have negligible overestimation effects on calculated vascular region-based CBF and cerebrovascular reserve capacity values derived from single-delay 3D pseudocontinuous arterial spin-labeling.
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Affiliation(s)
- M Fahlström
- From the Departments of Surgical Sciences (M.F., E.-M.L., J.W.) and Neuroscience (A.L., P.E.), Uppsala University, Uppsala, Sweden.
| | - A Lewén
- From the Departments of Surgical Sciences (M.F., E.-M.L., J.W.) and Neuroscience (A.L., P.E.), Uppsala University, Uppsala, Sweden
| | - P Enblad
- From the Departments of Surgical Sciences (M.F., E.-M.L., J.W.) and Neuroscience (A.L., P.E.), Uppsala University, Uppsala, Sweden
| | - E-M Larsson
- From the Departments of Surgical Sciences (M.F., E.-M.L., J.W.) and Neuroscience (A.L., P.E.), Uppsala University, Uppsala, Sweden
| | - J Wikström
- From the Departments of Surgical Sciences (M.F., E.-M.L., J.W.) and Neuroscience (A.L., P.E.), Uppsala University, Uppsala, Sweden
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17
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Liang L, Lei Y, Su J, Zhou P, Lv H, Wang T, Ma T. Perfusion Quantification using Arterial Spin Labeling Magnetic Resonance Imaging after Revascularization for Moyamoya Disease. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:4326-4329. [PMID: 31946825 DOI: 10.1109/embc.2019.8857824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The hemodynamics in the brains of individuals with Moyamoya disease are complex and variable. Cerebral revascularization is an important treatment when hemodynamics are severely damaged. It's of great value to accurately quantify blood perfusion of different functional brain regions for better postoperative prognosis. In this study, we developed methods to segment territory of middle cerebral arteries (MCA) and its functional brain regions based on T1 and arterial spin labeling (ASL) imaging, absolute and normalized cerebral blood perfusion (CBF) were calculated for target regions-of-interest (ROI), spatial coefficient of variation was introduced to detect information of arterial transit time (ATT) contained in CBF images. After revascularization of Moyamoya disease, we detected perfusion improvement within MCA territory, while different alterations exist within different functional sub-regions. We also conformed that the spatial coefficient of variation of ASL CBF images can be used as an alternative ROI-based hemodynamic measurement to predict alterations of ATT. In summary, our methods show potential in postoperative evaluation of patients with Moyamoya disease.
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18
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Guilliams KP, Fields ME, Dowling MM. Advances in Understanding Ischemic Stroke Physiology and the Impact of Vasculopathy in Children With Sickle Cell Disease. Stroke 2019; 50:266-273. [PMID: 30661504 DOI: 10.1161/strokeaha.118.020482] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Kristin P Guilliams
- From the Department of Neurology (K.P.G.), Washington University School of Medicine, St Louis, MO.,Department of Pediatrics (K.P.G., M.E.F.), Washington University School of Medicine, St Louis, MO
| | - Melanie E Fields
- Department of Pediatrics (K.P.G., M.E.F.), Washington University School of Medicine, St Louis, MO
| | - Michael M Dowling
- Department of Pediatrics and Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas (M.M.D.)
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19
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Bolar DS, Gagoski B, Orbach DB, Smith E, Adalsteinsson E, Rosen BR, Grant PE, Robertson RL. Comparison of CBF Measured with Combined Velocity-Selective Arterial Spin-Labeling and Pulsed Arterial Spin-Labeling to Blood Flow Patterns Assessed by Conventional Angiography in Pediatric Moyamoya. AJNR Am J Neuroradiol 2019; 40:1842-1849. [PMID: 31694821 PMCID: PMC6975103 DOI: 10.3174/ajnr.a6262] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 08/21/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Imaging CBF is important for managing pediatric moyamoya. Traditional arterial spin-labeling MR imaging detects delayed transit thorough diseased arteries but is inaccurate for measuring perfusion because of these delays. Velocity-selective arterial spin-labeling is insensitive to transit delay and well-suited for imaging Moyamoya perfusion. This study assesses the accuracy of a combined velocity-selective arterial spin-labeling and traditional pulsed arterial spin-labeling CBF approach in pediatric moyamoya, with comparison to blood flow patterns on conventional angiography. MATERIALS AND METHODS Twenty-two neurologically stable pediatric patients with moyamoya and 5 asymptomatic siblings without frank moyamoya were imaged with velocity-selective arterial spin-labeling, pulsed arterial spin-labeling, and DSA (patients). Qualitative comparison was performed, followed by a systematic comparison using ASPECTS-based scoring. Quantitative pulsed arterial spin-labeling CBF and velocity-selective arterial spin-labeling CBF for the middle cerebral artery, anterior cerebral artery, and posterior cerebral artery territories were also compared. RESULTS Qualitatively, velocity-selective arterial spin-labeling perfusion maps reflect the DSA parenchymal phase, regardless of postinjection timing. Conversely, pulsed arterial spin-labeling maps reflect the DSA appearance at postinjection times closer to the arterial spin-labeling postlabeling delay, regardless of vascular phase. ASPECTS comparison showed excellent agreement (88%, κ = 0.77, P < .001) between arterial spin-labeling and DSA, suggesting velocity-selective arterial spin-labeling and pulsed arterial spin-labeling capture key perfusion and transit delay information, respectively. CBF coefficient of variation, a marker of perfusion variability, was similar for velocity-selective arterial spin-labeling in patient regions of delayed-but-preserved perfusion compared to healthy asymptomatic sibling regions (coefficient of variation = 0.30 versus 0.26, respectively, Δcoefficient of variation = 0.04), but it was significantly different for pulsed arterial spin-labeling (coefficient of variation = 0.64 versus 0.34, Δcoefficient of variation = 0.30, P < .001). CONCLUSIONS Velocity-selective arterial spin-labeling offers a powerful approach to image perfusion in pediatric moyamoya due to transit delay insensitivity. Coupled with pulsed arterial spin-labeling for transit delay information, a volumetric MR imaging approach capturing key DSA information is introduced.
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Affiliation(s)
- D S Bolar
- From the Department of Radiology (D.S.B.)
- Center for Functional Magnetic Resonance Imaging (D.S.B.), UC San Diego, La Jolla, California
| | - B Gagoski
- Fetal Neonatal Neuroimaging and Developmental Science Center (B.G., P.E.G.)
- Department of Radiology (B.G., D.B.O., P.E.G., R.L.R.)
| | - D B Orbach
- Department of Radiology (B.G., D.B.O., P.E.G., R.L.R.)
- Division of Neurointerventional Radiology (D.B.O.)
| | - E Smith
- Department of Neurosurgery (E.S.)
| | - E Adalsteinsson
- Department of Electrical Engineering & Computer Science (E.A.), Massachusetts Institute of Technology, Cambridge, Massachusetts
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging (E.A., B.R.R.), Charlestown, Massachusetts
| | - B R Rosen
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging (E.A., B.R.R.), Charlestown, Massachusetts
| | - P E Grant
- Fetal Neonatal Neuroimaging and Developmental Science Center (B.G., P.E.G.)
- Department of Radiology (B.G., D.B.O., P.E.G., R.L.R.)
- Division of Newborn Medicine (P.E.G.), Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - R L Robertson
- Department of Radiology (B.G., D.B.O., P.E.G., R.L.R.)
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20
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Fan AP, Khalighi MM, Guo J, Ishii Y, Rosenberg J, Wardak M, Park JH, Shen B, Holley D, Gandhi H, Haywood T, Singh P, Steinberg GK, Chin FT, Zaharchuk G. Identifying Hypoperfusion in Moyamoya Disease With Arterial Spin Labeling and an [ 15O]-Water Positron Emission Tomography/Magnetic Resonance Imaging Normative Database. Stroke 2019; 50:373-380. [PMID: 30636572 DOI: 10.1161/strokeaha.118.023426] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Noninvasive imaging of brain perfusion has the potential to elucidate pathophysiological mechanisms underlying Moyamoya disease and enable clinical imaging of cerebral blood flow (CBF) to select revascularization therapies for patients. We used hybrid positron emission tomography (PET)/magnetic resonance imaging (MRI) technology to characterize the distribution of hypoperfusion in Moyamoya disease and its relationship to vessel stenosis severity, through comparisons with a normative perfusion database of healthy controls. Methods- To image CBF, we acquired [15O]-water PET as a reference and simultaneously acquired arterial spin labeling (ASL) MRI scans in 20 Moyamoya patients and 15 age-matched, healthy controls on a PET/MRI scanner. The ASL MRI scans included a standard single-delay ASL scan with postlabel delay of 2.0 s and a multidelay scan with 5 postlabel delays (0.7-3.0s) to estimate and account for arterial transit time in CBF quantification. The percent volume of hypoperfusion in patients (determined as the fifth percentile of CBF values in the healthy control database) was the outcome measure in a logistic regression model that included stenosis grade and location. Results- Logistic regression showed that anterior ( P<0.0001) and middle cerebral artery territory regions ( P=0.003) in Moyamoya patients were susceptible to hypoperfusion, whereas posterior regions were not. Cortical regions supplied by arteries with stenosis on MR angiography showed more hypoperfusion than normal arteries ( P=0.001), but the extent of hypoperfusion was not different between mild-moderate versus severe stenosis. Multidelay ASL did not perform differently from [15O]-water PET in detecting perfusion abnormalities, but standard ASL overestimated the extent of hypoperfusion in patients ( P=0.003). Conclusions- This simultaneous PET/MRI study supports the use of multidelay ASL MRI in clinical evaluation of Moyamoya disease in settings where nuclear medicine imaging is not available and application of a normative perfusion database to automatically identify abnormal CBF in patients.
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Affiliation(s)
- Audrey P Fan
- From the Department of Radiology (A.P.F., J.G., Y.I., J.R., M.W., J.H.P., B.S., D.H., H.G., T.H., P.S., F.T.C., G.Z.), Stanford University, CA
| | | | - Jia Guo
- From the Department of Radiology (A.P.F., J.G., Y.I., J.R., M.W., J.H.P., B.S., D.H., H.G., T.H., P.S., F.T.C., G.Z.), Stanford University, CA.,Department of Bioengineering, University of California Riverside (J.G.)
| | - Yosuke Ishii
- From the Department of Radiology (A.P.F., J.G., Y.I., J.R., M.W., J.H.P., B.S., D.H., H.G., T.H., P.S., F.T.C., G.Z.), Stanford University, CA.,Department of Neurosurgery, Tokyo Medical and Dental University, Japan (Y.I.)
| | - Jarrett Rosenberg
- From the Department of Radiology (A.P.F., J.G., Y.I., J.R., M.W., J.H.P., B.S., D.H., H.G., T.H., P.S., F.T.C., G.Z.), Stanford University, CA
| | - Mirwais Wardak
- From the Department of Radiology (A.P.F., J.G., Y.I., J.R., M.W., J.H.P., B.S., D.H., H.G., T.H., P.S., F.T.C., G.Z.), Stanford University, CA
| | - Jun Hyung Park
- From the Department of Radiology (A.P.F., J.G., Y.I., J.R., M.W., J.H.P., B.S., D.H., H.G., T.H., P.S., F.T.C., G.Z.), Stanford University, CA
| | - Bin Shen
- From the Department of Radiology (A.P.F., J.G., Y.I., J.R., M.W., J.H.P., B.S., D.H., H.G., T.H., P.S., F.T.C., G.Z.), Stanford University, CA
| | - Dawn Holley
- From the Department of Radiology (A.P.F., J.G., Y.I., J.R., M.W., J.H.P., B.S., D.H., H.G., T.H., P.S., F.T.C., G.Z.), Stanford University, CA
| | - Harsh Gandhi
- From the Department of Radiology (A.P.F., J.G., Y.I., J.R., M.W., J.H.P., B.S., D.H., H.G., T.H., P.S., F.T.C., G.Z.), Stanford University, CA
| | - Tom Haywood
- From the Department of Radiology (A.P.F., J.G., Y.I., J.R., M.W., J.H.P., B.S., D.H., H.G., T.H., P.S., F.T.C., G.Z.), Stanford University, CA
| | - Prachi Singh
- From the Department of Radiology (A.P.F., J.G., Y.I., J.R., M.W., J.H.P., B.S., D.H., H.G., T.H., P.S., F.T.C., G.Z.), Stanford University, CA
| | | | - Frederick T Chin
- From the Department of Radiology (A.P.F., J.G., Y.I., J.R., M.W., J.H.P., B.S., D.H., H.G., T.H., P.S., F.T.C., G.Z.), Stanford University, CA
| | - Greg Zaharchuk
- From the Department of Radiology (A.P.F., J.G., Y.I., J.R., M.W., J.H.P., B.S., D.H., H.G., T.H., P.S., F.T.C., G.Z.), Stanford University, CA
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21
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Chiarelli PA, Patel AP, Lee A, Chandra SR, Sekhar LN. Sternocleidomastoid Encephalomyosynangiosis for Treatment-Resistant Moyamoya Disease. Oper Neurosurg (Hagerstown) 2019; 17:E23-E28. [PMID: 30169838 DOI: 10.1093/ons/opy234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 07/31/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Refractory ischemic symptoms in moyamoya disease are a challenging problem, particularly in situations in which multiple direct and indirect revascularization techniques have already been employed. In addition, revascularization of the parietal lobes is difficult, as this area is a watershed between the middle cerebral artery and posterior cerebral artery distributions. CLINICAL PRESENTATION This is the case of a 50-yr-old woman with hemibody sensorimotor deficits, who had previously undergone bilateral arterial bypass and temporalis myosynangiosis. A method for indirect surgical cerebral revascularization is described, utilizing a rotated and tunneled sternocleidomastoid flap. The perfused muscle is approximated to the cortical surface, with adjacent sulci dissected to expose the underlying vasculature. After sternocleidomastoid encephalomyosynangiosis, the patient experienced symptomatic improvement, along with the appearance of new pial collateral vasculature on diagnostic cerebral angiography. Pre- and postoperative dynamic perfusion computed tomography with acetazolamide challenge demonstrate an increase in cerebral blood flow and decrease in mean transit time, as well as improved cerebrovascular reserve. CONCLUSION Sternocleidomastoid encephalomyosynangiosis using a tunneled muscle flap is a useful method for revascularization of the parietal and occipital lobes, particularly for refractory moyamoya in cases where a variety of other options have been exhausted.
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Affiliation(s)
- Peter A Chiarelli
- Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Anoop P Patel
- Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Amy Lee
- Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Srinivasa R Chandra
- Division of OMF - Head and Neck Surgery, University of Nebraska, Omaha, Nebraska
| | - Laligam N Sekhar
- Department of Neurological Surgery, University of Washington, Seattle, Washington
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22
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Mirone G, Cicala D, Meucci C, d'Amico A, Santoro C, Muto M, Cinalli G. Multiple Burr-Hole Surgery for the Treatment of Moyamoya Disease and Quasi-Moyamoya Disease in Children: Preliminary Surgical and Imaging Results. World Neurosurg 2019; 127:e843-e855. [PMID: 30954732 DOI: 10.1016/j.wneu.2019.03.282] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/27/2019] [Accepted: 03/28/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Moyamoya disease (MMD) is characterized by a progressive spontaneous occlusion of distal internal carotid arteries and its main branches. It is necessary to promptly diagnose and treat this condition, especially in children, because of the high risk of stroke and consequent severe disability. In this study, we examine the role of multiple burr-hole surgery (MBHS) in the treatment of pediatric patients with MMD and quasi-MMD and the role of perfusion magnetic resonance imaging (MRI) in the surgical indication and during follow-up. METHODS We reviewed preoperative, early postoperative, and late postoperative MRI perfusion and digital subtraction angiography images together with clinical and surgical outcomes in 10 children with MMD treated by MBHS. RESULTS Fourteen MBHS procedures (6 unilateral, 2 bilateral, and 2 single-setting bilateral) were performed in 10 children. Clinical and radiologic follow-up for all patients ranges from 16 months to 7 years. No ischemic events (transient ischemic attacks or stroke) occurred during the follow-up period. Postoperative digital subtraction angiography showed good revascularization around the burr-hole sites in all patients. The functional efficacy of the surgery was confirmed by dynamic susceptibility contrast perfusion MRI studies in 8 patients. CONCLUSIONS Our data underline the good rate of success of MBHS in pediatric MMD and quasi-MMD. This technique results in good collateral revascularization, improved cerebral perfusion and excellent short and long-term symptoms control, with low perioperative risk. Postoperative changes of perfusion parameters and ivy sign MRI finding seem to show a positive correlation and mainly occur in posterior middle cerebral artery territory.
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Affiliation(s)
- Giuseppe Mirone
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy.
| | - Domenico Cicala
- Department of Pediatric Neuroradiology, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Chiara Meucci
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Alessandra d'Amico
- Department of Neuroradiology, School of Medicine, "Federico II" University of Naples, Naples, Italy
| | - Claudia Santoro
- Department of Woman, Child, General and Specialistic Surgery, School of Medicine, "Luigi Vanvitelli" University of Campania, Naples, Italy
| | - Mario Muto
- Department of Neuroradiology, A.O.R.N. Cardarelli, Naples, Italy
| | - Giuseppe Cinalli
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy
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McKetton L, Venkatraghavan L, Rosen C, Mandell DM, Sam K, Sobczyk O, Poublanc J, Gray E, Crawley A, Duffin J, Fisher JA, Mikulis DJ. Improved White Matter Cerebrovascular Reactivity after Revascularization in Patients with Steno-Occlusive Disease. AJNR Am J Neuroradiol 2018; 40:45-50. [PMID: 30573457 DOI: 10.3174/ajnr.a5912] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/08/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE One feature that patients with steno-occlusive cerebrovascular disease have in common is the presence of white matter (WM) lesions on MRI. The purpose of this study was to evaluate the effect of direct surgical revascularization on impaired WM cerebrovascular reactivity in patients with steno-occlusive disease. MATERIALS AND METHODS We recruited 35 patients with steno-occlusive disease, Moyamoya disease (n = 24), Moyamoya syndrome (n = 3), atherosclerosis (n = 6), vasculitis (n = 1), and idiopathic stenosis (n = 1), who underwent unilateral brain revascularization using a direct superficial temporal artery-to-MCA bypass (19 women; mean age, 45.8 ± 16.5 years). WM cerebrovascular reactivity was measured preoperatively and postoperatively using blood oxygen level-dependent (BOLD) MR imaging during iso-oxic hypercapnic changes in end-tidal carbon dioxide and was expressed as %Δ BOLD MR signal intensity per millimeter end-tidal partial pressure of CO2. RESULTS WM cerebrovascular reactivity significantly improved after direct unilateral superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass in the revascularized hemisphere in the MCA territory (mean ± SD, -0.0005 ± 0.053 to 0.053 ± 0.046 %BOLD/mm Hg; P < .0001) and in the anterior cerebral artery territory (mean, 0.0015 ± 0.059 to 0.021 ± 0.052 %BOLD/mm Hg; P = .005). There was no difference in WM cerebrovascular reactivity in the ipsilateral posterior cerebral artery territory nor in the vascular territories of the nonrevascularized hemisphere (P < .05). CONCLUSIONS Cerebral revascularization surgery is an effective treatment for reversing preoperative cerebrovascular reactivity deficits in WM. In addition, direct-STA-MCA bypass may prevent recurrence of preoperative symptoms.
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Affiliation(s)
- L McKetton
- From the Division of Neuroradiology, Joint Department of Medical Imaging (L.M., C.R., D.M.M., K.S., O.S., J.P., E.G., A.C., D.J.M.)
| | - L Venkatraghavan
- Department of Anesthesia and Pain Management (L.V., J.A.F.), University Health Network, Toronto, Ontario, Canada
| | - C Rosen
- From the Division of Neuroradiology, Joint Department of Medical Imaging (L.M., C.R., D.M.M., K.S., O.S., J.P., E.G., A.C., D.J.M.)
| | - D M Mandell
- From the Division of Neuroradiology, Joint Department of Medical Imaging (L.M., C.R., D.M.M., K.S., O.S., J.P., E.G., A.C., D.J.M.)
| | - K Sam
- From the Division of Neuroradiology, Joint Department of Medical Imaging (L.M., C.R., D.M.M., K.S., O.S., J.P., E.G., A.C., D.J.M.).,Russell H. Morgan Department of Radiology and Radiological Science (K.S.), John Hopkins School of Medicine, Baltimore, Maryland
| | - O Sobczyk
- From the Division of Neuroradiology, Joint Department of Medical Imaging (L.M., C.R., D.M.M., K.S., O.S., J.P., E.G., A.C., D.J.M.)
| | - J Poublanc
- From the Division of Neuroradiology, Joint Department of Medical Imaging (L.M., C.R., D.M.M., K.S., O.S., J.P., E.G., A.C., D.J.M.)
| | - E Gray
- From the Division of Neuroradiology, Joint Department of Medical Imaging (L.M., C.R., D.M.M., K.S., O.S., J.P., E.G., A.C., D.J.M.)
| | - A Crawley
- From the Division of Neuroradiology, Joint Department of Medical Imaging (L.M., C.R., D.M.M., K.S., O.S., J.P., E.G., A.C., D.J.M.)
| | - J Duffin
- Department of Physiology (J.D., J.A.F.).,Institute of Medical Sciences (J.D., J.A.F., D.J.M.), University of Toronto, Toronto, Ontario, Canada
| | - J A Fisher
- Department of Anesthesia and Pain Management (L.V., J.A.F.), University Health Network, Toronto, Ontario, Canada.,Department of Physiology (J.D., J.A.F.).,Institute of Medical Sciences (J.D., J.A.F., D.J.M.), University of Toronto, Toronto, Ontario, Canada
| | - D J Mikulis
- From the Division of Neuroradiology, Joint Department of Medical Imaging (L.M., C.R., D.M.M., K.S., O.S., J.P., E.G., A.C., D.J.M.) .,Institute of Medical Sciences (J.D., J.A.F., D.J.M.), University of Toronto, Toronto, Ontario, Canada
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Kazumata K, Uchino H, Tokairin K, Ito M, Shiga T, Osanai T, Kawabori M. Cerebral Hyperperfusion Syndrome After Revascularization Surgery in Moyamoya Disease: Region-Symptom Mapping and Estimating a Critical Threshold. World Neurosurg 2018. [DOI: 10.1016/j.wneu.2018.02.190] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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25
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Hervé D, Kossorotoff M, Bresson D, Blauwblomme T, Carneiro M, Touze E, Proust F, Desguerre I, Alamowitch S, Bleton JP, Borsali A, Brissaud E, Brunelle F, Calviere L, Chevignard M, Geffroy-Greco G, Faesch S, Habert MO, De Larocque H, Meyer P, Reyes S, Thines L, Tournier-Lasserve E, Chabriat H. French clinical practice guidelines for Moyamoya angiopathy. Rev Neurol (Paris) 2018. [PMID: 29519672 DOI: 10.1016/j.neurol.2017.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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26
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Blauwblomme T, Mathon B, Naggara O, Kossorotoff M, Bourgeois M, Puget S, Meyer P, Brousse V, de Montalembert M, Brunelle F, Zerah M, Sainte-Rose C. Long-term Outcome After Multiple Burr Hole Surgery in Children With Moyamoya Angiopathy: A Single-Center Experience in 108 Hemispheres. Neurosurgery 2018; 80:950-956. [PMID: 28327981 DOI: 10.1093/neuros/nyw161] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 12/22/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Multiple burr hole (MBH) surgery is a simple, safe, and effective indirect technique of revascularization in moyamoya angiopathy (MM). However, it is not yet recognized as a first-line treatment. OBJECTIVE To assess the long-term outcome and perioperative complications in a large single-center cohort of children with MM who underwent burr hole surgery. METHODS This study is a retrospective analysis of children who underwent surgery for MM in a national reference center for pediatric stroke between 1999 and 2015. Sixty-four children (108 hemispheres, median age 7 years) were consecutively treated. The indication for revascularization was previous stroke or transient ischemic attack (TIA) or rapidly progressive disease on brain magnetic resonance imaging (MRI) and digital subtraction angiography. Children were followed with clinical examinations, telephone interviews, and MRI with any clinical recurrence of stroke or TIA used as the primary endpoint. Surgical mortality and morbidity were documented. RESULTS Sixty-four patients were operated (bilateral MBH n = 39, unilateral procedure n = 25). At a mean follow-up of 4.2 years and 270.6 patient years, 89.1% of patients had not suffered any recurrent stroke or TIA. A second surgery was required in 5 cases after unilateral revascularization, and in 3 cases after bilateral MBH. Mortality associated with the procedure was 0. Postoperative Matsushima angiographic grading was the only predictive factor of ischemic recurrence ( P = .036). CONCLUSION In pediatric MM, MBH compares favorably to other indirect or direct revascularization techniques in children in the prevention of stroke or TIA.
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Affiliation(s)
- Thomas Blauwblomme
- Université René Descartes, PRES Sorbonne Paris Cité, Paris, France.,APHP, Department of Pediatric Neurosurgery, Necker Hospital, Paris, France
| | | | - Olivier Naggara
- Université René Descartes, PRES Sorbonne Paris Cité, Paris, France.,INSERM U894, Department of Neuroradiology, Sainte-Anne Hospital, Paris, France.,APHP, Department of Pediatric Neurology, French Center for Pediatric Stroke, Necker Hospital, Paris, France
| | - Manoelle Kossorotoff
- Université René Descartes, PRES Sorbonne Paris Cité, Paris, France.,APHP, Department of Pediatric Neurology, French Center for Pediatric Stroke, Necker Hospital, Paris, France.,APHP, Department of Anesthesiology, Necker Hospital, Paris, France
| | - Marie Bourgeois
- APHP, Department of Pediatric Neurosurgery, Necker Hospital, Paris, France
| | - Stéphanie Puget
- Université René Descartes, PRES Sorbonne Paris Cité, Paris, France.,APHP, Department of Pediatric Neurosurgery, Necker Hospital, Paris, France
| | - Philippe Meyer
- APHP, Department of Anesthesiology, Necker Hospital, Paris, France
| | - Valentine Brousse
- Université René Descartes, PRES Sorbonne Paris Cité, Paris, France.,Reference Centre for Sickle Cell Disease, Necker Hospital, Paris, France
| | - Marianne de Montalembert
- Université René Descartes, PRES Sorbonne Paris Cité, Paris, France.,Reference Centre for Sickle Cell Disease, Necker Hospital, Paris, France
| | - Francis Brunelle
- Université René Descartes, PRES Sorbonne Paris Cité, Paris, France.,APHP, Department of Neuroradiology, Necker Hospital, Paris, France
| | - Michel Zerah
- Université René Descartes, PRES Sorbonne Paris Cité, Paris, France.,APHP, Department of Pediatric Neurosurgery, Necker Hospital, Paris, France.,French National Reference Centre for Pediatric Stroke, Paris, France
| | - Christian Sainte-Rose
- Université René Descartes, PRES Sorbonne Paris Cité, Paris, France.,APHP, Department of Pediatric Neurosurgery, Necker Hospital, Paris, France
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Color Doppler ultrasonography as an alternative tool for postoperative evaluation of collaterals after indirect revascularization surgery in Moyamoya disease. PLoS One 2017; 12:e0188948. [PMID: 29220356 PMCID: PMC5722285 DOI: 10.1371/journal.pone.0188948] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 11/11/2017] [Indexed: 11/23/2022] Open
Abstract
The cerebral hypoperfusion caused by chronic progressive stenosis or occlusion of intracranial arteries in moyamoya disease can be treated by direct bypass or indirect revascularization procedures. The extent of collaterals from the external carotid artery (ECA) after indirect revascularization surgery is the key point of angiographic follow-up, and the invasiveness of angiography impelled us to investigate the role of ultrasonography in the evaluation of collaterals. We hypothesized that the collaterals shown on angiography might produce corresponding hemodynamic changes in color Doppler ultrasonography. We prospectively recruited moyamoya patients who underwent indirect revascularization surgery and received both preoperative and postoperative angiography and color Doppler ultrasound studies. The collaterals on angiography were graded according to Matsushima method. A total of 21 patients (age, 17 ± 10.2 years) with 24 operated hemispheres were enrolled. Patients who showed better collateral establishment by angiography had higher end-diastolic velocity (EDV), lower resistance index (RI), and larger flow volume in the superficial temporal artery (STA) and ECA (all p < 0.05). In STA, increase of EDV greater than 13.5 cm/sec or reduction of RI greater than 0.19 after operation corresponded to 94% of Matsushima grade A+B. In ECA, post-operative EDV greater than 22 cm/sec or increase of EDV greater than 6.4 cm/sec also corresponded to 94% of Matsushima grade A+B. Our findings revealed potential roles of color Doppler ultrasonography in identifying patients with poor collaterals after indirect revascularization procedures.
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Ishii Y, Tanaka Y, Momose T, Yamashina M, Sato A, Wakabayashi S, Maehara T, Nariai T. Chronologic Evaluation of Cerebral Hemodynamics by Dynamic Susceptibility Contrast Magnetic Resonance Imaging After Indirect Bypass Surgery for Moyamoya Disease. World Neurosurg 2017; 108:427-435. [PMID: 28893695 DOI: 10.1016/j.wneu.2017.09.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/30/2017] [Accepted: 09/01/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Although indirect bypass surgery is an effective treatment option for patients with ischemic-onset moyamoya disease (MMD), the time point after surgery at which the patient's hemodynamic status starts to improve and the time point at which the improvement reaches a maximum have not been known. The objective of the present study is to evaluate the hemodynamic status time course after indirect bypass surgery for MMD, using dynamic susceptibility contrast-magnetic resonance imaging (DSC-MRI). METHODS We retrospectively analyzed the cases of 25 patients with MMD (37 sides; mean age, 14.7 years; range, 3-36 years) who underwent indirect bypass surgery and repeated DSC-MRI measurement within 6 months after the operation. The difference in the mean transit time (MTT) between the target regions and the control region (cerebellum) was termed the MTT delay, and we measured the MTT delay's chronologic changes after surgery. RESULTS The postoperative MTT delay was 1.81 ± 1.16 seconds within 1 week after surgery, 1.57 ± 1.01 at weeks 1-2, 1.55 ± 0.68 at weeks 2-4, 1.32 ± 0.68 at months 1-2, 0.95 ± 0.32 at months 2-3, and 0.77 ± 0.33 at months 3-6. Compared with the preoperative value (2.11 ± 0.98 seconds), the MTT delay decreased significantly from 2 to 4 weeks after surgery (P < 0.05). CONCLUSIONS The amelioration of cerebral hemodynamics by indirect bypass surgery began soon after surgery and gradually reached a maximum at 3 months after surgery. DSC-MRI detected small changes in hemodynamic improvement, which are suspected to be caused by the initiation of angiogenesis and arteriogenesis in the early postoperative period.
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Affiliation(s)
- Yosuke Ishii
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan; Department of Radiology, Stanford University, California, USA
| | - Yoji Tanaka
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshiya Momose
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Motoshige Yamashina
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Akihito Sato
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Taketoshi Maehara
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tadashi Nariai
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan.
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29
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Utility of Arterial Spin Labeling MRI in Pediatric Neuroimaging: A Pictorial Essay. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0232-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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30
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Dlamini N, Wintermark M, Fullerton H, Strother S, Lee W, Bjornson B, Guilliams KP, Miller S, Kirton A, Filippi CG, Linds A, Askalan R, deVeber G. Harnessing Neuroimaging Capability in Pediatric Stroke: Proceedings of the Stroke Imaging Laboratory for Children Workshop. Pediatr Neurol 2017; 69:3-10. [PMID: 28259513 DOI: 10.1016/j.pediatrneurol.2017.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 01/05/2017] [Accepted: 01/06/2017] [Indexed: 12/22/2022]
Abstract
On June 5, 2015 the International Pediatric Stroke Study and the Stroke Imaging Laboratory for Children cohosted a unique workshop focused on developing neuroimaging research in pediatric stroke. Pediatric neurologists, neuroradiologists, interventional neuroradiologists, physicists, nurse practitioners, neuropsychologists, and imaging research scientists from around the world attended this one-day meeting. Our objectives were to (1) establish a group of experts to collaborate in advancing pediatric neuroimaging for stroke, (2) develop consensus clinical and research magnetic resonance imaging protocols for pediatric stroke patients, and (3) develop imaging-based research strategies in pediatric ischemic stroke. This article provides a summary of the meeting proceedings focusing on identified challenges and solutions and outcomes from the meeting. Further details on the workshop contents and outcomes are provided in three additional articles in the current issue of Pediatric Neurology.
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Affiliation(s)
- Nomazulu Dlamini
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
| | - Max Wintermark
- Division of Neuroradiology, Department of Radiology, Stanford University, Stanford, California
| | - Heather Fullerton
- Department of Neurology, University of California, San Francisco, San Francisco, California; Department of Pediatrics, University of California, San Francisco, San Francisco, California
| | - Stephen Strother
- Department of Medical Biophysics, Rotman Research Institute at Baycrest, University of Toronto, Toronto, Ontario, Canada
| | - Wayne Lee
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Bruce Bjornson
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Developmental Neurosciences and Child Health, Child and Family Research Institute, Vancouver, British Columbia, Canada
| | - Kristin P Guilliams
- Division of Pediatric Neurology, Department of Neurology, Washington University in St. Louis, St. Louis, Missouri; Division of Critical Care Medicine, Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri
| | - Steven Miller
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Adam Kirton
- Department of Pediatrics, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Clinical Neurosciences, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Christopher G Filippi
- Department of Radiology, Northwell Health, Manhasset, New York; Department of Neurology, University of Vermont Medical Center, Burlington, Vermont
| | - Alexandra Linds
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Rand Askalan
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Gabrielle deVeber
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Dlamini N, Yau I, Westmacott R, Shroff M, Armstrong D, Logan W, Mikulis D, deVeber G, Kassner A. Cerebrovascular Reactivity and Intellectual Outcome in Childhood Stroke With Transient Cerebral Arteriopathy. Pediatr Neurol 2017; 69:71-78. [PMID: 28258787 DOI: 10.1016/j.pediatrneurol.2017.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 01/02/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hypercapnic-challenge blood oxygen level-dependent magnetic resonance imaging cerebrovascular reactivity (CVR), measures the regional perfusion response to altered carbon dioxide. CVR correlates with the tissue-level microvascular dysfunction and ischemic risk. Among children with arterial ischemic stroke, transient cerebral arteriopathy (TCA) is a frequent, nonprogressive unilateral intracranial arteriopathy, which typically results in basal ganglia infarction and chronic cerebral artery stenosis. Therefore TCA provides a model for studying the consequences of chronic nonprogressive stenosis using CVR and intellectual outcome. We hypothesized that children with TCA and chronic nonprogressive intracranial artery stenosis have impaired CVR distal to the stenosis and associated cognitive impairment. METHODS We studied children with a prior diagnosis of TCA as defined by infarction limited to the basal ganglia, internal capsule, or both; and significant (greater than 50% diameter) residual stenosis of the supraclinoid internal carotid artery, its proximal branches or both. All children had CVR, intellectual function, and infarct volumes quantified. RESULTS We performed CVR studies in five children at mean 8.96 years (3.33 to 14.58 years) poststroke. Impaired CVR was limited to the infarct zone and adjacent white matter in most children. Intellectual function was broadly average in all but one subject. CONCLUSIONS In children with typical TCA, ipsilateral cortical CVR and intellectual function seem to be preserved despite persistent arterial stenosis in the majority. These findings suggest that chronic revascularization strategies in these children may not be indicated and require further exploration in a larger cohort of children.
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Affiliation(s)
- Nomazulu Dlamini
- Department of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada.
| | - Ivanna Yau
- Department of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Robyn Westmacott
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Manohar Shroff
- Department of Radiology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Derek Armstrong
- Department of Radiology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - William Logan
- Department of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - David Mikulis
- Department of Radiology, University of Toronto, Toronto, Ontario, Canada
| | - Gabrielle deVeber
- Department of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Andrea Kassner
- Department of Medical Physics, University of Toronto, Toronto, Ontario, Canada
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Ni WW, Christen T, Rosenberg J, Zun Z, Moseley ME, Zaharchuk G. Imaging of cerebrovascular reserve and oxygenation in Moyamoya disease. J Cereb Blood Flow Metab 2017; 37:1213-1222. [PMID: 27207169 PMCID: PMC5453445 DOI: 10.1177/0271678x16651088] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study aimed to determine whether measurements of cerebrovascular reserve and oxygenation, assessed with spin relaxation rate R2', yield similar information about pathology in pre-operative Moyamoya disease patients, and to assess whether R2' is a better measure of oxygenation than other proposed markers, such as R2* and R2. Twenty-five pre-operative Moyamoya disease patients were scanned at 3.0T with acetazolamide challenge. Cerebral blood flow mapping with multi-delay arterial spin labeling, and R2*, R2, and R2' mapping with Gradient-Echo Sampling of Free Induction Decay and Echo were performed. No baseline cerebral blood flow difference was found between angiographically abnormal and normal regions (49 ± 12 vs. 48 ± 11 mL/100 g/min, p = 0.44). However, baseline R2' differed between these regions (3.2 ± 0.7 vs. 2.9 ± 0.6 s-1, p < 0.001), indicating reduced oxygenation in abnormal regions. Cerebrovascular reserve was lower in angiographically abnormal regions (21 ± 38 vs. 41 ± 26%, p = 0.001). All regions showed trend toward significantly improved oxygenation post-acetazolamide. Regions with poorer cerebrovascular reserve had lower baseline oxygenation (Kendall's τ = -0.24, p = 0.003). A number of angiographically abnormal regions demonstrated preserved cerebrovascular reserve, likely due to the presence of collaterals. Finally, of the concurrently measured relaxation rates, R2' was superior for oxygenation assessment.
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Affiliation(s)
- Wendy W Ni
- 1 Department of Radiology, Stanford University, Stanford, CA, USA.,2 Department of Electrical Engineering, Stanford University, Stanford, CA, USA
| | - Thomas Christen
- 1 Department of Radiology, Stanford University, Stanford, CA, USA
| | | | - Zungho Zun
- 3 Division of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC, USA.,4 Department of Pediatrics, George Washington University, Washington, DC, USA
| | | | - Greg Zaharchuk
- 1 Department of Radiology, Stanford University, Stanford, CA, USA
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Laiwalla AN, Kurth F, Leu K, Liou R, Pamplona J, Ooi YC, Salamon N, Ellingson BM, Gonzalez NR. Evaluation of Encephaloduroarteriosynangiosis Efficacy Using Probabilistic Independent Component Analysis Applied to Dynamic Susceptibility Contrast Perfusion MRI. AJNR Am J Neuroradiol 2017; 38:507-514. [PMID: 28104642 DOI: 10.3174/ajnr.a5041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 10/17/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Indirect cerebral revascularization has been successfully used for treatment in Moyamoya disease and symptomatic intracranial atherosclerosis. While angiographic neovascularization has been demonstrated after surgery, measurements of local tissue perfusion are scarce and may not reflect the reported successful clinical outcomes. We investigated probabilistic independent component analysis and conventional perfusion parameters from DSC-MR imaging to measure postsurgical changes in tissue perfusion. MATERIALS AND METHODS In this prospective study, 13 patients underwent unilateral indirect cerebral revascularization and DSC-MR imaging before and after surgery. Conventional perfusion parameters (relative cerebral blood volume, relative cerebral blood flow, and TTP) and probabilistic independent components that reflect the relative contributions of DSC signals consistent with arterial, capillary, and venous hemodynamics were calculated and examined for significant changes after surgery. Results were compared with postsurgical DSA studies to determine whether changes in tissue perfusion were due to postsurgical neovascularization. RESULTS Before surgery, tissue within the affected hemisphere demonstrated a high probability for hemodynamics consistent with venous flow and a low probability for hemodynamics consistent with arterial flow, whereas the contralateral control hemisphere demonstrated the reverse. Consistent with symptomatic improvement, the probability for venous hemodynamics within the affected hemisphere decreased with time after surgery (P = .002). No other perfusion parameters demonstrated this association. Postsurgical DSA revealed an association between an increased preoperative venous probability in the symptomatic hemisphere and neovascularization after surgery. CONCLUSIONS Probabilistic independent component analysis yielded sensitive measurements of changes in local tissue perfusion that may be associated with newly formed vasculature after indirect cerebral revascularization surgery.
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Affiliation(s)
- A N Laiwalla
- From the Departments of Neurosurgery (A.N.L., Y.C.O.)
| | - F Kurth
- Department of Neurosurgery (F.K., R.L., N.R.G.), Cedars Sinai Medical Center, Los Angeles, California
| | - K Leu
- Radiology (K.L., J.P., N.S., B.M.E.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - R Liou
- Department of Neurosurgery (F.K., R.L., N.R.G.), Cedars Sinai Medical Center, Los Angeles, California
| | - J Pamplona
- Radiology (K.L., J.P., N.S., B.M.E.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Y C Ooi
- From the Departments of Neurosurgery (A.N.L., Y.C.O.)
| | - N Salamon
- Radiology (K.L., J.P., N.S., B.M.E.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - B M Ellingson
- Radiology (K.L., J.P., N.S., B.M.E.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - N R Gonzalez
- Department of Neurosurgery (F.K., R.L., N.R.G.), Cedars Sinai Medical Center, Los Angeles, California.
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Kazumata K, Tha KK, Uchino H, Shiga T, Shichinohe H, Ito M, Nakayama N, Abumiya T. Topographic changes in cerebral blood flow and reduced white matter integrity in the first 2 weeks following revascularization surgery in adult moyamoya disease. J Neurosurg 2016; 127:260-269. [PMID: 27588593 DOI: 10.3171/2016.6.jns16653] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE After revascularization surgery, hyperperfusion and ischemia are associated with morbidity and mortality in adult moyamoya disease (MMD). However, structural changes within the brain following revascularization surgery, especially in the early postsurgical period, have not been thoroughly studied. Such knowledge may enable improved monitoring and clinical management of hyperperfusion and ischemia in MMD. Thus, the objective of this study was to investigate the topographic and temporal profiles of cerebral perfusion and related white matter microstructural changes following revascularization surgery in adult MMD. METHODS The authors analyzed 20 consecutive surgeries performed in 17 adults. Diffusion imaging in parallel with serial measurements of regional cerebral blood flow (rCBF) using SPECT was performed. Both voxel-based and region-of-interest analyses were performed, comparing neuroimaging parameters of postoperative hemispheres with those of preoperative hemispheres at 4 different time points within 2 weeks after surgery. RESULTS Voxel-based analysis showed a distinct topographic pattern of cerebral perfusion, characterized by increased rCBF in the basal ganglia for the first several days and gradually increased rCBF in the lateral prefrontal cortex over 1 week (p < 0.001). Decreased rCBF was also observed in the lateral prefrontal cortex, occipital lobe, and cerebellum contralateral to the surgical hemisphere (p < 0.001). Reduced fractional anisotropy (FA) and axial diffusivity (AD), as well as increased radial diffusivity (RD), were demonstrated in both the anterior and posterior limbs of the internal capsule (p < 0.001). Diffusion parameters demonstrated the greatest changes in both FA and RD on Days 1-2 and in AD on Days 3-6; FA, RD, and AD recovered to preoperative levels on Day 14. Patients with transient neurological deteriorations (TNDs), as compared with those without, demonstrated greater increases in rCBF in both the lateral prefrontal cortex and striatum as well as smaller FAs in the posterior limb of the internal capsule (p < 0.05). CONCLUSIONS The excessively increased rCBF and the recovery process were heterogeneous across brain regions, demonstrating a distinct topographic pattern during the initial 2 weeks following revascularization surgery in MMD. Temporary impairments in the deep white matter tract and immediate postoperative ischemia were also identified. The study results characterized postoperative brain perfusion as well as the impact of revascularization surgery on the brain microstructure. Notably, rCBF and white matter changes correlated to TNDs, suggesting that these changes represent potential neuroimaging markers for tracking tissue structural changes associated with hyperperfusion during the acute postoperative period following revascularization surgery for MMD.
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Affiliation(s)
| | | | | | - Tohru Shiga
- Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Hu HH, Li Z, Pokorney AL, Chia JM, Stefani N, Pipe JG, Miller JH. Assessment of cerebral blood perfusion reserve with acetazolamide using 3D spiral ASL MRI: Preliminary experience in pediatric patients. Magn Reson Imaging 2016; 35:132-140. [PMID: 27580517 DOI: 10.1016/j.mri.2016.08.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 08/03/2016] [Accepted: 08/20/2016] [Indexed: 01/04/2023]
Abstract
PURPOSE To demonstrate the clinical feasibility of a new non-Cartesian cylindrically-distributed spiral 3D pseudo-continuous arterial spin labeling (pCASL) magnetic resonance imaging (MRI) pulse sequence in pediatric patients in quantifying cerebral blood flow (CBF) response to an acetazolamide (ACZ) vasodilator challenge. MATERIALS AND METHODS MRI exams were performed on two 3 Tesla Philips Ingenia systems using 32 channel head coil arrays. After local institutional review board approval, the 3D spiral-based pCASL technique was added to a standard brain MRI exam and evaluated in 13 pediatric patients (average age: 11.7±6.4years, range: 1.4-22.2years). All patients were administered ACZ for clinically indicated reasons. Quantitative whole-brain CBF measurements were computed pre- and post-ACZ to assess cerebrovascular reserve. RESULTS 3D spiral pCASL data were successfully reconstructed in all 13 cases. In 11 patients, CBF increased 2.8% to 93.2% after administration of ACZ. In the two remaining patients, CBF decreased by 2.4 to 6.0% after ACZ. The group average change in CBF due to ACZ was approximately 25.0% and individual changes were statistically significant (p<0.01) in all patients using a paired t-test analysis. CBF perfusion data were diagnostically useful in supporting conventional MR angiography and clinical findings. CONCLUSION 3D cylindrically-distributed spiral pCASL MRI provides a robust approach to assess cerebral blood flow and reserve in pediatric patients.
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Affiliation(s)
- Houchun H Hu
- Department of Medical Imaging and Radiology, Phoenix Children's Hospital, Phoenix, AZ, USA.
| | - Zhiqiang Li
- Keller Center for Imaging Innovation, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Amber L Pokorney
- Department of Medical Imaging and Radiology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | | | | | - James G Pipe
- Keller Center for Imaging Innovation, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Jeffrey H Miller
- Department of Medical Imaging and Radiology, Phoenix Children's Hospital, Phoenix, AZ, USA
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