Diagnostic value of perfusion-weighted MRI for evaluating postoperative alteration of cerebral hemodynamics following STA-MCA anastomosis in patients with moyamoya disease

Objective: Surgical revascularization for moyamoya disease prevents cerebral ischemic attacks by improving cerebral blood flow (CBF). But little is known about the changes of CBF and its effect on neurological status during the acute stage after direct bypass for moyamoya disease. Methods and Results: Perfusion-weighted magnetic resonance imaging (PWI) by the SE-EPI method was performed 4 and 10 days after superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis on 11 sides of 9 patients (male:female = 2:7, 24-61 years old) with moyamoya disease. All patients underwent single-photon emission computed tomography (SPECT) 1 and 7 days after surgery. The time-to-peak (TTP) by PWI showed focal decrease at the site of the anastomosis 4 days after STA-MCA anastomosis compared to preoperative TTP, and was further decreased in larger territory 10 days after surgery in all patients. Postoperative cerebral blood volume (CBV) by PWI showed significant increase compared to preoperative CBV in four patients who suffered symptomatic cerebral hyperperfusion after surgery. Postoperative SPECT revealed apparent increase of CBF in all patients and the patency of the STA-MCA bypass was confirmed by MRA. All patients were discharged without neurological deterioration compared to preoperative neurological status, and none of them suffered ischemic attack after surgery. Conclusion: Postoperative decrease in TTP by PWI could be a sensitive parameter for the normalization of CBF after STA-MCA anastomosis in patients with moyamoya disease. Postoperative increase in CBV may suggest cerebral hyperperfusion and could be the optimal predictor for hyperperfusion syndrome after STA-MCA anastomosis in patients with moyamoya disease.