Preoperative Collateral Perfusion Using Arterial Spin Labeling: A Predictor of Surgical Collaterals in Moyamoya Angiopathy

Maoxue Wang; Yi Wang; Wen Zhang; Xiance Zhao; Yongbo Yang; Bing Zhang

doi:10.3389/fnins.2022.839485

Preoperative Collateral Perfusion Using Arterial Spin Labeling: A Predictor of Surgical Collaterals in Moyamoya Angiopathy

Front Neurosci. 2022 Mar 14:16:839485. doi: 10.3389/fnins.2022.839485. eCollection 2022.

Authors

Maoxue Wang¹, Yi Wang², Wen Zhang¹, Xiance Zhao³, Yongbo Yang², Bing Zhang^{1

4}

Affiliations

¹ Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
² Department of Neurosurgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
³ Philips Healthcare, Shanghai, China.
⁴ Institute of Brain Science, Nanjing University, Nanjing, China.

Abstract

Objectives: Various degrees of surgical collateral circulation are often found in moyamoya angiopathy (MMA) patients after revascularization. Little is known about arterial spin labeling (ASL) that affects surgical collateral circulation. This study aimed to investigate the effect of ASL on surgical collaterals in patients with MMA after combined bypass surgery.

Methods: MMA patients with complete radiological and clinical information, who had undergone combined bypass, were enrolled in this study. Surgical collaterals were classified as good or poor based on the Matsushima standard. Cerebral perfusion on ASL was quantitatively analyzed as relative cerebral blood flow (rCBF). The qualitative collateral score was calculated using a four-grade scale. Univariable and multivariable logistic regressions were performed to identify the predictors for surgical collaterals after combined bypass.

Results: In total, 66 hemispheres of 61 patients (47 years old ± 8.66) were prospectively included (29 and 37 hemispheres with good and poor surgical collaterals, respectively). The presurgical collateral score was significantly lower in patients with good surgical collaterals (13.72 scores ± 7.83) than in those with poor surgical collaterals (19.16 scores ± 6.65, P = 0.005). The presurgical rCBF and modified Rankin scale (mRS) scores were not significantly different between the two groups (P_rCBF = 0.639, P_mRS = 0.590). The collateral score was significantly elevated (good: 13.72 scores ± 7.83 vs. 20.79 scores ± 6.65, P < 0.001; poor: 19.16 scores ± 6.65 vs. 22.84 scores ± 5.06, P < 0.001), and the mRS was reduced (good: 1.66 scores ± 1.14 vs. 0.52 scores ± 0.83, P < 0.001; poor: 1.49 scores ± 0.90 vs. 0.62 scores ± 0.76, P < 0.001) in patients after revascularization. Multivariable logistic regression showed that preoperative collateral scores [odds ratio (OR): 0.791; 95% confidence interval (CI): 0.695, 0.900; P < 0.001], age (OR: 0.181; 95% CI: 0.039, 0.854; P = 0.031), sex (OR: 0.154; 95% CI: 0.035, 0.676; P = 0.013), and hypertension (OR: 0.167; 95% CI: 0.038, 0.736; P = 0.018) were predictors of surgical collaterals after combined revascularization.

Conclusion: The preoperative collateral score based on ASL could be a predictor for surgical collaterals in patients with MMA after combined bypass surgery. Combined with age, sex, and hypertension, it may have a better predictive effect.

Keywords: arterial spin labeling; collateral circulation; moyamoya angiopathy; predictors; revascularization.