Screening of postoperative cerebral hyperperfusion syndrome in moyamoya disease: a three-dimensional pulsed arterial-spin labeling magnetic resonance imaging approach

Feng Gao; Jianhua Cong; Yu Duan; Wei Zhao; Zhenfang Zhu; Yu Zheng; Liang Jin; Ming Ji; Ming Li

doi:10.3389/fnins.2023.1274038

Screening of postoperative cerebral hyperperfusion syndrome in moyamoya disease: a three-dimensional pulsed arterial-spin labeling magnetic resonance imaging approach

Front Neurosci. 2023 Oct 19:17:1274038. doi: 10.3389/fnins.2023.1274038. eCollection 2023.

Authors

Feng Gao¹, Jianhua Cong², Yu Duan³, Wei Zhao⁴, Zhenfang Zhu¹, Yu Zheng⁵, Liang Jin¹, Ming Ji¹, Ming Li¹

Affiliations

¹ Department of Radiology, Huadong Hospital Fudan University, Shanghai, China.
² Department of Medical Centre, Huadong Hospital Fudan University, Shanghai, China.
³ Department of Neurosurgery, Huadong Hospital Fudan University, Shanghai, China.
⁴ Department of Radiology, Second Xiangya Hospital, Central South University, Changsha, China.
⁵ Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, China.

Abstract

Introduction: Moyamoya disease (MMD) is associated with a risk of postoperative cerebral hyperperfusion syndrome (CHS) after revascularization surgery. This study aimed to explore the feasibility of using three-dimensional pulsed arterial spin labeling (3D PASL) and phase contrast (PC) magnetic resonance imaging (MRI) for predicting CHS occurrence in patients with MMD before revascularization surgery.

Methods: Overall, 191 adult patients (207 hemispheres) with MMD who underwent combined revascularization surgery were included in this study. Preoperative 3D PASL-MRI and PC-MRI were performed before surgery. The PASL-MRI data were analyzed using SPM12. Patient clinical information, average flow, and preoperative cerebral blood flow (CBF) were compared between the non-CHS and CHS groups.

Results: Among the patients, 45 (21.74%) developed CHS after revascularization surgery. No significant differences were noted in age, sex, clinical symptoms, hypertension, diabetes, surgical side, or history of revascularization surgery between the non-CHS and CHS groups. However, the average flow in the superficial temporal artery was significantly lower in the CHS group than in the non-CHS group (p < 0.05). Furthermore, 11 clusters of preoperative CBF values were significantly greater in the CHS group than in the non-CHS group [p < 0.05, false discovery rate (FDR) corrected]. A significant correlation was also observed between the preoperative time-to-flight MR angiography (MRA) scores and CBF values in patients with MMD (p < 0.05).

Conclusion: Compare patients with lower preoperative CBF and higher preoperative average flow in the STA, patients with higher preoperative CBF and lower preoperative average flow in the STA are more likely to develop postoperative CHS Preoperative PASL-MRI and PC-MRI examinations may help to screen patients at high risk of developing CHS after revascularization surgery.

Keywords: arterial spin labeling; cerebral hyperperfusion syndrome; magnetic resonance imaging; moyamoya disease; phase contrast MRI; surgery.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was funded by the National Natural Science Foundation of China (grant number 61976238), Science and Technology Planning Project of Shanghai Science and Technology Commission (grant number 22Y11910700), Science and Technology Planning Project of Shanghai Science and Technology Commission (grant number 20Y11902900), Shanghai “Rising Stars of Medical Talent” Youth Development Program “Outstanding Youth Medical Talents” (grant number SHWJRS [2021]-99), and National key research and development program (grant number 2022YFF1203301). Leading Talent Program (LJRC2202) of Huadong Hospital, and Excellent Academic Leaders of Shanghai (2022XD042).