Objective: To evaluate cerebral hemodynamic changes using three-dimensional pseudo-continuous arterial spin labeling (3D-pCASL) and its association with the changes of neurological symptoms in adult patients with moyamoya disease after revascularization.
Methods: We prospectively collected the clinical and radiographic data of 40 adult patients with moyamoya disease diagnosed by digital subtraction angiography (DSA) or magnetic resonance angiography (MRA) undergoing unilateral superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis. All the patients underwent 3D-pCASL examination before and after the surgery, and were followed up for 3 to 11 months after the operation. The region of interest (ROI) was located in the middle cerebral artery cortical territory covering the surgical side and ipsilateral cerebellar hemisphere. Cerebral blood flow (CBF) and relative CBF (rCBF) values were compared before and after the surgery, and the changes in cerebral hemodynamics were evaluated. The correlations were analyzed between preoperative rCBF and Suzuki stage and between the changes in postoperative neurological symptoms and rCBF.
Results: The mean CBF of the patients increased significantly from 53.96±10.04 mL·100 g-1·min-1 to 58.90±13.57 mL·100 g-1·min-1 after the operation (t=-3.068, P=0.004); the mean rCBF also increased significantly after the operation (0.96 ± 0.14 vs 1.15 ± 0.18; t=-7.155, P < 0.001). The changes in postoperative neurological symptoms were significantly correlated with the changes in rCBF (P=0.017) and the type of disease onset (P < 0.001).
Conclusion: 3D-pCASL is an valuable means for noninvasive monitoring of hemodynamic changes after revascularization in adult patients with moyamoya disease without the use of contrast agent.
目的: 利用三维伪连续动脉自旋标记（3D-pCASL）技术评估成年烟雾病患者血管重建术后脑血流动力学的变化及其与神经症状预后的关系。
方法: 收集我院经DSA或MRA确诊并接受单侧颞浅动脉（STA）-大脑中动脉（MCA）搭桥术的40例成年烟雾病患者，所有患者均于术前及术后行3D-pCASL检查，术后随访时间为3~11月。在覆盖手术侧大脑中动脉皮层区域及同侧小脑半球勾画感兴趣区（ROI），比较术前术后脑血流量（CBF）及相对脑血流量（rCBF）值，评估脑血流动力学改变情况。分析术前rCBF与铃木（Suzuki）分期的关系以及术后神经症状变化与rCBF变化之间的关系。
结果: 手术前后CBF分别为（53.96 ± 10.04）mL/100 g·min、（58.90±13.57）mL/100 g·min，差异有统计学意义（t=-3.068，P=0.004）；rCBF分别0.96±0.14、1.15±0.18，差异有统计学意义（t=-7.155，P < 0.001）。术后神经症状变化与rCBF变化（P=0.017）及发病类型（P < 0.001）有关。
结论: 3D-pCASL可以用于监测成年烟雾病患者血管重建术后血流动力学变化情况，且由于其无创、无需使用对比剂等特点，值得在临床推广。
Keywords: Moyamoya disease; cerebral hemodynamics; revascularization; three-dimensional pseudo-continuous arterial spin labeling.