Hemodynamic study about cortical hyperintensity belt sign after direct bypass surgery for moyamoya disease |
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| Affiliation: | 1. Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto City, Kumamoto, Japan;2. Department of Neurosurgery, Kurume University School of Medicine, Kurume City, Fukuoka, Japan;3. Departments of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto City, Kumamoto, Japan;1. Department of Neurosurgery, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC 3000, Australia;2. Department of Pathology, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC 3000, Australia;3. Department of Surgery, University of Melbourne, Parkville, VIC 3000, Australia;1. Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel;2. Department of Surgery, The University of Melbourne, Parkville, VIC, Australia;1. Division of Pediatric Neurology, Department of Pediatrics, University of Alabama at Birmingham, School of Medicine, Birmingham, Alabama;2. Division of Pediatric Radiology, Children''s Hospital of Alabama, Birmingham, Alabama |
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| Abstract: | Transient neurological events (TNEs) are observed after direct bypass surgery in patients with moyamoya disease (MMD). Although a correlation between cortical hyperintensity belt signs (CHBs) and TNEs has been reported, the pathophysiology of CHBs is still unknown. The purpose of this study was to reveal the pathophysiology of CHBs by using dynamic susceptibility contrast-magnetic resonance imaging. Thirty patients with MMD were included in this study. We provided scores (0–2) for the existence of CHBs on postoperative FLAIR images. We placed the ROI for the presented area of CHBs in the images of cerebral blood flow, CBV, and MTT. We calculated the change of the hemodynamic parameters (increase ratio, IR) and analyzed the relationship between IRs, CHB scores, and TNEs. TNEs were observed in 15 cases (50%) and CHBs were detected in 28 cases (93%). TNEs showed significantly higher CHB scores than those without (p < 0.05). The group of CHB score 2 showed a significantly higher CBV IR than the group with of score 0 (p < 0.05). Patients with TNEs showed a significantly higher CBV IR than those without (p < 0.05). As for the cut-off level to predict an appearance of TNEs, the CBV IR was 1.36 by the Receiver Operating Characteristic analysis, and the sensitivity and specificity were 80% respectively. We hypothesize that the pathophysiology of the CHBs are vasogenic edemas because the postoperative CBV increase correlated with the CHBs. |
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| Keywords: | Moyamoya disease CHB sign TNEs CBV |
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