scholarly journals Postoperative Neovascularization, Cerebral Hemodynamics and Clinical Prognosis Between Combined and Indirect bypass Revascularization Procedures in Hemorrhagic Moyamoya Disease.

2020 ◽  
Author(s):  
Jun Sun ◽  
Yu Zhang Li ◽  
Chuan Chen ◽  
Cong Ling ◽  
Hao Li ◽  
...  
Keyword(s):  
Moyamoya Disease ◽  
Cerebral Blood Volume ◽  
Recurrent Stroke ◽  
Mean Transit Time ◽  
Cerebral Hemodynamics ◽  
Clinical Prognosis ◽  
Time To Peak ◽  
Anterior Choroidal ◽  
Revascularization Procedures ◽  
Collateral Formation

Abstract BACKGROUND: Present primary focus was rebleeding and prognosis of hemorrhagic moyamoya disease (MMD), while limited researches emphasized the postoperative collateral formation and cerebral hemodynamics. OBJECTIVE: To compare the diverse effects of combined (CB) and indirect (IB) bypass revascularization procedures on the postoperative collateral formation and hemodynamics in hemorrhagic MMD patients.METHODS: Hemorrhagic MMD patients treated surgically were retrospectively collected and dichotomized into CB and IB group. Postoperative complications and clinical prognosis, as well as pre- and post-operative Modified Rankin Scale (mRS), collateral circulation status and cerebral hemodynamics were observed and compared between the CB and IB groups. RESULTS: A total of 37 patients with hemorrhagic MMD were identified. Of 68 cerebral hemispheres, 47(69.1%) were combined revascularization and the rest indirect. During an average follow-up of 16.5±8.7 months, the recurrent stroke events were significantly lower, as well as postoperative mRS scores≤2, satisfactory postoperative collateral formation, improved dilation or extension of anterior choroidal /posterior communication artery (AchA/PcoA) were significantly higher in the CB group than in the IB group (all P< .05). Compared with preoperative cerebral hemodynamics, relative cerebral blood flow (rCBF), relative cerebral blood volume (rCBV), mean transit time (MTT) and relative time to peak (rTTP) in the CB group; but in the IB group, rCBF, rCBV and MTT were significantly improved (all P< .001). The CB group’s postoperative rCBF was significantly improved as compared with the IB group (P< .001).CONCLUSION: CB can obtain better postoperative collateral formation, cerebral hemodynamics, and clinical prognosis as compared with IB.

Correlation between cognitive impairment and cerebral hemodynamic disturbances on perfusion magnetic resonance imaging in European adults with moyamoya disease

2010 ◽  
Vol 113 (4) ◽  
pp. 753-759 ◽  
Author(s):  
Lionel Calviere ◽  
Isabelle Catalaa ◽  
Fabienne Marlats ◽  
Alain Viguier ◽  
Fabrice Bonneville ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Moyamoya Disease ◽  
Cerebral Blood Volume ◽  
Mean Transit Time ◽  
Perfusion Magnetic Resonance Imaging ◽  
Cerebrovascular Reserve ◽  
Cerebral Hemodynamic ◽  
Perfusion Mr ◽  
Perfusion Mr Imaging ◽  
Relationship Of

Object Although cognitive impairment has been reported in adults with moyamoya disease (MMD), its relationship with cerebral hemodynamic disturbances has not been investigated. The aims of the present study were to confirm the presence of dysexecutive cognitive syndrome (DCS) in adults with MMD and to explore the relationship of DCS with frontal lobe perfusion as measured by perfusion MR imaging. Methods Cerebral blood volume (CBV) ratio and mean transit time delay were measured in frontal and temporoparietal regions using the cerebellum as a reference region in 10 European adults with MMD. In addition, the authors calculated the cerebrovascular reserve (CVR) using the CBV ratio and the acetazolamide challenge. All patients underwent a standardized neuropsychological assessment test battery. The authors defined DCS as an impairment shown on 3 tests or more of executive function. Results The authors found DCS in 6 patients. The frontal CVR was lower in patients with DCS than in patients without DCS (mean ± SD: −13.5 ± 13.2% and 20.3 ± 21.3%; p = 0.019, Mann-Whitney U-test). Other parameters of frontal perfusion and temporoparietal CVR were not correlated with DCS. Conclusions The authors' findings suggest that DCS is common in European adults with MMD and may be related to frontal perfusion impairment.

Abstract 103: MR Perfusion Lesions in Minor Stroke and TIA Patients Predict New Brain Infarction at 7-days

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Jun Lee ◽  
Michael Ke ◽  
Michael Mlynash ◽  
Sharan Mann ◽  
Manabu Inoue ◽  
...  
Keyword(s):  
Recurrent Stroke ◽  
Brain Infarction ◽  
Mean Transit Time ◽  
Intracranial Stenosis ◽  
High Rate ◽  
Minor Stroke ◽  
Imaging Evaluation ◽  
Symptomatic Carotid ◽  
Time To Peak ◽  
Stroke Center

Background: Although DWI-positive patients who present with transient symptoms have higher day-7 stroke rates than DWI-negative cohorts, little is known about the outcomes of TIA patients with focal perfusion lesions. The aim of the current study is to determine the day-7 recurrent stroke rate in TIA/minor stroke patients who have perfusion lesions on baseline MRI. Methods: Consecutive TIA and minor stroke (NIHSS < 4) patients who underwent baseline DWI and perfusion imaging as well as day-7 follow-up MRI with DWI and FLAIR at Yeungnam University Stroke Center in Korea were enrolled. Two perfusion parameters (Time to Peak and Mean Transit Time), DWI, ADC and FLAIR sequences were reviewed by 2 raters blinded to clinical outcomes. New brain infarction was defined by the presence of a new lesion on day-7 DWI and FLAIR. Symptomatic carotid and intracranial stenosis was assessed on baseline MRA. New neurological symptoms that occurred within 7 days were recorded. Results: Sixty-four patients met the inclusion criteria. Mean age was 64±13 years. Median ABCD2 was 4 (IQR: 3-5). At baseline, perfusion lesions were identified in 30 (47%), DWI lesions in 24 (38%) and symptomatic carotid and/or intracranial stenosis in 22 (34%) patients. Nine patients (14%) developed a new brain infarction on day-7 MRI, and all 9 patients had a baseline perfusion lesion. Thus, the rate of new brain infarction in patients with perfusion lesions at baseline was 30% (9/30). Of the 9 patients with new infarcts, 7 (78%) were clinically symptomatic, 5 (56%) had a negative baseline DWI, and 6 (67%) had normal vessel imaging. Conclusion: Our data suggest that the identification of a focal perfusion lesion during the imaging evaluation of TIA or minor stroke predicts a high rate of recurrent stroke within 1 week, even in the absence of identifiable vessel stenosis or DWI positivity on initial MRI.

scholarly journals Intravoxel incoherent motion perfusion in patients with Moyamoya disease: comparison with 15O-gas positron emission tomography

2019 ◽  
Vol 8 (5) ◽  
pp. 205846011984658
Author(s):  
Shoko Hara ◽  
Masaaki Hori ◽  
Ryo Ueda ◽  
Akifumi Hagiwara ◽  
Shihori Hayashi ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
White Matter ◽  
Moyamoya Disease ◽  
Cerebral Blood Volume ◽  
Mean Transit Time ◽  
Emission Tomography ◽  
Intravoxel Incoherent Motion ◽  
Healthy Controls ◽  
Diffusion Weighted Images ◽  
Positron Emission

Background Intravoxel incoherent motion magnetic resonance imaging (IVIM) enables non-invasive measurement of brain perfusion. Purpose To investigate whether IVIM could be used to evaluate the hemodynamic disturbance of Moyamoya disease (MMD) by comparison with the gold-standard 15O-gas positron emission tomography (PET) method. Material and Methods Ten consecutive patients with MMD (six women; mean age = 42.8 years) and 10 age-matched healthy controls were evaluated by diffusion-weighted images with 12 different b values in the range of 0–900 s/mm2 and 15O-gas PET. Tomographic maps of IVIM parameters, perfusion fraction ( f ), pseudo-diffusion coefficient ( D*), and f・D*, as well as cerebral blood volume (CBV), cerebral blood flow (CBF), and mean transit time (MTT) maps obtained with PET, were normalized and hemispheric gray and white matter values were calculated. IVIM parametric values were compared with PET parameters and with clinically assessed disease severity. Results There was significant correlation between D* and MTT ( r = –0.74, P < 0.001) and between f・D* and CBF ( r = 0.52, P = 0.02) in the cortical areas. The f values in the white matter were significantly higher in symptomatic MMD patients than in healthy controls ( P = 0.01). Conclusion IVIM may be used to non-invasively investigate cerebral hemodynamic impairment in patients with MMD. Further evaluation is needed to establish IVIM usage in clinical settings.

scholarly journals Spatial Distribution of Perfusion Abnormality in Acute MCA Occlusion is Associated with Likelihood of Later Recanalization

2014 ◽  
Vol 34 (5) ◽  
pp. 813-819 ◽  
Author(s):  
Susanne Siemonsen ◽  
Nils Daniel Forkert ◽  
Anne Hansen ◽  
Andre Kemmling ◽  
Götz Thomalla ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Cerebral Blood Volume ◽  
Mean Transit Time ◽  
Three Dimensional ◽  
Area Under The Curve ◽  
Fibrinolytic Therapy ◽  
Data Sets ◽  
Infarct Core ◽  
Compensatory Mechanisms ◽  
Time To Peak

The aim of this study is to investigate whether different spatial perfusion-deficit patterns, which indicate differing compensatory mechanisms, can be recognized and used to predict recanalization success of intravenous fibrinolytic therapy in acute stroke patients. Twenty-seven acute stroke data sets acquired within 6 hours from symptom onset including diffusion- (DWI) and perfusion-weighted magnetic resonance (MR) imaging (PWI) were analyzed and dichotomized regarding recanalization outcome using time-of-flight follow-up data sets. The DWI data sets were used for calculation of apparent diffusion coefficient (ADC) maps and subsequent infarct core segmentation. A patient-individual three-dimensional (3D) shell model was generated based on the segmentation and used for spatial analysis of the ADC as well as cerebral blood volume (CBV), cerebral blood flow, time to peak (TTP), and mean transit time (MTT) parameters derived from PWI. Skewness, kurtosis, area under the curve, and slope were calculated for each parameter curve and used for classification (recanalized/nonrecanalized) using a LogitBoost Alternating Decision Tree (LAD Tree). The LAD tree optimization revealed that only ADC skewness, CBV kurtosis, and MTT kurtosis are required for best possible prediction of recanalization success with a precision of 85%. Our results suggest that the propensity for macrovascular recanalization after intravenous fibrinolytic therapy depends not only on clot properties but also on distal microvascular bed perfusion. The 3D approach for characterization of perfusion parameters seems promising for further research.

Abstract WP170: Long Time Follow Up Of Patients With Moyamoya Disease Treated By Multiple Burr Hole Surgery

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Yoshito Uchihashi ◽  
Kohkichi Hosoda ◽  
Tetsuro Kawaguchi ◽  
Mitsugu Nakamura ◽  
Eiji Kohmura
Keyword(s):  
Moyamoya Disease ◽  
Recurrent Stroke ◽  
Significant Risk ◽  
Cerebral Hemodynamics ◽  
Burr Hole ◽  
Long Term Results ◽  
Initial Symptom ◽  
Revascularization Surgery

Background The best revascularization surgery and its long term result for Moyamoya disease (MMD) remains unclear. From the 1980’s we have been performed Multiple Burr Hole Operation (MBHO, see figure). We report on the incidence of stroke in the long-term follow up. Materials and Methods This study includes 46 patients with MMD treated in Hyogo Brain and Heart Center, Japan. There were 29 female and 17 male patients with a mean age of 40 years. The initial symptom was cerebral ischemia in 29 patients, hemorrhage in 15, and other in 2, respectively. The average follow-up period was 10.8 years. Evaluation of cerebral hemodynamics was performed in 32 cases. Revascularization surgery was performed in 39 patients. Among them, 31 cases were treated with MBHO. 7 cases were followed without any surgical procedures. Results 12 patients (26%) suffered recurrent strokes in the follow-up period. The recurrent rate of stroke after diagnosis of MMD was 3.0% /patient-year. In the patients with initial ischemic presentation, MBHO provided similar stroke prevention comparing with direct surgery (27% vs. 25%). Poor CBF and Cerebral Vasoriactivity (CVR) were the statistically significant risk factors for recurrent stroke (OR=11, see figure, p=0.04). Discussion/Conclusion MBHO could provid similar long-term results compared with direct bypass in patients with ischemic MMD. Evaluation of cerebral hemodynamics may predict future strokes. MBHO revealed to be a useful method as it is less invasive and can be easily done, performed in any place, and added to any other revascularization surgery.

scholarly journals Predictive Value of the Velocity of Collateral Filling in Patients with Acute Ischemic Stroke

2014 ◽  
Vol 35 (2) ◽  
pp. 206-212 ◽  
Author(s):  
Sebastian E Beyer ◽  
Louisa von Baumgarten ◽  
Kolja M Thierfelder ◽  
Marietta Rottenkolber ◽  
Hendrik Janssen ◽  
...  
Keyword(s):  
Cerebral Blood Volume ◽  
Ct Perfusion ◽  
Mean Transit Time ◽  
Intravenous Thrombolysis ◽  
Lesion Size ◽  
Small Lesion ◽  
Time Resolved ◽  
Time To Peak ◽  
Magnetic Resonance Imaging Mri

The velocity of collateral filling can be assessed in dynamic time-resolved computed tomography (CT) angiographies and may predict initial CT perfusion (CTP) and follow-up lesion size. We included all patients with an M1± internal carotid artery (ICA) occlusion and follow-up imaging from an existing cohort of 1791 consecutive patients who underwent multimodal CT for suspected stroke. The velocity of collateral filling was quantified using the delay of time-to-peak (TTP) enhancement of the M2 segment distal to the occlusion. Cerebral blood volume (CBV) and mean transit time (MTT)-CBV mismatch were assessed in initial CTP. Follow-up lesion size was assessed by magnetic resonance imaging (MRI) or non-enhanced CT (NECT). Multivariate analyses were performed to adjust for extent of collateralization and type of treatment. Our study comprised 116 patients. Multivariate analysis showed a short collateral blood flow delay to be an independent predictor of a small CBV lesion ( P<0.001) and a large relative mismatch ( P<0.001) on initial CTP, of a small follow-up lesion ( P<0.001), and of a small difference between initial CBV and follow-up lesion size ( P=0.024). Other independent predictors of a small lesion on follow-up were a high morphologic collateral grade ( P=0.001), lack of an additional ICA occlusion ( P=0.009), and intravenous thrombolysis ( P=0.022). Fast filling of collaterals predicts initial CTP and follow-up lesion size and is independent of extent of collateralization.

The influence of decompressive craniectomy for major stroke on early cerebral perfusion

2015 ◽  
Vol 123 (1) ◽  
pp. 59-64 ◽  
Author(s):  
Philipp Jörg Slotty ◽  
Marcel Alexander Kamp ◽  
Thomas Beez ◽  
Henrieke Beenen ◽  
Hans-Jakob Steiger ◽  
...  
Keyword(s):  
Decompressive Craniectomy ◽  
Cerebral Perfusion ◽  
Cerebral Blood Volume ◽  
Mean Transit Time ◽  
Residue Function ◽  
Perfusion Ct ◽  
Local Pressure ◽  
Partial Restoration ◽  
Time To Peak ◽  
Major Stroke

OBJECT Multiple trials have shown improved survival and functional outcome in patients treated with decompressive craniectomy (DC) for brain swelling following major stroke. It has been assumed that decompression induces an improvement in cerebral perfusion. This observational study directly measured cerebral perfusion before and after decompression. METHODS Sixteen patients were prospectively examined with perfusion CT within 6 hours prior to surgery and 12 hours after surgery. Preoperative and postoperative perfusion measurements were compared and correlated. RESULTS Following DC there was a significant increase in cerebral blood flow in all measured territories and additionally an increase in cerebral blood volume in the penumbra (p = 0.03). These changes spread as far as the contralateral hemisphere. No significant changes in mean transit time or Tmax (time-to-peak residue function) were observed. CONCLUSIONS The presurgical perfusion abnormalities likely reflected local pressure-induced hypoperfusion with impaired autoregulation. The improvement in perfusion after decompression implied an increase in perfusion pressure, likely linked to partial restoration of autoregulation. The increase in perfusion that was observed might partially be responsible for improved clinical outcome following decompressive surgery for major stroke. The predictive value of perfusion CT on outcome needs to be evaluated in larger trials.

scholarly journals Clinically Meaningful MRI Perfusion Abnormalities in Acute Stroke: Comparison of Analytic Techniques

Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 339-339
Author(s):  
Chen-Sen Wu ◽  
Lawrence L Latour ◽  
Steven Warach
Keyword(s):  
At Risk ◽  
Acute Stroke ◽  
Moment Method ◽  
Cerebral Blood Volume ◽  
Mean Transit Time ◽  
Clinical Severity ◽  
Perfusion Parameter ◽  
Time Curve ◽  
Time To Peak ◽  
First Moment

P2 Background: MRI perfusion imaging (PWI) can demonstrate hemodynamic abnormalities in acute stroke. The volume of hypoperfusion derived from calculated perfusion parameter maps has been used to predict tissue at risk for infarction and to identify presumptive ischemic penumbra. It is unclear how best to distinguish true tissue at risk from benign hypoperfusion. A first step toward this goal is identifying clinically significant PWI abnormalities in stroke patients. Our purpose was to evaluate four different perfusion parameter maps to determine which algorithm best correlates with clinical severity. Methods: Twenty patients were retrospectively selected from our database. Selection criteria included 1) acute hemispheric lesion, 2) MRI within 24 hours of symptom onset, and 3) no history of prior stroke. Perfusion maps were derived using four different algorithms to estimate relative mean transit time (rMTT): 1) cerebral blood volume (CBV) / cerebral blood flow (CBF), 2) CBV / peak of the concentration-time curve, 3) time to peak (TTP), and 4) ratio of the 1 st / 0 th moment of the transfer function (first moment method). Abnormal perfusion volumes were derived from ever-increasing thresholds of rMTT delay relative to normal contralateral tissue. The volumes at each delay threshold were correlated with National Institutes of Health Stroke Scale (NIHSS) for each algorithm. Results: Significant correlations between hypoperfusion volumes and NIHSS were found for all algorithms. The first moment method had the highest correlation (r = 0.76) and the correlations for this method were independent of the delay threshold used to derive the volumes. For the other algorithms, the best correlations were observed for volumes including only voxels with delays of 4 seconds or greater. Conclusions: This analysis suggests that the first moment method may have advantages over the others in determining the correlation of hypoperfusion volume to NIHSS. Further analyses correlating acute hypoperfusion volumes to final infarct volumes may help refine the choice of best analytic method for determining clinically relevant PWI abnormalities.

Sign in / Sign up

Export Citation Format

Share Document