Assessment of Cerebral Hemodynamic Changes in Pediatric Patients with Moyamoya Disease Using Probabilistic Maps on Analysis of Basal/Acetazolamide Stress Brain Perfusion SPECT.
- Author:
Ho Young LEE
1
;
Jae Sung LEE
;
Seung Ki KIM
;
Kyu Chang WANG
;
Byung Kyu CHO
;
June Key CHUNG
;
Myung Chul LEE
;
Dong Soo LEE
Author Information
1. Department of Nuclear Medicine, Seoul National University College of Medicine, Korea. dsl@plaza.snu.ac.kr
- Publication Type:Original Article
- Keywords:
moyamoya disease;
brain SPECT;
acetazolamide;
clinical outcome;
revascularization
- MeSH:
Acetazolamide;
Brain;
Follow-Up Studies;
Frontal Lobe;
Hemodynamics;
Humans;
Ischemic Attack, Transient;
Logistic Models;
Moyamoya Disease;
Occipital Lobe;
Parietal Lobe;
Perfusion;
Pons;
Tomography, Emission-Computed, Single-Photon
- From:Nuclear Medicine and Molecular Imaging
2008;42(3):192-200
- CountryRepublic of Korea
- Language:English
-
Abstract:
To evaluate the hemodynamic changes and the predictive factors of the clinical outcome in pediatric patients with moyamoya disease, we analyzed pre/post basal/acetazolamide stress brain perfusion SPECT with automated volume of interest (VOIs) method. METHODS: Total fifty six (M:F=33:24, age 6.7+/-3.2 years) pediatric patients with moyamoya disease, who underwent basal/acetazolamide stress brain perfusion SPECT within 6 before and after revascularization surgery (encephalo-duro-arterio-synangiosis (EDAS) with frontal encephalo-galeo-synangiosis (EGS) and EDAS only followed on contralateral hemisphere), and followed-up more than 6 months after post-operative SPECT, were included. A mean follow-up period after post-operative SPECT was 33+/-21 months. Each patient's SPECT image was spatially normalized to Korean template with the SPM2. For the regional count normalization, the count of pons was used as a reference region. The basal/acetazolamide-stressed cerebral blood flow (CBF), the cerebral vascular reserve index (CVRI), and the extent of area with significantly decreased basal/acetazolamide-stressed rCBF than age-matched normal control were evaluated on both medial frontal, frontal, parietal, occipital lobes, and whole brain in each patient's images. The post-operative clinical outcome was assigned as good, poor according to the presence of transient ischemic attacks and/or fixed neurological deficits by pediatric neurosurgeon. RESULTS: In a paired t-test, basal/acetazolamide-stressed rCBF and the CVRI were significantly improved after revascularization (p<0.05). The significant difference in the pre-operative basal/acetazolamide-stressed rCBF and the CVRI between the hemispheres where EDAS with frontal EGS was performed and their contralateral counterparts where EDAS only was done disappeared after operation (p<0.05). In an independent student t-test, the pre-operative basal rCBF in the medial frontal gyrus, the post-operative CVRI in the frontal lobe and the parietal lobe of the hemispheres with EDAS and frontal EGS, the post-operative CVRI, and deltaCVRI showed a significant difference between patients with a good and poor clinical outcome (p<0.05). In a multivariate logistic regression analysis, the deltaCVRI and the post-operative CVRI of medial frontal gyrus on the hemispheres where EDAS with frontal EGS was performed were the significant predictive factors for the clinical outcome (p=0.002, p=0.015). CONCLUSION: With probabilistic map, we could objectively evaluate pre/post-operative hemodynamic changes of pediatric patients with moyamoya disease. Specifically the post-operative CVRI and the post-operative CVRI of medial frontal gyrus where EDAS with frontal EGS was done were the significant predictive factors for further clinical outcomes.
