Time-of-Flight MR Angiography for Detection of Cerebral Hyperperfusion Syndrome after Superficial Temporal Artery-Middle Cerebral Artery Anastomosis in Moyamoya Disease

• Published in: American journal of neuroradiology : AJNR 2016-07, Vol.37 (7), p.1244-1248
• Main Authors: Sato, K, Yamada, M, Kuroda, H, Yamamoto, D, Asano, Y, Inoue, Y, Fujii, K, Kumabe, T
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Adult Brain; Aged; Anastomosis, Surgical - methods; Cerebrovascular Disorders - diagnostic imaging; Cerebrovascular Disorders - etiology; Child; Extracranial Vascular; Female; Humans; Magnetic Resonance Angiography - methods; Male; Middle Aged; Middle Cerebral Artery - surgery; Moyamoya Disease - diagnostic imaging; Moyamoya Disease - surgery; Multimodal Imaging; Neurosurgical Procedures - methods; Pediatrics; Postoperative Complications - diagnostic imaging; Retrospective Studies; Subarachnoid Hemorrhage - diagnostic imaging; Subarachnoid Hemorrhage - etiology; Temporal Arteries - surgery; Tomography, Emission-Computed, Single-Photon; Young Adult
• ISSN: 0195-6108; 1936-959X
• DOI: 10.3174/ajnr.a4715

Cerebral hyperperfusion syndrome is a potential complication of superficial temporal artery-MCA anastomosis for Moyamoya disease. In this study, we evaluated whether TOF-MRA could assess cerebral hyperperfusion syndrome after superficial temporal artery-MCA anastomosis for this disease. This retrospective study included patients with Moyamoya disease who underwent superficial temporal artery-MCA single anastomosis. TOF-MRA and SPECT were performed before and 1-6 days after anastomosis. Bilateral ROIs on the source image of TOF-MRA were manually placed directly on the parietal branch of the superficial temporal artery just after branching the frontal branch of the superficial temporal artery and on the contralateral superficial temporal artery on the same axial image, respectively. The change ratio of the maximum signal intensity of the superficial temporal artery on TOF-MRA was calculated by using the following formula: (Postoperative Ipsilateral/Postoperative Contralateral)/(Preoperative Ipsilateral/Preoperative Contralateral). Of 23 patients (26 sides) who underwent the operation, 5 sides showed cerebral hyperperfusion syndrome postoperatively. There was a significant difference in the change ratio of signal intensity on TOF-MRA observed between the cerebral hyperperfusion syndrome and non-cerebral hyperperfusion syndrome groups (cerebral hyperperfusion syndrome group: 1.88 ± 0.32; non-cerebral hyperperfusion syndrome group: 1.03 ± 0.20; P = .0009). The minimum ratio value for the cerebral hyperperfusion syndrome group was 1.63, and the maximum ratio value for the non-cerebral hyperperfusion syndrome group was 1.30. Thus, no overlap was observed between the 2 groups for the change ratio of signal intensity on TOF-MRA. Diagnosis of cerebral hyperperfusion syndrome is indicated by an increase in the change ratio of signal intensity on TOF-MRA by more than approximately 1.5 times the preoperative levels.