CT Perfusion Evaluation To Postoperative Cerebral Hemodynamic Changes In Patients With Moyamoya Disease

Moyamoya disease (MMD) is a chronic cerebrovascular disease characterizedby progressive stenosis or occlusion of terminal branches of the bilateral internalcarotid arteries (ICA) as well as initial branches of the anterior arteries (ACA)and themiddle arteries (MCA), resulting in the formation of abnormal collateral vessels atthe circle of the Willis. Medical treatment includes drugs and surgery. No drug hasbeen currently found to control or reverse disease progression so that vascularsurgical reconstruction has been advocated in clinic by increasing cerebral bloodsupply to improve cerebral ischemic symptoms. Compared to PET, SPECT and MRI,CT perfusion has advantages in low cost, quick scanning speed, and no contrain-dications. Multi-slice spiral CT is used before and after surgery to learn on changesin cerebral hemodynamics in patients with MMD.Objective: In this study,128-slice spiral CT scan is performed to understandchanges in cerebral hemodynamics in patients with MMD before and after surgery,including cerebral blood flow(CBF), cerebral blood volume(CBV), mean transittime(MTT), and time to peak(TTP), so as to provide a new assessment method inpatients after surgery.Materials and methods: In this study25Cases of MMD (13women and12men; mean age45.16±7.84years;aging from35to64) were collected from June2012to March2014in neurosurgery of the First Affiliated Hospital of NanchangUniversity. Siemens128-slice spiral CT perfusion scan were performed in patients inpre-operative, post-operative1day, and after the3-6month respectively. Acquiredimages were processed by the company’s specialized perfusion CT post-processingsoftware. Then the data was conducted on data statistical analysis to observe cerebralhemodynamics changes.Results: In25patients the average cerebral blood flow before surgery was（56.23±10.07） ml/min/100g, the average cerebral blood volume （3.3±0.59） ml/100g,the average mean transit time (4.04±0.6)s，and the average time to peak(11.12±1.64)s; On post-operative1day, the average cerebral blood flow was（53.74±9.88）ml/min/100g, the average cerebral blood volume （3.04±1.48）ml/100g,the average mean transit time (4.12±0.55)s，and the average time to peak(11.44±1.81)s; After3-6month, the average cerebral blood flow before surgery was（58.34±13.59） ml/min/100g, the average cerebral blood volume （3.2±0.63）ml/100g,the average mean transit time (3.72±0.5)s，and the average time to peak(10.49±1.15)s.TTP、MTT at pre-operation and after3-6month were significance(P<0.05), other’s were not.Conclusions:1.Spiral CT perfusion imaging has advantages in low cost, quickscanning speed, and no contraindications, and can present cerebral hemodynamicschanges to provide a new method in clinical evaluation of curative effect in patientswith MMD after surgery.2.Spiral CT perfusion scan can present the abnormal perfusion which can not befound on non-enhanced CT so as to provide instructive help to neurosurgery.3.Direct revascularization can improve clinical symptoms and quality of life inpatients with MMD improve.