Effect Of Revascularization On Cerebral Hemodynamics And Cognitive Function In Adults With Moyamoya Disease Based On 3D-pCASL Technique

Part Ⅰ Association of preoperative cerebral hemodynamics and cognitive function in adults with moyamoya diseaseObjectiveTo investigate the correlation between preoperative cerebral hemodynamics and cognitive function in adult MMD patients by using 3D-pCASL technique.MethodsWe prospectively enrolled 74 adult MMD patients diagnosed by DSA or MRA in our hospital.During the same period,31 healthy adults matched for sex,age,and years of education were included as the healthy control group.All subjects underwent 3DpCASL,and their cognitive function was assessed by using the Mini-Mental State Examination(MMSE),Montreal Cognitive Assessment Scale(MoCA),and Trail Making Test Part A(TMTA).Select the bilateral lateral orbital frontal lobe(LOFL),anterior cingulate gyrus(ACG),supplemental motor area(SMA),superior temporal gyrus(STG),insular gyrus(IG),precuneus(PCu)and inferior parietal lobe(IPL)as the region of interest(ROI),the CBF value was measured in each brain region,and the cerebellar hemisphere was used as a reference standard to obtain the relative cerebral blood flow(rCBF)in each brain region.The rCBF values and cognitive score characteristics in the brain regions of MMD patients were analyzed,and multiple linear regression was used to adjust for the effects of other factors to explore the correlation between rCBF values and cognitive function in each brain region based on the ROI.According to the results of MoCA scale score,MMD patients were divided into cognitive normal group and cognitive dysfunction group,and the multivariate Logistic regression was used to analyze the independent risk factors of cognitive dysfunction in adults with moyamoya disease.Results1.The rCBF values of bilateral anterior cingulate gyrus,supplemental motor area,precuneus,inferior parietal lobe,left lateral orbital frontal lobe and left superior temporal gyrus regions were lower in the case group than those in the healthy control group.and the differences between the two groups were statistically significant(all P<0.05).In the assessment of cognitive function,the MMSE and MoCA scores in the case group were lower than those in the healthy control group,and the TMTA timeconsuming in the case group was longer than that in the healthy controls,and the differences were statistically significant in the three scales(all P<0.001).2.In the case group,the results of the multiple linear regression analysis showed that the rCBF values of left lateral orbital frontal lobe(P=0.008),left supplemental motor area(P=0.007)and left inferior parietal lobe(P=0.008)were associated with MMSE score;the rCBF values of left lateral orbital frontal lobe(P=0.011),left anterior cingulate gyrus(P=0.032),left supplemental motor area(P=0.007),left inferior parietal lobe(P=0.004)and right supplemental motor area(P=0.041)were associated with MoCA score;the rCBF values of left insular gyrus(P=0.023),left precuneus(P=0.009)and left inferior parietal lobe(P=0.006)were associated with TMTA time-consuming.3.The results of multivariate Logistic regression analysis showed that years of education(B=-0.116,P=0.049)and the rCBF values of left anterior cingulate gyrus(B=-4.685,P=0.008)were independent risk factors of cognitive dysfunction in adults with MMD.Conclusion3D-pCASL can detect the cerebral blood flow reduction areas in adult MMD patients.With the decrease of cerebral blood flow,patients may experience different degrees of cognitive dysfunction,and changes in cerebral blood flow in specific brain areas can reflect the cognitive function of MMD patients to a certain extent.Part Ⅱ Evaluating cerebral hemodynamic and cognitive function changes after revascularization in adults with moyamoya diseaseObjectiveTo evaluate changes in cerebral hemodynamics and cognitive function after revascularization in adult MMD patients,and to explore the relationship between postoperative neurological symptom changes and cerebral hemodynamics changes.MethodsA total of 40 adult patients with moyamoya disease who were diagnosed by DSA or MRA were collected.According to the pathophysiological basis of their clinical symptoms,patients were divided into four types,transient ischemic attack(TIA),cerebral infarction,cerebral hemorrhage,and asymptomatic.They all underwent unilateral superficial temporal artery-middle cerebral artery(STA-MCA)anastomosis,and all of them underwent 3D-pCASL examination and cognitive function by using MMSE,MoCA and TMTA before and after surgery.The ROI was located in the middle cerebral artery cortical territory covering the surgical side and ipsilateral cerebellar hemisphere.Then the cerebral blood flow(CBF)and relative cerebral blood flow(rCBF)values were compared before and after surgery to evaluate the changes in cerebral hemodynamics,and the preoperative and postoperative scores of the three scales were compared to evaluate the changes in patients’ cognitive function.The correlation between preoperative rCBF and Suzuki stage was analyzed.Furthermore,the relationship between postoperative neurological symptoms changes and rCBF changes was investigated.Results1.There was no correlation between preoperative rCBF and bilateral Suzuki stage(operative:P=0.770;contralateral:P=0.644).2.The CBF of the cerebral hemisphere was(53.96±10.04)ml/100 g·min before surgery,and the CBF was(58.90 ± 13.57)ml/100 g·min after surgery,which was statistically significant(t=-3.068,P=0.004),The rCBF before and after surgery was 0.96 ± 0.14 and 1.15 ± 0.18,respectively,with statistically significant differences(t=-7.155,P<0.001),and the cerebral perfusion of patients was improved.3.Of 40 adult MMD patients,postoperative MMSE and MoCA scores were improved,and the differences were statistically significant(all P<0.05),and postoperative TMTA time-consuming was shorter than preoperative,but there was no significant difference(P=0.072).In the MMSE score,the main manifestations of cognitive improvement after revascularization were orientation(P=0.022)and recall(P=0.002);In the MoCA score,it was mainly in visual space and executive function(P=0.001),abstraction(P=0.001),delayed recall(P=0.018),and directional force(P=0.043).4.Changes in postoperative neurological symptoms were associated with changes in rCBF(P=0.017)and type of onset(P<0.001).Conclusion3D-pCASL can be used to monitor hemodynamic changes after revascularization in adults with moyamoya disease,and STA-MCA bypass can effectively improve the cerebral hemodynamics and cognitive function in adult MMD patients,and changes in postoperative neurological symptoms in patients are associated with changes in rCBF.