The Application Of MR 3D-Arterial Spinning Labelingperfusion Imaging In Evaluation The Preoperative And Postoperative Hemodynamic Of Moyamoya Disease

First part compare three dimensional arterial spin labeling with dynamic susceptibility contrast perfusion weighted image in evaluation of the cerebral hemodynamic of adult moyamoya patientsobjective To compare three perfusion weighted image(3D-ASL) with dynamic susceptibility contrast perfusion weighted image(DSC-PWI) in evaluating the cerebral hemodynamic of moyamoya disease. Methods and materials Approved by the institutional review board, 26 cases of moyamoya patients who were diagnosed by DSA were enrolled. Diffusion weighted image, 3D-TOF-MRA, 3D-ASL, DSC-WPI, and T1 contrast weighted image were performed in GE MR750 3.0T scanner. Regions of interest were positioned in the cerebral abnormal perfusion areas and the control area according to the arterial dominant territory to obtain quantitative parameters of perfusion. Perfusion parameters including cerebral blood flow(CBF) of ASL, cerebral blood flow(CBF), cerebral blood volume(CBV), mean transit time(MTT), and time to peak(TTP)of DSC-PWI, and relative parameters(ASL-rCBF, DSC-rCBF, DSC-rCBV, DSC-rMTT, DSC-rTTP) that the ratio of abnormal perfusion area and the control area were calculated. Meanwhile, we measure the area of the lower perfusion region of the same slice. Difference of the above-mentioned parameters and areas is processed by paired Student? t test. Correlation of ASL-CBF, DSC-CBF, DSC-CBV, DSC-MTT, and DSC-TTP was performed by Pearson correlation test. Furthermore, Correlation of relative values of perfusion parameters(ASL-rCBF, DSC-rCBF, DSC-rCBV, DSC-rMTT, and DSC-rTTP) was processed by Pearson correlation test. Results Student? t test shows significant statistics differences of ASL-CBF, DSC-MTT, and DSC-TTP between abnormal perfusion area and the control area(P values are <0.01, <0.01, <0.01, respectively). There is no significant statistics difference in the lower perfusion area between ASL-CBF and DSC-TTP(P value is 0.089). Furthermore, the Pearson correlation test shows significant linear dependence between ASL-rCBF and DSC-rMTT, and DSC-rTTP(r=-0.630,-0.748, p<0.05, p<0.01). Conclusions There is a correlation between 3D-ASL and DSC perfusion weighted image in assessing the reduction of blood perfusion of moyamoya patients. The ASL technique possesses advantages like, non-invasion, no ionization effect, and repeatability. So 3D-ASL is a reliable technique that could apply to the evaluation of the cerebral hemodynamic of moyamoya disease.Second part 3D-ASL perfusion weighted imaging in evaluating hemodynamic change of postoperative moyamoya patientsObjective To study the value of three-dimensional arterial spin labeling(3D-ASL) perfusion weighted imaging in evaluating hemodynamic change of postoperative moyamoya patients. Methods Our study enroll 19 moyamoya patients who diagnosed by DSA, all cases accept surgical therapy of STA-MCA anastomosis and encephalomyosynangiosis, 19 cases were both performed 3DASL and DSC perfusion imaging in preoperative and 3 month after postoperative. Region of interest(ROI) is placed in the operating hemisphere region supplied middle cerebral artery of the slice that ASL-CBF improving significantly. Measure the preoperative and postoperative changes of ASL-CBF and DSC-TTP. Pre-postoperative images coregistration of ASL-CBF and DSC-TTP are implemented by software of integrated-registration(GE). Preoperative clinical symptom and postoperative clinical follow-up of 19 patients are recorded. Results Both ASL-CBF and DSC-TTP of operating hemisphere region supplied by middle cerebral artery between preoperative and postoperative show significant difference(P <0.01), and imaging perfusion of ASL-CBF and DSC-TTP is improving. Diagnostic accuracy of imaging perfusion improvement of ASL-CBF and DSC-TTP are corresponding with Follow-up results of clinical symptom improvement(Mc Nemar test, P value of DSC-TTP 1.00, 0.625, respectively). Moreover diagnostic accuracies perfusion improvement of ASL-CBF and DSC-TTP are consistent performed by paired samples ?2 test(P value = 0.625). Conclusion 3D-ASL has the advantages of reproducible, safe, and noninvasive. In evaluating postoperative perfusion changes show good consistency with follow-up results and DSC-TTP. 3D-ASL can be applied to evaluate the postoperative perfusion changes of moyamoya patients received revascularization surgery.