医学
烟雾病
流体衰减反转恢复
侧支循环
灌注
大脑中动脉
血流动力学
脑血流
脑灌注压
脑动脉
心脏病学
大脑后动脉
大脑前动脉
搭桥手术
外科
内科学
动脉
放射科
磁共振成像
缺血
作者
Sung Ho Lee,Won‐Sang Cho,Hee Chang Lee,Hansan Oh,Jin Woo Bae,Jin Ho Choi,Jin Chul Paeng,Joonhyung Gil,Kang Min Kim,Hyun‐Seung Kang,Jeong Eun Kim
标识
DOI:10.3171/2023.4.jns23294
摘要
OBJECTIVE Little is known about the relationship between postoperative changes in cerebral perfusion and the ivy sign representing leptomeningeal collateral burden in moyamoya disease (MMD). This study aimed to investigate the usefulness of the ivy sign in evaluating cerebral perfusion status following bypass surgery in patients with adult MMD. METHODS Two hundred thirty-three hemispheres in 192 patients with adult MMD undergoing combined bypass between 2010 and 2018 were retrospectively enrolled. The ivy sign was represented as the ivy score on FLAIR MRI in each territory of the anterior, middle, and posterior cerebral arteries. Ivy scores, as well as clinical and hemodynamic states on SPECT, were semiquantitatively compared both preoperatively and at 6 months after surgery. RESULTS Clinical status improved at 6 months after surgery (p < 0.01). On average, ivy scores in whole and individual territories were decreased at 6 months (all p values < 0.01). Cerebral blood flow (CBF) postoperatively improved in three individual vascular territories (all p values ≤ 0.03) except for the posterior cerebral artery territory (PCAt), and cerebrovascular reserve (CVR) improved in those areas (all p values ≤ 0.04) except for the PCAt. Postoperative changes in ivy scores and CBF were inversely correlated in all territories (p ≤ 0.02), except for the PCAt. Furthermore, changes in ivy scores and CVR were only correlated in the posterior half of the middle cerebral artery territory (p = 0.01). CONCLUSIONS The ivy sign was significantly decreased after bypass surgery, which was well correlated with postoperative hemodynamic improvement in the anterior circulation territories. The ivy sign is believed to be a useful radiological marker for postoperative follow-up of cerebral perfusion status.
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