title: Postoperative evaluation of moyamoya disease with perfusion-weighted MR imaging: initial experience.
abstract: OBJECTIVE
  Encephaloduroarteriosynangiosis (EDAS) has become the main treatment for moyamoya disease, a chronically progressive cerebrovascular occlusive disease in children. We aimed to assess the utility of perfusion-weighted MR imaging for evaluating hemodynamic changes before and after EDAS.
  
  
  METHODS
  Thirteen patients with angiographically confirmed moyamoya disease who underwent EDAS were investigated, and results were compared with those of a control group (n = 5). Perfusion MR imaging was performed before and after EDAS by using a T2*-weighted contrast material-enhanced technique. Relative cerebral blood volume (rCBV) and time to peak enhancement (TTP) maps were calculated. Relative ratios of rCBV and TTP in the middle cerebral artery (MCA) and basal ganglia were measured and compared with those of the posterior cerebral artery (PCA). Changes in hemodynamic parameters between pre- and post-EDAS perfusion maps were investigated.
  
  
  RESULTS
  The mean rCBV ratio of MCA to PCA in the patient group was slightly higher than that in the control group, without statistical significance. All 13 patients showed a delayed TTP in the MCA before EDAS compared with the control group (P =.0006), and the TTP after EDAS was significantly reduced (P =.0002). In the basal ganglia, shortening of the TTP was demonstrated before EDAS, but no significant change was observed after EDAS.
  
  
  CONCLUSIONS
  Perfusion-weighted MR imaging can be applied for evaluating postoperative changes in cerebral blood flow in moyamoya disease. Shortening of the TTP in the MCA of the hemisphere operated on is a marker for the development of collateral circulation from the external carotid artery to the internal carotid artery.
authors.affiliation: Department of Diagnostic Radiology, BK21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Seung-Koo
authors.initials: SK
authors.lastname: Lee
authors.forename: Dong Ik
authors.initials: DI
authors.lastname: Kim
authors.forename: Eun-Kee
authors.initials: EK
authors.lastname: Jeong
authors.forename: Si-Yeon
authors.initials: SY
authors.lastname: Kim
authors.forename: Sang Heum
authors.initials: SH
authors.lastname: Kim
authors.forename: Yon Kwon
authors.initials: YK
authors.lastname: In
authors.forename: Dong-Seok
authors.initials: DS
authors.lastname: Kim
authors.forename: Joong-Uhn
authors.initials: JU
authors.lastname: Choi
mesh_terms: D000293:Adolescent; D000328:Adult; D001810:Blood Volume / Q000502:physiology; D001921:Brain / Q000098:blood supply*; D002545:Brain Ischemia / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D002533:Cerebral Angiography; D002548:Cerebral Revascularization; D002648:Child; D002675:Child, Preschool; D003097:Collateral Circulation / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007089:Image Enhancement; D007091:Image Processing, Computer-Assisted; D008297:Male; D009072:Moyamoya Disease / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000503:physiopathology; D012039:Regional Blood Flow / Q000502:physiology; D015899:Tomography, Emission-Computed, Single-Photon