Severe haemodynamic stress in selected subtypes of patients with moyamoya disease: a positron emission tomography study.
BACKGROUND
The optimum management of patients with moyamoya disease remains controversial.


OBJECTIVE
To examine retrospectively the correlation between the degree of haemodynamic stress and the clinical presentation by measuring cerebral haemodynamics and metabolism using positron emission tomography (PET).


METHODS
57 patients with moyamoya disease (mean age 32 years, range 12 to 64), classified into five groups according to clinical manifestations, underwent PET measurement of cerebral blood flow (CBF), cerebral blood volume (CBV), cerebral metabolic rate for oxygen (CMR(O2)), and oxygen extraction fraction (OEF) using (15)O labelled gases. The regional values in patient groups were compared with a normal group.


RESULTS
CBF in non-symptomatic patients, patients presenting with transient ischaemic attacks (TIA), and patients with haemorrhagic onset (H) was not significantly lower than in normal controls in any region. CBV in the TIA group and in patients with infarction associated with TIA (I/TIA) was significantly higher than in the controls in most regions. OEF in the frontal, parietal, and temporal cortex was significantly higher in the I/TIA group than in the controls. Patients in the H group and those with a permanent deficit with infarction (PD group) had decreased metabolism with normal OEF. Multivariate analysis to test the distribution of the three dimensional vector (CBF, CBV, OEF) showed significant differences between every possible pair among the six groups except NS v H and H v PD in the frontal cortex.


CONCLUSIONS
The haemodynamic status of moyamoya disease is not uniform, and severe haemodynamic stress occurs in selected subgroups of patients.
Nariai
T
T
Department of Neurosurgery, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo 113-8519, Japan. nariai.nsrg@tmd.ac.jp
Matsushima
Y
Y
Imae
S
S
Tanaka
Y
Y
Ishii
K
K
Senda
M
M
Ohno
K
K
D000293:Adolescent; D000328:Adult; D001479:Basal Ganglia / Q000098:blood supply / Q000378:metabolism / Q000473:pathology; D001921:Brain / Q000098:blood supply* / Q000378:metabolism / Q000473:pathology*; D002648:Child; D005260:Female; D005625:Frontal Lobe / Q000098:blood supply / Q000378:metabolism / Q000473:pathology; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology / Q000378:metabolism / Q000473:pathology; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009072:Moyamoya Disease / Q000150:complications / Q000378:metabolism* / Q000473:pathology*; D010100:Oxygen / Q000378:metabolism; D010296:Parietal Lobe / Q000098:blood supply / Q000378:metabolism / Q000473:pathology; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013702:Temporal Lobe / Q000098:blood supply / Q000378:metabolism / Q000473:pathology
D010100:Oxygen