title: Prediction of the clinical outcome of pediatric moyamoya disease with postoperative basal/acetazolamide stress brain perfusion SPECT after revascularization surgery.
abstract: OBJECTIVE
  We evaluated whether basal/acetazolamide stress brain perfusion SPECT performed after revascularization surgery can predict the further clinical outcome of patients with pediatric moyamoya disease.
  
  
  METHODS
  A total of 77 (31 males, 46 females, age 6.6+/-3.2 years) patients with postoperative pediatric moyamoya disease who underwent basal/acetazolamide stress brain perfusion SPECT 6 to 12 months after revascularization surgery and who were followed-up >12 months after SPECT were included. Mean follow-up period after SPECT was 36+/-19 months. Sixty-two patients underwent bilateral ribbon encephaloduroarteriosynangiosis (EDAS), 14 bilateral EDAS, and 1 unilateral EDAS. Ordinal logistic regression analysis using 5 independent variables (infarction on preoperative MRI, age at the first operation, highest Suzuki stage on cerebral angiography, and regional cerebrovascular reserve on postoperative SPECT) against postoperative clinical outcomes was performed.
  
  
  RESULTS
  Fifty-one patients had preserved reserve on postoperative SPECT and their clinical outcomes were excellent (30), good (15), fair (4), and poor (2); 26 patients had decreased reserve (excellent, 1; good, 7; fair, 14; poor, 4). On ordinal logistic regression analysis, age at the first operation (P=0.033) and reserve on postoperative SPECT (P<0.001) were statistically significant.
  
  
  CONCLUSIONS
  Basal/acetazolamide stress brain perfusion SPECT performed at 6 to 12 months after the indirect bypass operation could predict the further clinical outcome of pediatric patients with moyamoya disease. Patients with decreased cerebrovascular reserve will have remaining neurological deficit and ischemic attacks on follow-up.
authors.affiliation: Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul 110-744, Korea.
authors.forename: Young
authors.initials: Y
authors.lastname: So
authors.forename: Ho-Young
authors.initials: HY
authors.lastname: Lee
authors.forename: Seung-Ki
authors.initials: SK
authors.lastname: Kim
authors.forename: Jae Sung
authors.initials: JS
authors.lastname: Lee
authors.forename: Kyu-Chang
authors.initials: KC
authors.lastname: Wang
authors.forename: Byung-Kyu
authors.initials: BK
authors.lastname: Cho
authors.forename: Eunjoo
authors.initials: E
authors.lastname: Kang
authors.forename: Dong Soo
authors.initials: DS
authors.lastname: Lee
mesh_terms: D000086:Acetazolamide / Q000494:pharmacology*; D000293:Adolescent; D000927:Anticonvulsants / Q000494:pharmacology; D001921:Brain / Q000473:pathology*; D002533:Cerebral Angiography / Q000379:methods; D002548:Cerebral Revascularization / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009072:Moyamoya Disease / Q000473:pathology* / Q000628:therapy*; D010477:Perfusion; D011379:Prognosis; D012044:Regression Analysis; D013312:Stress, Physiological; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants; D000086:Acetazolamide