title: Cerebral blood flow and metabolism of hyperperfusion after cerebral revascularization in patients with moyamoya disease.
abstract: In moyamoya disease (MMD), surgical revascularization may be complicated with postoperative hyperperfusion. We analyzed cerebral perfusion and metabolism using positron emission tomography (PET) or single-photon emission computed tomography (SPECT) before and after bypass surgery on 42 sides of 34 adult patients with MMD. In seven cases (16.7%) with symptomatic hyperperfusion, diagnosed by qualitative (123)I-iodoamphetamine (IMP) SPECT, a subsequent PET study during postoperative subacute stages revealed significantly increased cerebral blood flow (CBF) from 34.1 ± 8.2 to 74.3 ± 12.8 mL/100 g per minute (P<0.01), a persistent increase in cerebral blood volume (CBV) from 5.77 ± 1.67 to 7.01 ± 1.44 mL/100 g and a significant decrease in oxygen extraction fraction (OEF) from 0.61 ± 0.09 to 0.40 ± 0.08 (P<0.01). Mean absolute CBF values during symptomatic hyperperfusion were more than the normal control +2 standard deviations, the predefined criteria of PET. Interestingly, two patients with markedly increased cerebral metabolic rate of oxygen (CMRO(2)) at hyperperfusion were complicated with postoperative seizure. Among preoperative PET parameters, increased OEF was the only significant risk factor for symptomatic hyperperfusion (P<0.05). This study revealed that symptomatic hyperperfusion in MMD is characterized by temporary increases in CBF >100% over preoperative values caused by prolonged recovery of increased CBV.
authors: Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors: Yasuyuki
authors: Y
authors: Kaku
authors: Koji
authors: K
authors: Iihara
authors: Norio
authors: N
authors: Nakajima
authors: Hiroharu
authors: H
authors: Kataoka
authors: Kenji
authors: K
authors: Fukuda
authors: Jun
authors: J
authors: Masuoka
authors: Kazuhito
authors: K
authors: Fukushima
authors: Hidehiro
authors: H
authors: Iida
authors: Nobuo
authors: N
authors: Hashimoto
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D002548:Cerebral Revascularization / Q000379:methods*; D002560:Cerebrovascular Circulation / Q000502:physiology; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging* / Q000378:metabolism; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D020367:Iofetamine; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000601:surgery; D009072:Moyamoya Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D010104:Oxygen Radioisotopes; D049268:Positron-Emission Tomography; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000378:metabolism; D019275:Radiopharmaceuticals; D013699:Temporal Arteries / Q000601:surgery; D015899:Tomography, Emission-Computed, Single-Photon; D055815:Young Adult
chemical_list: D010104:Oxygen Radioisotopes; D019275:Radiopharmaceuticals; D020367:Iofetamine