title: Role of CT perfusion imaging in evaluating the effects of multiple burr hole surgery on adult ischemic Moyamoya disease.
abstract: BACKGROUND
  To evaluate the effects of the multiple burr hole (MBH) revascularization on ischemic type adult Moyamoya disease (MMD) by computed tomography perfusion (CTP).
  
  
  METHODS
  Eighty-six ischemic MMD patients received CTP 1 week before and 3 weeks after MBH operation. Fifty-seven patients received it again at 6 month and underwent digital subtraction angiography (DSA) and mRS follow-up. Cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), time to peak (TTP), and relative values of ischemic symptomatic hemispheres were measured. Differences in pre- and post-surgery perfusion CT values were assessed.
  
  
  RESULTS
  There were significant differences of CBF, TTP, and relative time to peak (rTTP) in ischemic hemisphere between 1 week before and 3 weeks after surgery, and no significant difference in relative cerebral blood flow (rCBF), CBV, relative cerebral blood volume (rCBV), MTT, relative mean transit time (rMTT). According to whether there was symptom improvement or not on 3 weeks after MBH, the rTTP value was not statistically significant in the patients whose symptoms were not improved at all on 3 weeks after operation. Six-month follow-up showed that CBF, rCBF, and rCBV values were significantly higher than those before operation. Postoperative MTT, TTP, rMTT, and rTTP values were significantly lower than those before operation.
  
  
  CONCLUSIONS
  CTP is a sensitive method to obtain functional imaging of cerebral microcirculation, which can be a noninvasive assessment of the abnormalities of intracranial arteries and cerebral perfusion changes in MMD before and after surgery. CBF and TTP map, especially the relative values of TTP, seems to have the capability of being quite sensitive to the presence of altered brain perfusion at early time after indirect revascularization.
authors.affiliation: Department of Neurosurgery, Changhai Hospital, Second Military Medical University, No. 168 Changhai Road, Yangpu District, Shanghai, 200433, People's Republic of China.
authors.forename: Dong Wei
authors.initials: DW
authors.lastname: Dai
authors.forename: Wen Yuan
authors.initials: WY
authors.lastname: Zhao
authors.forename: Yong Wei
authors.initials: YW
authors.lastname: Zhang
authors.forename: Zhi Gang
authors.initials: ZG
authors.lastname: Yang
authors.forename: Qiang
authors.initials: Q
authors.lastname: Li
authors.forename: Bing
authors.initials: B
authors.lastname: Xu
authors.forename: Xiao Long
authors.initials: XL
authors.lastname: Ma
authors.forename: Bing
authors.initials: B
authors.lastname: Tian
authors.forename: Jian Min
authors.initials: JM
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery*; D002533:Cerebral Angiography / Q000379:methods; D002548:Cerebral Revascularization / Q000379:methods*; D006801:Humans; D066298:In Vitro Techniques; D008297:Male; D008875:Middle Aged; D009072:Moyamoya Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D055420:Perfusion Imaging / Q000379:methods; D025321:Surgery, Computer-Assisted / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome; D014207:Trephining / Q000379:methods