title: Apparent Diffusion Coefficient and Transient Neurological Deficit after Revascularization Surgery in Moyamoya Disease.
abstract: BACKGROUND
  Transient neurological deficits are relatively common after direct revascularization surgery for moyamoya disease (MMD). Although recent evidence has revealed the clinical features and pathophysiology, preoperative predictors have remained unclear. This study investigated whether the apparent diffusion coefficient (ADC) in normal-appearing white matter (NAWM) on magnetic resonance imaging could offer a predictor of postoperative transient neurological deficits.
  
  
  METHODS
  This study included adult patients with MMD who underwent superficial temporal artery-middle cerebral artery bypass. Preoperative ADCs were measured in NAWM on ipsilateral hemisphere. Single photon emission computed tomography (SPECT) with (123)I-iodoamphetamine was performed on postoperative days 2-6. Relationships between mean ADC and postoperative transient neurological deficits were assessed.
  
  
  RESULTS
  Twenty of the 26 subjects (76.9%) experienced transient neurological deficits. Focal hyperemia on postoperative SPECT appeared in 11 of the 20 subjects with postoperative transient neurological deficits and 1 of the 6 subjects without (P = .12). Mean ADCs in patients with and without postoperative transient neurological deficits were 748.3 ± 12 mm(2)/second × 10(-6) and 679.7 ± 21.9 mm(2)/second × 10(-6), respectively (P = .0091).
  
  
  CONCLUSIONS
  Preoperative ADC elevation in NAWM may indicate postoperative transient neurological deficits not only in patients with postoperative hyperemia on SPECT, but also in patients with this pathology.
authors.affiliation: Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan. Electronic address: yaraki@kuhp.kyoto-u.ac.jp.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Araki
authors.affiliation: Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Takagi
authors.affiliation: Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Yasutaka
authors.initials: Y
authors.lastname: Fushimi
authors.affiliation: Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Arakawa
authors.affiliation: Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Funaki
authors.affiliation: Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Kikuchi
authors.affiliation: Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Jun C
authors.initials: JC
authors.lastname: Takahashi
authors.affiliation: Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Kaori
authors.initials: K
authors.lastname: Togashi
authors.affiliation: Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Miyamoto
mesh_terms: D000328:Adult; D002548:Cerebral Revascularization / Q000009:adverse effects*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009072:Moyamoya Disease / Q000601:surgery*; D009422:Nervous System Diseases / Q000175:diagnosis / Q000209:etiology*; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D015899:Tomography, Emission-Computed, Single-Photon; D066127:White Matter / Q000473:pathology; D055815:Young Adult
keywords: Adult; diffusion; moyamoya disease; revascularization surgery; transient neurological deficit