title: Cerebral Blood Flow Improvement after Indirect Revascularization for Pediatric Moyamoya Disease: A Statistical Analysis of Arterial Spin-Labeling MRI.
abstract: OBJECTIVE
  The severity of Moyamoya disease is generally scaled with conventional angiography and nuclear medicine. Arterial spin-labeling MR imaging is now acknowledged for the noninvasive quantification of cerebral blood flow. This study aimed to analyze CBF modifications with statistical parametric mapping of arterial spin-labeling MR imaging in children undergoing an operation for Moyamoya disease.
  
  
  METHODS
  We included 15 children treated by indirect cerebral revascularization with multiple burr-holes between 2011 and 2013. Arterial spin-labeling MR imaging and T1 sequences were then analyzed under SPM8, according to the general linear model, before and after the operation (3 and 12 months). Voxel-based analysis was performed at the group level, comparing all diseased hemispheres with all normal hemispheres and, at the individual level, comparing each patient with a control group.
  
  
  RESULTS
  Group analysis showed statistically significant preoperative hypoperfusion in the MCA territory in the Moyamoya hemispheres and a significant increase of cerebral perfusion in the same territory after revascularization (P < .05 family-wise error-corrected). Before the operation, individual analysis showed significant hypoperfusion for each patient co-localized with the angiographic defect on DSA. All except 1 patient had improvement of CBF after revascularization, correlated with their clinical status.
  
  
  CONCLUSIONS
  SPM analysis of arterial spin-labeling MR imaging offers a noninvasive evaluation of preoperative cerebral hemodynamic impairment and an objective assessment of postoperative improvement in children with Moyamoya disease.
authors.affiliation: From the Université René Descartes (T.B., O.N., R.C., B.M., S.P., M.Z., F.B., C.S.-R., N.B.), PRES Sorbonne Paris Cité, Paris, France APHP, Departments of Pediatric Neurosurgery (T.B., M.B., S.P., M.Z., C.S.-R.) French Institute of Health and Medical Research U1000 (T.B., H.L., R.C., N.B.), Institut Imagine, University Paris-Sud 11 and University Paris Descartes, Paris, France thomas.blauwblomme@nck.aphp.fr.
authors.forename: T
authors.identifier: http://orcid.org/0000-0003-4076-9642
authors.initials: T
authors.lastname: Blauwblomme
authors.affiliation: French Institute of Health and Medical Research U1000 (T.B., H.L., R.C., N.B.), Institut Imagine, University Paris-Sud 11 and University Paris Descartes, Paris, France.
authors.forename: H
authors.identifier: http://orcid.org/0000-0002-5952-076X
authors.initials: H
authors.lastname: Lemaitre
authors.affiliation: From the Université René Descartes (T.B., O.N., R.C., B.M., S.P., M.Z., F.B., C.S.-R., N.B.), PRES Sorbonne Paris Cité, Paris, France Neuroradiology (O.N., R.C., F.B., N.B.), Hospital Necker, Paris, France Department of Neuroradiology (O.N.), French Institute of Health and Medical Research U894, Hospital Sainte-Anne, Paris, France.
authors.forename: O
authors.identifier: http://orcid.org/0000-0002-9544-379X
authors.initials: O
authors.lastname: Naggara
authors.affiliation: From the Université René Descartes (T.B., O.N., R.C., B.M., S.P., M.Z., F.B., C.S.-R., N.B.), PRES Sorbonne Paris Cité, Paris, France Neuroradiology (O.N., R.C., F.B., N.B.), Hospital Necker, Paris, France French Institute of Health and Medical Research U1000 (T.B., H.L., R.C., N.B.), Institut Imagine, University Paris-Sud 11 and University Paris Descartes, Paris, France.
authors.forename: R
authors.identifier: http://orcid.org/0000-0003-2234-6777
authors.initials: R
authors.lastname: Calmon
authors.affiliation: APHP, Department of Pediatric Neurology (M.K.), French Center for Pediatric Stroke, Hospital Necker, Paris, France.
authors.forename: M
authors.identifier: http://orcid.org/0000-0002-0813-9045
authors.initials: M
authors.lastname: Kossorotoff
authors.affiliation: APHP, Departments of Pediatric Neurosurgery (T.B., M.B., S.P., M.Z., C.S.-R.).
authors.forename: M
authors.identifier: http://orcid.org/0000-0001-8610-1109
authors.initials: M
authors.lastname: Bourgeois
authors.affiliation: From the Université René Descartes (T.B., O.N., R.C., B.M., S.P., M.Z., F.B., C.S.-R., N.B.), PRES Sorbonne Paris Cité, Paris, France.
authors.forename: B
authors.identifier: http://orcid.org/0000-0002-9182-5846
authors.initials: B
authors.lastname: Mathon
authors.affiliation: APHP, Departments of Pediatric Neurosurgery (T.B., M.B., S.P., M.Z., C.S.-R.).
authors.forename: S
authors.identifier: http://orcid.org/0000-0002-7654-4317
authors.initials: S
authors.lastname: Puget
authors.affiliation: From the Université René Descartes (T.B., O.N., R.C., B.M., S.P., M.Z., F.B., C.S.-R., N.B.), PRES Sorbonne Paris Cité, Paris, France APHP, Departments of Pediatric Neurosurgery (T.B., M.B., S.P., M.Z., C.S.-R.).
authors.forename: M
authors.identifier: http://orcid.org/0000-0002-4478-8747
authors.initials: M
authors.lastname: Zerah
authors.affiliation: From the Université René Descartes (T.B., O.N., R.C., B.M., S.P., M.Z., F.B., C.S.-R., N.B.), PRES Sorbonne Paris Cité, Paris, France Neuroradiology (O.N., R.C., F.B., N.B.), Hospital Necker, Paris, France.
authors.forename: F
authors.identifier: http://orcid.org/0000-0002-6763-6877
authors.initials: F
authors.lastname: Brunelle
authors.affiliation: From the Université René Descartes (T.B., O.N., R.C., B.M., S.P., M.Z., F.B., C.S.-R., N.B.), PRES Sorbonne Paris Cité, Paris, France APHP, Departments of Pediatric Neurosurgery (T.B., M.B., S.P., M.Z., C.S.-R.).
authors.forename: C
authors.identifier: http://orcid.org/0000-0002-8827-377X
authors.initials: C
authors.lastname: Sainte-Rose
authors.affiliation: From the Université René Descartes (T.B., O.N., R.C., B.M., S.P., M.Z., F.B., C.S.-R., N.B.), PRES Sorbonne Paris Cité, Paris, France Neuroradiology (O.N., R.C., F.B., N.B.), Hospital Necker, Paris, France French Institute of Health and Medical Research U1000 (T.B., H.L., R.C., N.B.), Institut Imagine, University Paris-Sud 11 and University Paris Descartes, Paris, France UMR 1163 (N.B.), Institut Imagine, Paris, France.
authors.forename: N
authors.identifier: http://orcid.org/0000-0003-0991-7774
authors.initials: N
authors.lastname: Boddaert
mesh_terms: D015901:Angiography, Digital Subtraction; D002533:Cerebral Angiography; D002536:Cerebral Arteries / Q000000981:diagnostic imaging; D002548:Cerebral Revascularization / Q000379:methods*; D002560:Cerebrovascular Circulation; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D009072:Moyamoya Disease / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D013113:Spin Labels; D016896:Treatment Outcome
chemical_list: D013113:Spin Labels