title: Cerebral-perfusion-based single-photon emission computed tomography (SPECT) staging using NeuroGam® in patients with moyamoya disease.
abstract: OBJECTIVE
  Cerebral angiography (CA) is the gold standard for moyamoya disease (MMD) staging and diagnosis, but CA findings are not well correlated with clinical symptoms. The purpose of this study was to establish novel cerebral-perfusion-based staging for MMD that is well correlated with clinical symptoms.
  
  
  METHODS
  From 2010 to 2015, regional cerebrovascular reserve (rCVR) was examined by single-photon emission computed tomography (SPECT) using NeuroGam® (Segamicorp, Houston, TX, USA) in 30 patients (17 women, 13 men; 60 hemispheres; mean 42.0 years old [range 5-60 years old]) with MMD, which was diagnosed by CA and magnetic resonance angiography (MRA). Brain CT or brain magnetic resonance imaging (MRI) was used to evaluate neurological conditions such as transient ischemic attack (TIA), cerebral hemorrhage, and cerebral infarction. A novel staging system for MMD was developed by combining findings from CA, MRI, and SPECT with NeuroGam®.
  
  
  RESULTS
  Our novel staging system was strongly associated with clinical symptoms. Twenty-two hemispheres out of 60 were categorized as stage I, 24 hemispheres were categorized as stage II, and 14 hemispheres were categorized as stage III. Hemispheres with higher scores exhibited a higher incidence of clinical symptoms. These findings indicate that cerebral-perfusion-based staging is predictive of MMD clinical symptoms.
  
  
  CONCLUSIONS
  Perfusion-based SPECT staging correlates well with clinical symptoms and may be a reliable alternative to the Suzuki staging by CA.
authors.affiliation: Department of Neurosurgery, Chungbuk National University Hospital, Chungbuk National University, College of Medicine, 776, Gaesindong, Sewongu, Cheongju, Republic of Korea.
authors.forename: Jai-Hyuck
authors.initials: JH
authors.lastname: Han
authors.affiliation: Department of Neurosurgery, Chungbuk National University Hospital, Chungbuk National University, College of Medicine, 776, Gaesindong, Sewongu, Cheongju, Republic of Korea. youngseokparkmd@gmail.com.
authors.forename: Young Seok
authors.initials: YS
authors.lastname: Park
authors.affiliation: Department of Nuclear Medicine, Chungbuk National University Hospital, Chungbuk National University, College of Medicine, Cheongju, Republic of Korea.
authors.forename: Won Hyoung
authors.initials: WH
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, Chungbuk National University Hospital, Chungbuk National University, College of Medicine, 776, Gaesindong, Sewongu, Cheongju, Republic of Korea.|Department of Nuclear Medicine, Chungbuk National University Hospital, Chungbuk National University, College of Medicine, Cheongju, Republic of Korea.|Department of Radiology, Chungbuk National University Hospital, Chungbuk National University, College of Medicine, Cheongju, Republic of Korea.
authors.forename: Sung-Soo
authors.initials: SS
authors.lastname: Koong
authors.affiliation: Department of Neurosurgery, Chungbuk National University Hospital, Chungbuk National University, College of Medicine, 776, Gaesindong, Sewongu, Cheongju, Republic of Korea.
authors.forename: Kyung-Soo
authors.initials: KS
authors.lastname: Min
authors.affiliation: Department of Neurosurgery, Chungbuk National University Hospital, Chungbuk National University, College of Medicine, 776, Gaesindong, Sewongu, Cheongju, Republic of Korea.
authors.forename: Mou-Seop
authors.initials: MS
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, Chungbuk National University Hospital, Chungbuk National University, College of Medicine, 776, Gaesindong, Sewongu, Cheongju, Republic of Korea.
authors.forename: Young-Gyu
authors.initials: YG
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Chungbuk National University Hospital, Chungbuk National University, College of Medicine, 776, Gaesindong, Sewongu, Cheongju, Republic of Korea.
authors.forename: Dong-Ho
authors.initials: DH
authors.lastname: Kim
authors.affiliation: Department of Radiology, Chungbuk National University Hospital, Chungbuk National University, College of Medicine, Cheongju, Republic of Korea.
authors.forename: Kyung-Sil
authors.initials: KS
authors.lastname: Yi
authors.affiliation: Department of Radiology, Chungbuk National University Hospital, Chungbuk National University, College of Medicine, Cheongju, Republic of Korea.
authors.forename: Sang-Hoon
authors.initials: SH
authors.lastname: Cha
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001921:Brain / Q000000981:diagnostic imaging*; D002560:Cerebrovascular Circulation / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009072:Moyamoya Disease / Q000000981:diagnostic imaging*; D015899:Tomography, Emission-Computed, Single-Photon; D055815:Young Adult
keywords: Moyamoya disease; NeuroGam; Perfusion; SPECT; Staging