title: Quantitative Assessment of Neovascularization after Indirect Bypass Surgery: Color-Coded Digital Subtraction Angiography in Pediatric Moyamoya Disease.
abstract: For the postoperative follow-up in pediatric patients with Moyamoya disease, it is essential to evaluate the degree of neovascularization status. Our aim was to quantitatively assess the neovascularization status after bypass surgery in pediatric Moyamoya disease by using color-coded digital subtraction angiography.
  
  
  
  Time-attenuation intensity curves were generated at ROIs corresponding to surgical flap sites from color-coded DSA images of the common carotid artery, internal carotid artery, and external carotid artery angiograms obtained pre- and postoperatively in 32 children with Moyamoya disease. Time-to-peak and area under the curve values were obtained. Postoperative changes in adjusted time-to-peak (ΔTTP) and ratios of adjusted area under the curve changes (ΔAUC ratio) of common carotid artery, ICA, and external carotid artery angiograms were compared across clinical and angiographic outcome groups. To analyze diagnostic performance, we categorized clinical outcomes into favorable and unfavorable groups.
  
  
  
  The ΔTTP at the common carotid artery increased among clinical and angiographic outcomes, in that order, with significant differences (P = .003 and .005, respectively). The ΔAUC ratio at the common carotid artery and external carotid artery also increased, in that order, among clinical and angiographic outcomes with a significant difference (all, P = .000). The ΔAUC ratio of ICA showed no significant difference among clinical and angiographic outcomes (P = .418 and .424, respectively). The ΔTTP for the common carotid artery of >1.27 seconds and the ΔAUC ratio of >33.5% for the common carotid artery and 504% for the external carotid artery are revealed as optimal cutoff values between favorable and unfavorable groups.
  
  
  
  Postoperative changes in quantitative values obtained with color-coded DSA software showed a significant correlation with outcome scores and can be used as objective parameters for predicting the outcome in pediatric Moyamoya disease, with an additional cutoff value calculated through the receiver operating characteristic curve.
authors.affiliation: From the Department of Radiology (H.-H.C., J.-E.C., Y.H.C., I.-O.K., W.S.K., S.-M.L., S.K.Y.), Seoul National University Hospital, Seoul, Korea.
authors.forename: H-H
authors.identifier: 0000-0002-4865-2601
authors.initials: HH
authors.lastname: Cho
authors.affiliation: From the Department of Radiology (H.-H.C., J.-E.C., Y.H.C., I.-O.K., W.S.K., S.-M.L., S.K.Y.), Seoul National University Hospital, Seoul, Korea Department of Radiology (J.-E.C., Y.H.C., I.-O.K., W.S.K.), Seoul National University College of Medicine, Seoul, Korea Institute of Radiation Medicine (J.-E.C., I.-O.K., W.S.K.), Seoul National University Medical Research Center, Seoul, Korea cheonje@snu.ac.kr.
authors.forename: J-E
authors.identifier: 0000-0003-1479-2064
authors.initials: JE
authors.lastname: Cheon
authors.affiliation: Division of Pediatric Neurosurgery (S.-K.K.), Seoul National University Children's Hospital, Seoul, Korea.
authors.forename: S-K
authors.identifier: 0000-0002-0039-0083
authors.initials: SK
authors.lastname: Kim
authors.affiliation: From the Department of Radiology (H.-H.C., J.-E.C., Y.H.C., I.-O.K., W.S.K., S.-M.L., S.K.Y.), Seoul National University Hospital, Seoul, Korea Department of Radiology (J.-E.C., Y.H.C., I.-O.K., W.S.K.), Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Y H
authors.identifier: 0000-0002-1842-9062
authors.initials: YH
authors.lastname: Choi
authors.affiliation: From the Department of Radiology (H.-H.C., J.-E.C., Y.H.C., I.-O.K., W.S.K., S.-M.L., S.K.Y.), Seoul National University Hospital, Seoul, Korea Department of Radiology (J.-E.C., Y.H.C., I.-O.K., W.S.K.), Seoul National University College of Medicine, Seoul, Korea Institute of Radiation Medicine (J.-E.C., I.-O.K., W.S.K.), Seoul National University Medical Research Center, Seoul, Korea.
authors.forename: I-O
authors.identifier: 0000-0001-5800-3536
authors.initials: IO
authors.lastname: Kim
authors.affiliation: From the Department of Radiology (H.-H.C., J.-E.C., Y.H.C., I.-O.K., W.S.K., S.-M.L., S.K.Y.), Seoul National University Hospital, Seoul, Korea Department of Radiology (J.-E.C., Y.H.C., I.-O.K., W.S.K.), Seoul National University College of Medicine, Seoul, Korea Institute of Radiation Medicine (J.-E.C., I.-O.K., W.S.K.), Seoul National University Medical Research Center, Seoul, Korea.
authors.forename: W S
authors.identifier: 0000-0003-2184-1311
authors.initials: WS
authors.lastname: Kim
authors.affiliation: From the Department of Radiology (H.-H.C., J.-E.C., Y.H.C., I.-O.K., W.S.K., S.-M.L., S.K.Y.), Seoul National University Hospital, Seoul, Korea.
authors.forename: S-M
authors.identifier: 0000-0002-2073-8198
authors.initials: SM
authors.lastname: Lee
authors.affiliation: From the Department of Radiology (H.-H.C., J.-E.C., Y.H.C., I.-O.K., W.S.K., S.-M.L., S.K.Y.), Seoul National University Hospital, Seoul, Korea.
authors.forename: S K
authors.identifier: 0000-0002-1026-5809
authors.initials: SK
authors.lastname: You
authors.affiliation: Department of Radiology (S.-M.S.), Seoul Metropolitan Government-Seoul National University, Boramae Medical Center, Seoul, Korea.
authors.forename: S-M
authors.identifier: 0000-0002-7250-9573
authors.initials: SM
authors.lastname: Shin
mesh_terms: D015901:Angiography, Digital Subtraction / Q000379:methods*; D002342:Carotid Artery, External / Q000000981:diagnostic imaging; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D002548:Cerebral Revascularization / Q000379:methods*; D002648:Child; D006801:Humans; D008297:Male; D009072:Moyamoya Disease / Q000000981:diagnostic imaging* / Q000601:surgery; D018919:Neovascularization, Physiologic / Q000502:physiology; D012372:ROC Curve