title: Subcortical Low-Intensity Lesions on Fluid-Attenuated Inversion Recovery Images After Revascularization Surgery for Moyamoya Disease.
abstract: OBJECTIVE
  Although uncommon, subcortical low-intensity (SCLI) changes on fluid-attenuated inversion recovery images are observed in various diseases, including cerebral ischemia. Here, we aimed to clarify the incidence and clinical implications of SCLI changes after revascularization surgery for moyamoya disease, focusing on the correlation with postoperative transient neurologic events (TNEs).
  
  
  METHODS
  In this retrospective case series analysis, we included 10 hemispheres from 9 adults with moyamoya disease who underwent revascularization surgery. Subcortical signal intensity at the 5 gyri around the anastomosis point was quantitatively measured at 1 week and 3 months postoperatively. Changes in cerebral blood flow (CBF) were assessed using single-photon emission computed tomography.
  
  
  RESULTS
  Images taken 1 week after surgery showed widespread SCLI changes below the operative fields in all 10 cases, but these changes normalized by 3 months. In addition, the changes in signal intensity at anastomoses negatively correlated with the changes in CBF (R2= 0.36; P = 0.039). Postoperative TNEs occurred in 6 cases (60%) but were resolved within 17 days after surgery. Postoperative CBF increased in 9 of the 10 cases, with a median of 23%; however, these increases were not associated with the development of TNEs. The SCLI changes at the anastomosis points did not differ by the experience of TNEs.
  
  
  CONCLUSIONS
  Early after surgery, SCLI changes are common findings below the operative fields but negatively correlate with increases in CBF. Although no significant association was found between TNEs and the SCLI changes, the synchronized development of these phenomena may suggest a common underlying pathogenesis.
authors.affiliation: Department of Neurosurgery, Chiba Cerebral and Cardiovascular Center, Ichihara, Chiba, Japan. Electronic address: tmachida@ca2.so-net.ne.jp.
authors.forename: Toshio
authors.initials: T
authors.lastname: Machida
authors.affiliation: Department of Neurosurgery, Chiba Cerebral and Cardiovascular Center, Ichihara, Chiba, Japan.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Nakano
authors.affiliation: Department of Neurosurgery, Chiba Cerebral and Cardiovascular Center, Ichihara, Chiba, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ishige
authors.affiliation: Department of Neurosurgery, Chiba Cerebral and Cardiovascular Center, Ichihara, Chiba, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Ono
authors.affiliation: Department of Neurosurgery, Chibaken Saiseikai Narashino Hospital, Narashino, Chiba, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Fujikawa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002544:Cerebral Infarction / Q000209:etiology / Q000473:pathology; D002548:Cerebral Revascularization / Q000379:methods*; D003287:Contrast Media; D005260:Female; D006801:Humans; D006987:Hypesthesia / Q000209:etiology; D007089:Image Enhancement; D002546:Ischemic Attack, Transient / Q000209:etiology / Q000473:pathology / Q000601:surgery; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D009072:Moyamoya Disease / Q000473:pathology / Q000601:surgery*; D009930:Organic Chemicals; D012189:Retrospective Studies; D014654:Vascular Patency / Q000502:physiology; D055815:Young Adult
chemical_list: D003287:Contrast Media; D009930:Organic Chemicals; C035709:iodocyanine green
keywords: Moyamoya disease; STA-MCA anastomosis; Subcortical low-intensity; Transient neurologic event