title: Evaluation of Encephaloduroarteriosynangiosis Efficacy Using Probabilistic Independent Component Analysis Applied to Dynamic Susceptibility Contrast Perfusion MRI.
abstract: Indirect cerebral revascularization has been successfully used for treatment in Moyamoya disease and symptomatic intracranial atherosclerosis. While angiographic neovascularization has been demonstrated after surgery, measurements of local tissue perfusion are scarce and may not reflect the reported successful clinical outcomes. We investigated probabilistic independent component analysis and conventional perfusion parameters from DSC-MR imaging to measure postsurgical changes in tissue perfusion.
  
  
  
  In this prospective study, 13 patients underwent unilateral indirect cerebral revascularization and DSC-MR imaging before and after surgery. Conventional perfusion parameters (relative cerebral blood volume, relative cerebral blood flow, and TTP) and probabilistic independent components that reflect the relative contributions of DSC signals consistent with arterial, capillary, and venous hemodynamics were calculated and examined for significant changes after surgery. Results were compared with postsurgical DSA studies to determine whether changes in tissue perfusion were due to postsurgical neovascularization.
  
  
  
  Before surgery, tissue within the affected hemisphere demonstrated a high probability for hemodynamics consistent with venous flow and a low probability for hemodynamics consistent with arterial flow, whereas the contralateral control hemisphere demonstrated the reverse. Consistent with symptomatic improvement, the probability for venous hemodynamics within the affected hemisphere decreased with time after surgery (P= .002). No other perfusion parameters demonstrated this association. Postsurgical DSA revealed an association between an increased preoperative venous probability in the symptomatic hemisphere and neovascularization after surgery.
  
  
  
  Probabilistic independent component analysis yielded sensitive measurements of changes in local tissue perfusion that may be associated with newly formed vasculature after indirect cerebral revascularization surgery.
authors.affiliation: From the Departments of Neurosurgery (A.N.L., Y.C.O.).
authors.forename: A N
authors.identifier: 0000-0003-4580-1074
authors.initials: AN
authors.lastname: Laiwalla
authors.affiliation: Department of Neurosurgery (F.K., R.L., N.R.G.), Cedars Sinai Medical Center, Los Angeles, California.
authors.forename: F
authors.identifier: 0000-0001-8662-1809
authors.initials: F
authors.lastname: Kurth
authors.affiliation: Radiology (K.L., J.P., N.S., B.M.E.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
authors.forename: K
authors.identifier: 0000-0002-0523-1575
authors.initials: K
authors.lastname: Leu
authors.affiliation: Department of Neurosurgery (F.K., R.L., N.R.G.), Cedars Sinai Medical Center, Los Angeles, California.
authors.forename: R
authors.identifier: 0000-0002-0370-9694
authors.initials: R
authors.lastname: Liou
authors.affiliation: Radiology (K.L., J.P., N.S., B.M.E.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
authors.forename: J
authors.identifier: 0000-0001-6920-8297
authors.initials: J
authors.lastname: Pamplona
authors.affiliation: From the Departments of Neurosurgery (A.N.L., Y.C.O.).
authors.forename: Y C
authors.identifier: 0000-0001-8475-9484
authors.initials: YC
authors.lastname: Ooi
authors.affiliation: Radiology (K.L., J.P., N.S., B.M.E.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
authors.forename: N
authors.identifier: 0000-0002-3520-9467
authors.initials: N
authors.lastname: Salamon
authors.affiliation: Radiology (K.L., J.P., N.S., B.M.E.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
authors.forename: B M
authors.identifier: 0000-0002-2764-6640
authors.initials: BM
authors.lastname: Ellingson
authors.affiliation: Department of Neurosurgery (F.K., R.L., N.R.G.), Cedars Sinai Medical Center, Los Angeles, California. nestor.gonzalez@cshs.org.
authors.forename: N R
authors.identifier: 0000-0002-1933-4815
authors.initials: NR
authors.lastname: Gonzalez
mesh_terms: D000328:Adult; D000368:Aged; D001921:Brain / Q000098:blood supply*; D002548:Cerebral Revascularization / Q000379:methods*; D002560:Cerebrovascular Circulation; D005260:Female; D006439:Hemodynamics; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000601:surgery; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009072:Moyamoya Disease / Q000601:surgery; D010477:Perfusion; D011446:Prospective Studies