BOLD-fMRI with median nerve electrical stimulation predict hemodynamic improvement after revascularization in patients with moyamoya disease.
To assess the severity of cerebral hemodynamic impairment and hemodynamic improvements, after revascularization in moyamoya disease (MMD) by means of blood-oxygen-level dependent functional magnetic resonance imaging (BOLD-fMRI).



BOLD-fMRI with median nerve electrical stimulation based on echo planar imaging was performed in 73 volunteers with MMD and 15 healthy volunteers using a 3.0 Tesla MRI scanner. Twenty-four MMD patients were reexamined after encephaloduroarteriosynangiosis. Time-signal intensity curves of the activated area of the contralateral primary somatosensory cortex were computed. Negative response time (Tnr) and peak (Pnr), positive response time (Tpr) and peak (Ppr), and time to negative peak (TTPn) and positive peak (TTPp) were measured.



Compared with nonparesthesia group and the asymptomatic side of paresthesia group, the patients with paresthesia showed extended Tnr (22.04 ± 3.34 s versus 9.57 ± 2.27 s and 12.67 ± 2.69 s, P = 0.0096), decreased Pnr (-0.47 ± 0.06 versus -0.30 ± 0.09 and -0.33 ± 0.09, P = 0.010), delayed TTPn (9.04 ± 1.39 s versus 3.66 ± 0.79 s and 4.88 ± 1.10 s, P = 0.0064), shortened Tpr (22.75 ± 2.30 s versus 36.85 ± 2.68 s and 33 ± 2.49 s, P = 0.0010), and decreased Ppr (0.62 ± 0.08 versus 0.99 ± 0.15 and 0.97 ± 0.11, P = 0.0149) when subjected to median nerve electrical stimulation in the symptomatic side. After surgery, the patients with paresthesia showed shorter Tnr (1.53 ± 1.66 s versus 17.88 ± 22.61 s, P = 0.0002), increased Pnr (-0.14 ± 0.17 versus -0.44 ± 0.53, P = 0.0178), advanced TTPn (1.29 ± 1.21 s versus 7.29 ± 8.21 s, P = 0.0005), extended Tpr (36.94 ± 6.41 s versus 25.18 ± 15.51 s, P = 0.0091), increased Ppr (1.21 ± 0.87 versus 0.77 ± 0.60, P = 0.0201), and advanced TTPp (11.18 ± 4.70 s versus 27.29 ± 20.00 s, P = 0.0046).



Bold-fMRI is useful to assess disease severity and surgical efficacy in MMD.



1 Technical Efficacy: Stage 4 J. Magn. Reson. Imaging 2017;46:1159-1166.
Department of Radiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.|Department of Radiology, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, China.
Peng-Gang
PG
Qiao
Department of Neurosurgery, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, China.
Cong
C
Han
Germany Siemens Healthcare, MR Collaborations NE Asia, Beijing, China.
Tianyi
T
Qian
Department of Radiology, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, China.
Gong-Jie
0000-0001-7680-3449
GJ
Li
Department of Radiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.
Hong
H
Yin
D000293:Adolescent; D000328:Adult; D004558:Electric Stimulation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008475:Median Nerve; D008875:Middle Aged; D009072:Moyamoya Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D055815:Young Adult
BOLD-fMRI; Moyamoya disease; brain revascularization; cerebral hemodynamics; median nerve electrical stimulation