A1 Refereed original research article in a scientific journal
Cerebral blood flow and metabolism of hyperperfusion after cerebral revascularization in patients with moyamoya disease
Authors: Kaku Y, Iihara K, Nakajima N, Kataoka H, Fukuda K, Masuoka J, Fukushima K, Iida H, Hashimoto N
Publisher: NATURE PUBLISHING GROUP
Publication year: 2012
Journal: Journal of Cerebral Blood Flow and Metabolism
Journal name in source: JOURNAL OF CEREBRAL BLOOD FLOW AND METABOLISM
Journal acronym: J CEREBR BLOOD F MET
Volume: 32
Issue: 11
First page : 2066
Last page: 2075
Number of pages: 10
ISSN: 0271-678X
DOI: https://doi.org/10.1038/jcbfm.2012.110
Abstract
In moyamoya disease (MMD), surgical revascularization may be complicated with postoperative hyperperfusion. We analyzed cerebral perfusion and metabolism using positron emission tomography (PET) or single-photon emission computed tomography (SPECT) before and after bypass surgery on 42 sides of 34 adult patients with MMD. In seven cases (16.7%) with symptomatic hyperperfusion, diagnosed by qualitative I-123-iodoamphetamine (IMP) SPECT, a subsequent PET study during postoperative subacute stages revealed significantly increased cerebral blood flow (CBF) from 34.1 +/- 8.2 to 74.3 +/- 12.8 mL/100 g per minute (P<0.01), a persistent increase in cerebral blood volume (CBV) from 5.77 +/- 1.67 to 7.01 +/- 1.44 mL/100 g and a significant decrease in oxygen extraction fraction (OEF) from 0.61 +/- 0.09 to 0.40 +/- 0.08 (P<0.01). Mean absolute CBF values during symptomatic hyperperfusion were more than the normal control +2 standard deviations, the predefined criteria of PET. Interestingly, two patients with markedly increased cerebral metabolic rate of oxygen (CMRO2) at hyperperfusion were complicated with postoperative seizure. Among preoperative PET parameters, increased OEF was the only significant risk factor for symptomatic hyperperfusion (P<0.05). This study revealed that symptomatic hyperperfusion in MMD is characterized by temporary increases in CBF >100% over preoperative values caused by prolonged recovery of increased CBV. Journal of Cerebral Blood Flow & Metabolism (2012) 32, 2066-2075; doi:10.1038/jcbfm.2012.110; published online 1 August 2012
In moyamoya disease (MMD), surgical revascularization may be complicated with postoperative hyperperfusion. We analyzed cerebral perfusion and metabolism using positron emission tomography (PET) or single-photon emission computed tomography (SPECT) before and after bypass surgery on 42 sides of 34 adult patients with MMD. In seven cases (16.7%) with symptomatic hyperperfusion, diagnosed by qualitative I-123-iodoamphetamine (IMP) SPECT, a subsequent PET study during postoperative subacute stages revealed significantly increased cerebral blood flow (CBF) from 34.1 +/- 8.2 to 74.3 +/- 12.8 mL/100 g per minute (P<0.01), a persistent increase in cerebral blood volume (CBV) from 5.77 +/- 1.67 to 7.01 +/- 1.44 mL/100 g and a significant decrease in oxygen extraction fraction (OEF) from 0.61 +/- 0.09 to 0.40 +/- 0.08 (P<0.01). Mean absolute CBF values during symptomatic hyperperfusion were more than the normal control +2 standard deviations, the predefined criteria of PET. Interestingly, two patients with markedly increased cerebral metabolic rate of oxygen (CMRO2) at hyperperfusion were complicated with postoperative seizure. Among preoperative PET parameters, increased OEF was the only significant risk factor for symptomatic hyperperfusion (P<0.05). This study revealed that symptomatic hyperperfusion in MMD is characterized by temporary increases in CBF >100% over preoperative values caused by prolonged recovery of increased CBV. Journal of Cerebral Blood Flow & Metabolism (2012) 32, 2066-2075; doi:10.1038/jcbfm.2012.110; published online 1 August 2012
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