Preoperative and postoperative mapping of cerebrovascular reactivity in moyamoya disease by using blood oxygen level—dependent magnetic resonance imaging

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  • 1 Departments of Medical Imaging (Division of Neuroradiology), Surgery (Division of Neurosurgery), and Anesthesia, The Toronto Western Hospital of the University Health Network, and the University of Toronto; and the Departments of Neurology and Surgery (Division of Neurosurgery), The Hospital for Sick Children, Toronto, Canada
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Object. The ability to map cerebrovascular reactivity (CVR) at the tissue level in patients with moyamoya disease could have considerable impact on patient management, especially in guiding surgical intervention and assessing the effectiveness of surgical revascularization. This paper introduces a new noninvasive magnetic resonance (MR) imaging—based method to map CVR. Preoperative and postoperative results are reported in three cases to demonstrate the efficacy of this technique in assessing vascular reserve at the microvascular level.

Methods. Three patients with angiographically confirmed moyamoya disease were evaluated before and after surgical revascularization. Measurements of CVR were obtained by rapidly manipulating end-tidal PCO2 between hypercapnic and hypocapnic states during MR imaging. The CVR maps were then calculated by comparing the percentage of changes in MR signal with changes in end-tidal PCO2.

Presurgical CVR maps showed distinct regions of positive and negative reactivity that correlated precisely with the vascular territories supplied by severely narrowed vessels. Postsurgical reactivity maps demonstrated improvement in the two patients with positive clinical outcome and no change in the patient in whom a failed superficial temporal artery—middle cerebral artery bypass was performed.

Conclusions. Magnetic imaging—based CVR mapping during rapid manipulation of end-tidal PCO2 is an exciting new method for determining the location and extent of abnormal vascular reactivity secondary to proximal large-vessel stenoses in moyamoya disease. Although the study group is small, there seems to be considerable potential for guiding preoperative decisions and monitoring efficacy of surgical revascularization.

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  • 1.

    Cox RW: AFNI: software for analysis and visualization of functional magnetic resonance neuroimages. Comput Biomed Res 29:162173, 1996 Cox RW: AFNI: software for analysis and visualization of functional magnetic resonance neuroimages. Comput Biomed Res 29:162–173, 1996

    • Search Google Scholar
    • Export Citation
  • 2.

    Davis TL, , Kwong KK, , Weisskoff RM, & Rosen BR: Calibrated functional MRI: mapping the dynamics of oxidative metabolism. Proc Natl Acad Sci USA 95:18341839, 1998 Davis TL, Kwong KK, Weisskoff RM, Rosen BR: Calibrated functional MRI: mapping the dynamics of oxidative metabolism. Proc Natl Acad Sci USA 95:1834–1839, 1998

    • Search Google Scholar
    • Export Citation
  • 3.

    Hedera P, , Lai S, , Lewin JS, , Haacke EM, , Wu D, & Lerner AJ, et al: Assessment of cerebral blood flow reserve using functional magnetic resonance imaging. J Magn Reson Imaging 6:718725, 1996 Hedera P, Lai S, Lewin JS, Haacke EM, Wu D, Lerner AJ, et al: Assessment of cerebral blood flow reserve using functional magnetic resonance imaging. J Magn Reson Imaging 6:718–725, 1996

    • Search Google Scholar
    • Export Citation
  • 4.

    Kohno K, , Oka Y, , Kohno S, , Ohta S, , Kumon Y, & Sakaki S: Cerebral blood flow measurement as an indicator for an indirect revascularization procedure for adult patients with moyamoya disease. Neurosurgery 42:752758, 1998 Kohno K, Oka Y, Kohno S, Ohta S, Kumon Y, Sakaki S: Cerebral blood flow measurement as an indicator for an indirect revascularization procedure for adult patients with moyamoya disease. Neurosurgery 42:752–758, 1998

    • Search Google Scholar
    • Export Citation
  • 5.

    Kuwabara Y, , Ichiya Y, , Sasaki M, , Yoshida T, , Masuda K, & Matsushima T, et al: Response to hypercapnia in moyamoya disease: cerebrovascular response to hypercapnia in pediatric and adult patients with moyamoya disease. Stroke 28:701707, 1997 Kuwabara Y, Ichiya Y, Sasaki M, Yoshida T, Masuda K, Matsushima T, et al: Response to hypercapnia in moyamoya disease: cerebrovascular response to hypercapnia in pediatric and adult patients with moyamoya disease. Stroke 28:701–707, 1997

    • Search Google Scholar
    • Export Citation
  • 6.

    Ogawa S, , Lee TM, , Kay AR, & Tank DW: Brain magnetic resonance imaging with contrast dependent on blood oxygenation. Proc Natl Acad Sci USA 87:98689872, 1990 Ogawa S, Lee TM, Kay AR, Tank DW: Brain magnetic resonance imaging with contrast dependent on blood oxygenation. Proc Natl Acad Sci USA 87:9868–9872, 1990

    • Search Google Scholar
    • Export Citation
  • 7.

    Ogawa A, , Nakamura N, , Yoshimoto T, & Suzuki J: Cerebral blood flow in moyamoya disease. Part 2: Autoregulation and CO2 response. Acta Neurochir (Wien) 105:107111, 1990 Ogawa A, Nakamura N, Yoshimoto T, Suzuki J: Cerebral blood flow in moyamoya disease. Part 2: Autoregulation and CO2 response. Acta Neurochir (Wien) 105:107–111, 1990

    • Search Google Scholar
    • Export Citation
  • 8.

    Oshima H, , Katayama Y, & Hirayama T: Intracerebral steal phenomenon associated with global hyperemia in moyamoya disease during revascularization surgery. J Neurosurg 92:949954, 2000 Oshima H, Katayama Y, Hirayama T: Intracerebral steal phenomenon associated with global hyperemia in moyamoya disease during revascularization surgery. J Neurosurg 92:949–954, 2000

    • Search Google Scholar
    • Export Citation
  • 9.

    Takeuchi S, , Tanaka R, , Ishii R, , Tsuchida T, , Kobayashi K, & Arai H: Cerebral hemodynamics in patients with moyamoya disease. A study of regional cerebral blood flow by the 133 Xe inhalation method. Surg Neurol 23:468474, 1985 Takeuchi S, Tanaka R, Ishii R, Tsuchida T, Kobayashi K, Arai H: Cerebral hemodynamics in patients with moyamoya disease. A study of regional cerebral blood flow by the 133 Xe inhalation method. Surg Neurol 23:468–474, 1985

    • Search Google Scholar
    • Export Citation
  • 10.

    Vesely A, , Sasano H, , Volgyesi G, , Somogyi R, , Tesler J, & Fedorko L, et al: MRI mapping of cerebrovascular reactivity using square wave changes in end tidal PCO2. Magn Reson Med 45:10111013, 2001 Vesely A, Sasano H, Volgyesi G, Somogyi R, Tesler J, Fedorko L, et al: MRI mapping of cerebrovascular reactivity using square wave changes in end tidal PCO2. Magn Reson Med 45:1011–1013, 2001

    • Search Google Scholar
    • Export Citation
  • 11.

    Yang Y, , Glover GH, , van Gelderen P, , Patel AC, , Mattay VS, & Frank JA, et al: A comparison of fast MR scan techniques for cerebral activation studies at 1.5 tesla. Magn Reson Med 39:6167, 1998 Yang Y, Glover GH, van Gelderen P, Patel AC, Mattay VS, Frank JA, et al: A comparison of fast MR scan techniques for cerebral activation studies at 1.5 tesla. Magn Reson Med 39:61–67, 1998

    • Search Google Scholar
    • Export Citation

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