Transcranial Doppler Ultrasonography In Patients With Moyamoya Disease

Moyamoya disease (MMD) is a unique cerebrovascular diseasecharacterized by progressive stenosis or occlusion of the bilateral terminalinternal carotid arteries (ICAs) and sedondary formation of unusual vascularnetworks that act as colateral pathways. But its exact cause is unknown.Thegold standard for moyamoya disease are based on conventional angiography,but it is an invasive procedure associated with non-negligible complicationsthat limit its used widely in the long-term follow-up. Now Transcrnial Dopplerultrasonography has been widely recognized as a sensitivity andspecificity,method to evaluate intracranial stenosis or occlusion. TCD can berepeated inspection or continuous monitoring, which is suitable for evaluationof the trends of intracranial vascular blood flow velocity and spectrum form.Furthermore it is an noninvasive,cost-effective and convenient operation. Thepurpose of our study is obtain the TCD changes of basal arteries in MMDpatients with different TCD stages.And using TCD assists moyamoya diseasediagnosis and intracranial vascular progress in the long-term follow-up.We reviewed43patients with moyamoya disease in the First Hospital ofJilin University between January2007and January2012. All patientsunderwent TCD examination in the First Hospital of Jilin Uniersity. Wecollected TCD data of all patients. Through the temporal window or eyewindow, bilateral middle cerebral artery (MCA), anterior cerebral arteries(ACA), posterior cerebral artery (MCA), siphon carotid artery and ophthalmicartery (OA) were detected. The peak systolic blood flow velocity (PSV),end-diastolic blood flow velocity (EDV), the mean blood flow velocity (MFV)and pulsatility index (PI) were measured for each artery based on the TCDspectra. Characteristics of TCD spectrum parameters in different stages wereanalyzed.1. General information: Data were collected on a consecutive series of43 patients with MMD; among them, we included28patients with DSA diagnosis;15patients with MRI/MRA diagnosis. A total of24patients with moyamoyadisease had2cases with moyamoya disease;7cases with unilateral moyamoyadisease;12cases with smoke syndrome. There were Males29, females14withMMD;2cases of minor (<16);41cases of adult quartile (≥16);5patients withcerebral hemorrhage performance;38patients with cerebral ischemia.2. TCD stage results: According to Dr. Gao’s “the smoke disease transcranialdoppler ultrasound change in the proposed staging system TCD staging”.Among all patients, I period9cases (21.00%), Ⅱ stage for13cases (30.00%),Ⅲ stage16cases (37.00%), Ⅳ period in5patients (12.00%).3. TCD stage results of five vessels Flow velocity:3.1The MFV of MCA were in the normal range at Ⅰand Ⅱ stage, but MFVdeclined obviously at Ⅲ and Ⅳ stage, and each stage is no significantdifference (Kruskal-Willis H inspection, P>0.05). Pulsatility Index (PI) firstlyincreased,then reduced with the advance of TCD stages, there were nosignificant difference each stage (Kruskal-Willis H inspection, P>0.05).3.2The MFV of ACA have no significant change from Ⅰ stage to Ⅳ stage.The PI of ACA is higher trend, further there are difference betweenⅠstage andⅡstage (Mann-Whitney U inspection, P <0.05).3.3The MFV Of SCA declined with the advance of TCD stages, no significantdifference between all stages (Kruskal-Willis H inspection, P>0.05). PI ofSCA has no significant change.3.4The MFV of PCA has a increased trend with the advance of TCD stages,PCA at all stage can find the high blood flow velocity spectrum. PI of PCA hasa increased trend, there is a significant difference between Ⅰ stage and Ⅳstage.(Mann-Whitney U inspection, P <0.05).3.5The MFV of OA has no significant change, PI of OA has no regular change.To sum up,with the advance of TCD stages, The MEV of MCA reducesignificantly at Ⅲ stage and Ⅳ stage. The MEV of ACA and SCA have areduced trend slowly. The MEV of PCA has a significant increased trend. TheMEV of OA has no significant change. The PI of ACA is higher trend.Conclusion:1. TCD spectrum duing internal carotid artery (SCA),siphon period middlecerebral artery (MCA), and anterior cerebral arteries (ACA) of the main vesselsof arterior circulation changed that can reflect intracranial vascular diseaseprogression.2. TCD spectrum changed of posterior cerbral artery (PCA) of the main loopcompensatory artery can reflect posterior cerebral circulation diseaseprogression compensatory.3. TCD could not be used for the signal diagnosis of moyamoya disease, andcan be used as an adjunct in the folIow-up evaluation of patients with MMD,with detecting dynamic vascular evolution and collateral circulation.