Efficacy Evaluation Of EDAS In Moyamoya Disease Via 3D-ASL Perfusion Imaging Combined With MRS Score

Objective Assessing the effectiveness of encephalo duro arterio synangiosis(EDAS)in treating moyamoya disease by comparing patients' preoperative and postoperative 3D-arterial spin labeling(3D-ASL)perfusion imaging parameters and modified rankin scale(mRS)scores.Discussing the application value of 3D-ASL perfusion imaging in surgical indications determination,surgical effect evaluation and postoperative prognosis estimation.Methods All patients who were diagnosed with moyamoya disease in our apartment from July 2015 to January 2017 and met our certain inclusion criteria were taken into present study.We grouped our objects according to their preoperative digital subtraction angiography(DSA)examination results and Suzuki classification standard grades.EDAS surgery for each patient was performed after collecting the clinical characteristic data.Surgical effectiveness was estimated by comparing the cerebral blood flow(CBF)scores of 3D-ASL perfusion imaging and mRS scores on injured side before and 3 months after EDAS surgery.We also compared the.CBF scores of 3D-ASL perfusion imaging between injured side and uninjured side before and 3 months after EDAS surgery as another estimation.All statistic analyses were performed under SPSS 17.0 software.Results 1.A total of 21 patients with 11 male and 10 female were participated in present study.Patients' mean age was 40.14± 12.63 years and mean course of disease was 3 years.Patients' initial symptoms were headache(2 in 21,9.25%),transient ischaemic attack(5 in 21,23.81%),cerebral infarction(10 in 21,47.62%)and cerebral hemorrhage(4 in 21,19.05%).2 patients underwent bilateral EDAS surgery while the other 19 patients underwent unilateral EDAS surgery.No surgical related complications were observed at 3 month follow-up.2.Preoperative suzuki staging were stage I in 4 patients(19.05%),stage ? in 7 patients(33.33%),stage ? in 6 patients(28.57%),stage IV in 3 patients(14.29%)and stage V in 1 patients(4.76%).3.Preoperative mRS scores was 1 in 14 patients(66.67%),2 in 4 patients(19.05%),3 in 1 patient(4.76%)and 4 in 2 patients(9.52%).Postoperative mRS score was 0 in 5 patients(23.81%),1 in 10 patients(47.62%),2 in 4 patients(19.05%),3 in 1 patient(4.76%),4 in 1 patient(4.76%).Preoperative and postoperative mRS scores were compared by the paired wilcoxon rank sum test:Z=-2.828,P =0.005.4.The comparison of preoperative CBF scores between operative side and contrast side were done by paired t-test.Frontal lobe:t =3.480,P =0.002;Temporal lobe:t =2.672,P=0.015;Anterior cortical watershed:t=1.684,P =0.108.5.Preoperative and postoperative CBF scores on operative sides were compared by the paired t-test.Frontal lobe:t =3.574,P =0.002;Temporal lobe:t =3.623,P =0.002;Anterior cortical watershed:t =1.912,P =0.070.6.The correlation between anterior cortical watershed CBF value and suzuki staging was analysed by the spearman rank correlation test:r =0.459,P =0.018.Conclusion 3D-ASL perfusion imaging can well help accessing ischemia stage of moyamoya disease patients preoperatively and determining surgical strategies.Moyamoya disease patients would benefit of cerebral blood flow perfusion increasing,clinical symptoms alleviating and prognoses improving after ED AS surgery.