Prediction of cerebral infarction after bypass surgery in adult moyamoya disease: combing parameters on 4D perfusion CT with clinical related factors

IF 1.9 3区医学 Q3 CLINICAL NEUROLOGY

Acta Neurochirurgica Pub Date : 2024-11-28 DOI:10.1007/s00701-024-06373-8

Jiangbo Ding, Xuying Chang, Yong Shen, Peiyu Ma, Ruoyu Zhang, Guangwu Yang, Linjie Mu, Xingkui Zhang, Zhigao Li, Jinwei Tang, Zhiwei Tang

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Abstract

Objective

This study aimed to identify predictive factors for cerebral infarction after bypass surgery in adult patients with moyamoya disease (MMD) using quantitative parameters in 4D-CT perfusion software.

Methods

A total of 108 patients who underwent combined revascularization, including superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis and encephalo-duro-myo-synangiosis (EDMS), in our hospital between September 2019 and August 2023 were analyzed retrospectively. Preoperative relative cerebral blood flow (rCBF), relative cerebral blood volume (rCBV), relative mean transit time (rMTT), and relative time to maximum residual function (rTmax) perfusion parameters were obtained using 4D-CT perfusion software. These quantitative parameters, combined with related clinical and angiographic factors, were statistically analyzed using univariate and multivariate regression analyses to determine the significant predictors of cerebral infarction after bypass surgery.

Results

Acute cerebral infarction occurred in 12 patients postoperatively. Univariate analysis showed that a history of previous ischemic events (P = 0.024), higher Suzuki stage (P = 0.006), higher modified Rankin score (mRS) (P = 0.013), rCBV (P = 0.026), rMTT (P = 0.001), and rTmax (P < 0.001) were associated with postoperative cerebral infarction. Further multivariate regression analysis showed that a history of previous ischemic events (OR = 12.830, 95%CI = 1.854–875.672, P = 0.031) and higher rTmax (OR = 16.968, 95%CI = 2.035–141.451, P = 0.009) were independently associated with new postoperative cerebral infarction. The cutoff value for rTmax was 2.025 (AUC = 0.935).

Conclusions

Previous ischemic event history and rTmax greater than 2.025 are independent risk factors for predicting cerebral infarction after combined revascularization with high sensitivity in adult patients with MMD. These patients should be more cautious when deciding on combined revascularization.

查看原文本刊更多论文

成人 moyamoya 病旁路手术后脑梗塞的预测：将四维灌注 CT 上的参数与临床相关因素相结合

方法回顾性分析了2019年9月至2023年8月期间在我院接受颞浅动脉-大脑中动脉（STA-MCA）吻合术和脑-黑质-脑血管吻合术（EDMS）等联合血管重建术的108例成人moyamoya病（MMD）患者。使用 4D-CT 灌注软件获得了术前相对脑血流（rCBF）、相对脑血容量（rCBV）、相对平均传输时间（rMTT）和最大残余功能相对时间（rTmax）灌注参数。使用单变量和多变量回归分析对这些定量参数以及相关的临床和血管造影因素进行统计分析，以确定旁路手术后脑梗死的重要预测因素。单变量分析显示，既往缺血事件史（P = 0.024）、较高的铃木分期（P = 0.006）、较高的改良Rankin评分（mRS）（P = 0.013）、rCBV（P = 0.026）、rMTT（P = 0.001）和rTmax（P < 0.001）与术后脑梗死相关。进一步的多变量回归分析显示，既往缺血事件史（OR = 12.830，95%CI = 1.854-875.672，P = 0.031）和较高的 rTmax（OR = 16.968，95%CI = 2.035-141.451，P = 0.009）与术后新发脑梗死独立相关。rTmax的临界值为2.025（AUC = 0.935）。结论既往缺血事件史和rTmax大于2.025是预测MMD成人患者联合血管再通术后脑梗死的独立危险因素，具有很高的灵敏度。这些患者在决定是否接受联合血管再通术时应更加谨慎。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Neurochirurgica 医学-临床神经学

CiteScore

4.40

自引率

4.20%

发文量

342

审稿时长

1 months

期刊介绍： The journal "Acta Neurochirurgica" publishes only original papers useful both to research and clinical work. Papers should deal with clinical neurosurgery - diagnosis and diagnostic techniques, operative surgery and results, postoperative treatment - or with research work in neuroscience if the underlying questions or the results are of neurosurgical interest. Reports on congresses are given in brief accounts. As official organ of the European Association of Neurosurgical Societies the journal publishes all announcements of the E.A.N.S. and reports on the activities of its member societies. Only contributions written in English will be accepted.