Project Details

Hemodynamic MRI Metrics to Assess Ischemic Risk and Predict Surgical Outcome in Moyamoya Disease

Jeffrey Stout, PhD

Summary

BACKGROUND: Currently there are no clear strategies to assess when in the progressive evolution of pediatric moyamoya patients would maximally benefit from surgical intervention to prevent ischemic brain injury, resulting in wide variation in practice among even high-volume tertiary referral centers. Advanced MRI techniques have been developed to quantify cerebral hemodynamics that may be useful in assessing brain physiology relevant to clinical management of moyamoya. GAP: Advanced MRI techniques to quantify cerebral hemodynamics have yet to be combined and incorporated into clinical practice because their diagnostic accuracy, both in terms of ischemic risk prognosis and prediction of collateral vessel formation after surgery, remains unknown. HYPOTHESIS: Quantitative MRI hemodynamic metrics will be sensitive to disease severity as well as cerebrovascular physiological changes resulting from surgery, and can be combined to accurately predict interval ischemic injury and degree of collateral formation after surgery. METHODS: In this prospective observational study of pediatric patients with moyamoya, we will add arterial spin labeling, breath hold cerebrovascular reactivitiy mapping, and 4D flow sequences to clinical MRI studies in order to quantify cerebral hemodynamics. RESULTS: We found that analyzing the pre-surgery cerebrovascular reactivitiy data using the average cerebellar signal as opposed to the measured end-tidal CO2 pressure as the main regressor yieled parameter maps that were in better agreement with observered neurological symptoms. IMPACT: If successful, new strategies to prevent interval stroke could be assessed and likelihood of response to therapy could be used to prioritize patients most likely to respond for earlier surgical interventions. These techniques might also aid in clinical management of other pediatric cerebrovascular conditions such as vein of Galen malformation, congenital heart disease and sickle cell disease. Website Link: https://www.fnndsc.org