Intraoperative contrast-enhanced ultrasound evaluates the hemodynamic change of cerebral revascularization in adult moyamoya disease: Preliminary results

Abstract

Purpose

This study aimed to determine the feasibility of using intraoperative contrast-enhanced ultrasound (CEUS) to assess subcortical hemodynamic changes in moyamoya disease patients who had undergone combined revascularization. It also aimed to investigate the correlation between quantitative CEUS parameters and post-operative neural functional recovery.

Methods

This study included seventeen patients diagnosed with moyamoya disease, confirmed through cerebral angiography, who underwent combined revascularization. Intraoperative subcortical hemodynamics were assessed using CEUS before and immediately after cerebrovascular bypass. Hemodynamic parameters were calculated by analyzing the time-intensity curve generated from a defined region of interest in each CEUS video. Post-operative neurological symptoms, computed tomography records, and short-term modified Rankin Scale (mRS) scores were also recorded.

Results

During the post-operative follow-up, 29.4 % of the patients experienced new neurological symptoms, including epilepsy, dyskinesia, and language impairment. Overall, CEUS quantitative parameters suggested that blood supply improved after surgery. And certain hemodynamic parameters exhibited a stronger correlation with the mRS scores, with correlation coefficients ranging up to 0.73 (p < 0.01). However, no statistically significant differences were observed among the different functional groups. The advanced parameter of wash-out intensity ($\delta$ WOI), which signifies the rate of change at the point when blood flow is completely washed out, demonstrated a significant difference between two functional groups (p = 0.02) and exhibited a correlation with mRS scores (correlation coefficients: 0.55, p = 0.02).

Conclusions

This preliminary study suggests that quantitative intraoperative CEUS can measure subcortical hemodynamic changes. It provides a novel non-invasive method that may predict the short-term post-operative neural functional recovery of combined revascularization in moyamoya disease patients.