Korean J Radiol.  2003 Jun;4(2):71-78. 10.3348/kjr.2003.4.2.71.

Localized 1H-MR Spectroscopy in Moyamoya Disease before and after Revascularization Surgery

• Lim SM
• Choi HY
• Suh JS
• Lee JH
• Lim KH
• Suh DC
• Lee HK
• Lim TH
• Ra YS

• KMID: 1118808
• DOI: http://doi.org/10.3348/kjr.2003.4.2.71

Abstract

OBJECTIVE
To evaluate, using localized proton magnetic resonance spectroscopy (1H-MRS), the cerebral metabolic change apparent after revascularization surgery in patients with moyamoya disease. MATERIALS AND METHODS: Sixteen children with moyamoya disease and eight age-matched normal controls underwent MR imaging, MR angiography, conventional angiography, and 99mTc- ECD SPECT. Frontal white matter and the basal ganglia of both hemispheres were subjected to localized 1H-MRS, and after revascularization surgery, four patients underwent follow-up 1H-MRS. RESULTS: Decreased NAA/Cr ratios (1.35+/-0.14 in patients vs. 1.55+/-0.24 in controls) and Cho/Cr ratios (0.96+/-0.13 in patients vs. 1.10+/-0.11 in controls) were observed in frontal white matter. After revascularization surgery, NAA/Cr and Cho/Cr ratios in this region increased. In the basal ganglia, there is no abnormal metabolic ratios. CONCLUSION: Localized 1H-MRS revealed abnormal metabolic change in both hemispheres of children with moyamoya disease. Because of its non-invasive nature, 1H-MRS is potentially useful for the preoperative evaluation of metabolic abnormalities and their postoperative monitoring.

Keyword

Magnetic resonance (MR), spectroscopy; Brain, infarction; Moyamoya disease

Figure

• 

  Fig. 1 MRI, basal and diamox stress SPECT, cerebral angiography and 1H-MR spectra obtained in patient No. 5.A. T2-weighted axial image shows a voxel location for 1H-MRS and no abnormal signal intensity in the brain.B. Basal SPECT (axial view) discloses normal uptake in both hemispheres.C. Diamox stress SPECT (axial view) reveals decreased uptake in both hemispheres.D. Arterial-phase angiogram of the left common carotid artery (frontal view) shows marked stenosis of the distal internal carotid and anterior and middle cerebral arteries, with tortuous and dilated medial and lateral lenticulostriate vessels (Suzuki stage II).E. Arterial-phase angiogram of the right common carotid artery (frontal view) demonstrates findings similar to those of the left side (Suzuki stage II).F. Representative 1H-MR spectra of frontal white matter (both sides) show lower NAA/Cr [Lt(b): 1.21, Rt(c): 1.34], Cho/Cr [Lt(b): 0.71, Rt (c): 0.77] ratios than in an age-matched control (a).

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  Fig. 2 MRI, cerebral angiography and 1H-MR spectra obtained in patient No. 1.A. T2-weighted axial image shows no abnormal signal intensity in the brain.B. Arterial-phase angiogram of the left common carotid artery (frontal view) reveals narrowing of the carotid fork (Suzuki stage I).C. Angiogram of the right common carotid artery (frontal view) shows the beginning of basal moyamoya vessels, and narrowing of the supraclinoid internal carotid and anterior and middle cerebral arteries (Suzuki stage II).D. 1H-MR spectra of frontal white matter (both sides) obtained after revascularization surgery disclose an increased NAA/Cr ratio [Lt(b): 1.56, Rt(d): 1.41] and a slightly increased upper normal range of Cho/Cr [Lt(b): 1.23, Rt(d): 1.20] as compared with preoperative NAA/Cr [Lt(a): 1.24, Rt(c): 1.14] and Cho/Cr [Lt(a): 0.93, Rt(c): 1.02] levels.

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