White and grey matter perfusion in children with moyamoya angiopathy after revascularization surgery.

INTRODUCTION: Surgical revascularization is very effective in patients with moyamoya angiopathy (MMA) and leads to improvements in cortical perfusion parameters. However, changes in white matter hemodynamics are still underestimated. To date, only a few studies have examined brain perfusion changes within deep white matter after bypass surgery in patients with MMA.

METHODS: Ten children with moyamoya angiopathy were evaluated using the CT perfusion technique before and after revascularization surgery. Brain perfusion parameters within grey and white matter were compared before and after surgery. The correlations between the perfusion parameters before surgery and the Suzuki stage, as well as between the perfusion parameters and the cognitive scores, were also evaluated.

RESULTS: Brain perfusion parameters improved significantly in both grey matter (predominantly due to cerebral blood flow within the anterior circulation, p < 0.01) and white matter (predominantly due to cerebral blood volume within the semiovale centrum, p < 0.001). We revealed that the pattern of improvement in perfusion in white matter differed from the pattern of improvement in perfusion in grey matter. Significant correlations were revealed between the Suzuki stage before surgery and the perfusion parameters within the posterior cerebral artery circulation (adjusted p < 0.05) were revealed. There were also significant correlations between cognitive scores and brain perfusion parameters in grey matter and white matter (adjusted p < 0.05).

CONCLUSIONS: The perfusion parameters of grey matter and white matter in the brain improve differently after bypass surgery in patients with MMA. Different hemodynamics within these compartments could explain this.