To assess the longitudinal evolution of cerebral perfusion after revascularization surgery in patients with moyamoya disease (MMD) by CT perfusion (CTP). Thirty-one clinically confirmed MMD patients (12 males and 19 females, average age: 33.26 y, Suzuki stages 3 and 4: 19 and 11, respectively) who underwent revascularization surgery (bilateral (n=13) or unilateral (n=18)) were studied retrospectively. All patients underwent CTP examinations before and in the week after surgery and long-term (>3 months). CTP metrics (CBF, CBV, MTT, TTP, and delay TTP) were derived. The corresponding CTP metric values of the ROIs, which were manually drawn in the white matter (WM) and gray matter (GM), were recorded. Six patients developed a new or progressive cerebral infarction/hemorrhage. In all patients, compared with the preoperative level, the TTP of GM and WM decreased in the short term after the surgery ( ≤ 0.005). Concurrently, the WM CBF increased significantly a week after surgery ( =0.02). However, in the long-term follow-up, the CBV and CBF in the GM and WM decreased to equal to or lower than the preoperative level, especially for CBV in the WM ( =0.012). Furthermore, cerebral perfusion began to decrease in the sixth month, and a continuous decline was observed over the next two months. It returned to the presurgical level after one year. In addition, the improvement in postsurgical perfusion was greater in Suzuki stage 3 patients than stage 4 patients. Cerebral perfusion in patients with MMD improved shortly after surgery. However, in the long-term, brain perfusion decreased, most seriously in 6-8 months postoperatively, which might indicate that patients with MMD need timely follow-up and long-term intervention.

中文翻译：

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CT灌注纵向评估烟雾病血运重建术后脑灌注演变

通过 CT 灌注（CTP）评估烟雾病（MMD）患者血运重建术后脑灌注的纵向演变。31例临床确诊的MMD患者（男12例，女19例，平均年龄：33.26岁，Suzuki 3期和4期：分别为19例和11例）接受血运重建手术（双侧（n=13）或单侧（n=18） ）进行了回顾性研究。所有患者在术前、术后一周以及长期（>3个月）均接受CTP检查。导出了 CTP 指标（CBF、CBV、MTT、TTP 和延迟 TTP）。记录在白质 (WM) 和灰质 (GM) 中手动绘制的 ROI 的相应 CTP 度量值。六名患者出现新发或进行性脑梗塞/出血。所有患者术后短期内GM、WM TTP均较术前下降（≤0.005）。同时，术后一周 WM CBF 显着增加 (=0.02)。然而，在长期随访中，GM和WM的CBV和CBF下降至等于或低于术前水平，尤其是WM的CBV（=0.012）。此外，脑灌注在第六个月开始下降，并在接下来的两个月内持续下降。一年后恢复到手术前水平。此外，Suzuki 3 期患者的术后灌注改善大于 4 期患者。MMD 患者的脑灌注在手术后不久得到改善。然而，从长远来看，脑灌注下降，尤其是术后6-8个月最为严重，这可能表明MMD患者需要及时随访和长期干预。