J Korean Neurosurg Soc.  2015 Jun;57(6):432-435. 10.3340/jkns.2015.57.6.432.

Quantitative Digital Subtraction Angiography in Pediatric Moyamoya Disease

• Cheon JE

• KMID: 2191250
• DOI: http://doi.org/10.3340/jkns.2015.57.6.432

Abstract

Moyamoya disease is a unique cerebrovascular disorder characterized by idiopathic progressive stenosis at the terminal portion of the internal carotid artery (ICA) and fine vascular network. The aim of this review is to present the clinical application of quantitative digital subtraction angiography (QDSA) in pediatric moyamoya disease. Using conventional angiographic data and postprocessing software, QDSA provides time-contrast intensity curves and then displays the peak time (Tmax) and area under the curve (AUC). These parameters of QDSA can be used as surrogate markers for the hemodynamic evaluation of disease severity and quantification of postoperative neovascularization in moyamoya disease.

Keyword

Moyamoya disease; Angiography; Digital subtraction

MeSH Terms

Angiography
Angiography, Digital Subtraction*
Biomarkers
Carotid Artery, Internal
Cerebrovascular Disorders
Constriction, Pathologic
Hemodynamics
Moyamoya Disease*

Figure

• 

  Fig. 1 A 4-year-old boy with left hemiparesis. A : Right internal carotid artery (ICA) angiography shows steno-occlusive change of the distal ICA with basal collateral formation (Suzuki type III). B : Color-coded quantitative DSA (QDSA) demonstrates slow flow (green to blue color) in the right middle cerebral artery (MCA) territory compared to the PCA territory (yellow to orange color). ROI analysis of the MCA territory depicts a time-contrast intensity curve using which Tmax and AUC can be calculated. C : Perfusion MRI of the same patient depicts delayed time to peak in the right MCA territory.

• 

  Fig. 2 A 9-year-old girl with left hemiparesis. A and B : Compared to the preoperative quantitative DSA (QDSA) of the right common carotid artery (CCA) (A), postoperative QDSA of the right CCA (B) demonstrates an improved delay of Tmax (7.47 s→5.33 s) and an increased mean AUC. C : Right external carotid artery (ECA) angiography after encephalo-duro-arterio-synangiosis (EDAS) shows good neovascularization (grade 2). D : QDSA of the right ECA angiography after EDAS provides Tmax and AUC of the neovascularization.

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