Prediction of postoperative complications in adults with moyamoya disease using CTP combined with TCD
Authors: Tang Zhiwei , Ding Jiangbo , Ma Peiyu , Chang Xuying , yang Guangwu , Zhang Ruoyu , Lei Ting , Mu Linjie , Zhang Xingkui , Li Zhigao 
Published: April 2022

Objective
To explore the relationship between cerebral hemodynamics and complications after superficial temporal artery-middle cerebral artery bypass combined with encephaloduromyosynangiosis in adults with moyamoya disease and whether preoperative CT perfusion (CTP) imaging and transcranial Doppler (TCD) can predict the occurrence of postoperative complications.
Methods
A total of 44 adult patients with moyamoya disease were treated with combined revascularization in our department from January 2020 to January 2022 and were divided into two groups according to perioperative complications. The general clinical data, preoperative CTP cerebral hemodynamic parameters and preoperative TCD cerebral hemodynamic parameters of the two groups were analyzed. Through a retrospective study, the preoperative CTP and TCD results were analyzed to explore the risk factors for complications after combined blood flow reconstruction.
Results
In 44 patients with moyamoya disease, complications occurred in 10 cases, and no complications occurred in 34 cases within one week after combined blood flow reconstruction. When univariate analysis of preoperative CTP parameters (complication group vs. no complications group) was performed, the following factors were found to have significant differences: aMTT (11.29 ± 3.41 vs. 7.73 ± 2.45; P = 0.001), aTMax (8.32 ± 2.49 vs. 5.48 ± 2.15; P = 0.001), rMTT (2.52 ± 0.92 vs. 1.68 ± 0.83; P = 0.001), rTMax (2.52 ± 0.92 vs. 1.68 ± 0.83; P = 0.010) and rTMax (2.88 ± 0.85 vs. 1.82 ± 0.83; P = 0.001). The binary logistic multivariate regression analysis showed that the increase in rTMax was an independent risk factor for postoperative complications (OR = 4.78; 95% CI = 1.25 ~ 18.14; P = 0.022). Univariate analysis of preoperative TCD test parameters (complication group vs. no complications group) showed that the following parameters had significant differences: ACA-Vm (117.41 ± 41.00 vs. 77.68 ± 38.18; P = 0.007); PCA-Vm (71.02 ± 17.59 vs. 53.05 ± 14.04; P < 0.001); ACA-RI (0.41 ± 0.07 vs. 0.46 ± 0.06, P = 0.020); and MCA-PI (0.56 ± 0.07 vs. 0.68 ± 0.06, P < 0.001). MCA-RI (0.38 ± 0.04 vs. 0.45 ± 0.05, P = 0.001); PCA-PI (0.58 ± 0.13 vs. 0.71 ± 0.12, P = 0.005); and PCA-RI (0.40 ± 0.08 vs. 0.48 ± 0.06, P = 0.002). After further binary logistic regression analysis of the above different single factors, it was found that a decrease in the MCA-PI was an independent risk factor for predicting postoperative complications (adjusted OR = 41.32; 95% CI = 5.88 ~ 289.52; P = 0.031). When the ROC(receiver operating characteristic curve) curve was constructed for rTMax, the area under the rTMax curve was 0.812 (AUC = 0.812 ± 0.080; 95% CI = 0.654% 0.969% P = 0.003); when the ROC curve was constructed for MCA-PI, the area under the MCA-PI curve was 0.907 (AUC = 0.907 ± 0.059; 95% CI = 0.792 ± 1.000; P < 0.001).
Conclusions
The increase in rTMax in CTP and the decrease in MCA-PI in TCD in patients with moyamoya disease support a greater tendency for these patients to develop complications after combined revascularization; rTMax and TCD are independent risk factors for predicting postoperative complications. rTMax has high sensitivity, and MCA-PI has high specificity