{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T15:29:46Z","timestamp":1786980586043,"version":"build-2736575974"},"reference-count":39,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,12,27]],"date-time":"2022-12-27T00:00:00Z","timestamp":1672099200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,12,27]],"date-time":"2022-12-27T00:00:00Z","timestamp":1672099200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100017268","name":"Berlin Institute of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100017268","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002839","name":"Charit\u00e9 - Universit\u00e4tsmedizin Berlin","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002839","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Neurosurg Rev"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    The Berlin Grading System assesses clinical severity of moyamoya angiopathy (MMA) by combining MRI, DSA, and cerebrovascular reserve capacity (CVRC). Our aim was to validate this grading system using [\n                    <jats:sup>15<\/jats:sup>\n                    O]H\n                    <jats:sub>2<\/jats:sub>\n                    O PET for CVRC. We retrospectively identified bilateral MMA patients who underwent [\n                    <jats:sup>15<\/jats:sup>\n                    O]H\n                    <jats:sub>2<\/jats:sub>\n                    O PET examination and were treated surgically at our department. Each hemisphere was classified using the Suzuki and Berlin Grading System. Preoperative symptoms and perioperative ischemias were collected, and a logistic regression analysis was performed. A total of 100 hemispheres in 50 MMA patients (36 women, 14 men) were included. Using the Berlin Grading System, 2 (2.8%) of 71 symptomatic hemispheres were categorized as grade I, 14 (19.7%) as grade II, and 55 (77.5%) as grade III. The 29 asymptomatic hemispheres were characterized as grade I in 7 (24.1%) hemispheres, grade II in 12 (41.4%), and grade III in 10 (34.5%) hemispheres. Berlin grades were independent factors for identifying hemispheres as symptomatic and higher grades correlated with increasing proportion of symptomatic hemispheres (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.01). The Suzuki grading did not correlate with preoperative symptoms (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.26). Perioperative ischemic complications occurred in 8 of 88 operated hemispheres. Overall, complications did not occur in any of the grade I hemispheres, but in 9.1% (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20092 of 22) and 9.8% (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20096 of 61) of grade II and III hemispheres, respectively. In this study, we validated the Berlin Grading System with the use of [\n                    <jats:sup>15<\/jats:sup>\n                    O]H\n                    <jats:sub>2<\/jats:sub>\n                    O PET for CVRC as it could stratify preoperative symptomatology. Furthermore, we highlighted its relevance for predicting perioperative ischemic complications.\n                  <\/jats:p>","DOI":"10.1007\/s10143-022-01920-2","type":"journal-article","created":{"date-parts":[[2022,12,27]],"date-time":"2022-12-27T04:03:06Z","timestamp":1672113786000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Validation of the Berlin Grading System for moyamoya angiopathy with the use of [15O]H2O PET"],"prefix":"10.1007","volume":"46","author":[{"given":"R.","family":"Mertens","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Acker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Kersting","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Lange","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Furth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Beyaztas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Truckenmueller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Moedl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. 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For this type of study, formal consent is not required according to the ethics approval of the Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Germany (EA2\/178\/18 and EA2\/225\/20).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"All procedures performed in this study involving human participants were in accordance with the Declaration of Helsinki (1964) and its later amendments or comparable ethical standards.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Human and animal ethics"}},{"value":"Included within the ethics approval of the Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Germany (EA2\/178\/18 and EA2\/225\/20), granted to the authors of the study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"25"}}