{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T01:18:47Z","timestamp":1784078327224,"version":"3.55.0"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,7,23]],"date-time":"2021-07-23T00:00:00Z","timestamp":1626998400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:p><jats:bold>Objective:<\/jats:bold> This study compared the clinical features and hemodynamic characteristics of patients in different Suzuki stages of ischemic moyamoya disease (iMMD) before and after treatment with extracranial-intracranial (EC-IC) bypass surgery combined with encephalo-duro-myo-synangiosis and whole-brain computed tomography perfusion (WB-CTP).<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> A total of 126 patients in different Suzuki stages (II, III, IV, and V) of iMMD who underwent bypass surgery from April 2013 to August 2020 were included in this retrospective study. MIStar automatic analysis of Whole brain CT perfusion imaging software (WB-CTP, Apollo Medical Imaging Technology, Melbourne, Australia) was used. The patients also underwent WB-CTP 1 day before and 1 week and 3 months after the surgery. The relationships between hemodynamic parameters in WB-CTP including delay time (DT) &amp;gt; 3 s, relative cerebral blood flow (rCBF) &amp;lt; 30%, mismatch and mismatch ratio, and clinical outcomes were evaluated for different Suzuki stages, with comparisons between early (II and III) and late (IV and V) stages.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> Combined bypass surgery was performed in 161 hemispheres of 126 patients with iMMD. Brain volume with DT &amp;gt; 3 s was decreased 1 week (51.5 \u00b1 11.8 ml, <jats:italic>P<\/jats:italic> &amp;lt; 0.05) and 3 months (41.5 \u00b1 10.7 ml, <jats:italic>P<\/jats:italic> &amp;lt; 0.05) after bypass compared to 1 day before bypass (104.7 \u00b1 15.1 ml) in early-stage patients. In late-stage patients, the volume was increased 1 week after bypass compared to the preoperative value (154.3 \u00b1 14.7 vs. 118.3 \u00b1 19.1 ml, <jats:italic>P<\/jats:italic> &amp;lt; 0.05). Preoperative brain volume with rCBF &amp;lt; 30% was lower (9.8 \u00b1 3.9 vs. 33.5 \u00b1 11.0 ml) whereas preoperative mismatch ratio was higher (11.2 \u00b1 2.8 vs. 3.6 \u00b1 1.6) in early-stage as compared to late-stage patients (both <jats:italic>P<\/jats:italic> &amp;lt; 0.05). A higher modified Rankin scale score (0\u20131) was achieved by early-stage patients than by those in the late stage (93.8 vs. 80.4%, <jats:italic>P<\/jats:italic> &amp;lt; 0.05) at the 3-month follow-up.<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold> WB-CTP is useful for assessing the effectiveness of combined bypass\/revascularization in different Suzuki stages of iMMD. Patients in the early stage of disease with higher preoperative brain volume with DT &amp;gt; 3 s and mismatch ratio show greater improvements in hemodynamic parameters and fewer postoperative complications associated with hemodynamic disturbance following bypass than patients in the late stage. Preoperative mismatch ratio can serve as a marker for assessing the status of collateral circulation in different Suzuki stages of iMMD.<\/jats:p>","DOI":"10.3389\/fneur.2021.683224","type":"journal-article","created":{"date-parts":[[2021,7,23]],"date-time":"2021-07-23T11:29:05Z","timestamp":1627039745000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":17,"title":["Evaluation of Revascularization in Different Suzuki Stages of Ischemic Moyamoya Disease by Whole-Brain CT Perfusion"],"prefix":"10.3389","volume":"12","author":[{"given":"Qingdong","family":"Han","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feirong","family":"Yao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhengyu","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yabo","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,7,23]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1007\/s00381-018-3985-5","article-title":"Posterior circulation involvement and collateral flow pattern in moyamoya disease with the RNF213 polymorphism","volume":"35","author":"Kim","year":"2019","journal-title":"Childs Nerv Syst"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3171\/2020.3.JNS192847","article-title":"Direct versus indirect bypass procedure for the treatment of ischemic moyamoya disease: results of an individualized selection strategy","volume":"12","author":"Nielsen","year":"2020","journal-title":"J Neurosurg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"527","DOI":"10.3171\/2015.12.JNS151499","article-title":"Postoperative executive function in adult moyamoya disease: a preliminary study of its functional anatomy and behavioral correlates","volume":"126","author":"Lei","year":"2017","journal-title":"J Neurosurg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"e593","DOI":"10.1016\/j.wneu.2018.08.132","article-title":"Postoperative intracerebral hemorrhage after combined revascularization surgery in moyamoya disease: profiles and clinical associations","volume":"120","author":"Tokairin","year":"2018","journal-title":"World Neurosurg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1407","DOI":"10.3174\/ajnr.A4303","article-title":"Perfusion deficits and mismatch in patients with acute lacunar infarcts studied with whole-brain CT perfusion","volume":"36","author":"Rudilosso","year":"2015","journal-title":"AJNR"},{"key":"B6","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1016\/j.neurad.2019.02.012","article-title":"Goliath and the ant: whole-brain CT perfusion against 16-slice CT angiography in stroke imaging","volume":"46","author":"Morelli","year":"2019","journal-title":"J Neuroradiol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"e57595","DOI":"10.1371\/journal.pone.0057595","article-title":"Whole-brain CT perfusion and CT angiography assessment of Moyamoya disease before and after surgical revascularization: preliminary study with 256-slice CT","volume":"8","author":"Zhang","year":"2013","journal-title":"PLoS ONE"},{"key":"B8","doi-asserted-by":"publisher","first-page":"e112","DOI":"10.1016\/j.wneu.2020.10.046","article-title":"Assessment of transient cerebral hemodynamic disturbance via whole-brain computed tomography perfusion after extracranial-intracranial bypass in ischemic moyamoya disease","volume":"146","author":"Yao","year":"2021","journal-title":"World Neurosurg"},{"key":"B9","doi-asserted-by":"publisher","first-page":"17","DOI":"10.3171\/2019.10.JNS191207","article-title":"Hemodynamic analysis of the recipient parasylvian cortical arteries for predicting postoperative hyperperfusion during STA-MCA bypass in adult patients with moyamoya disease","volume":"134","author":"Zhang","year":"2021","journal-title":"J Neurosurg"},{"key":"B10","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1161\/STROKEAHA.116.014529","article-title":"Infarct pattern and collateral status in adult moyamoya disease: a multimodal magnetic resonance imaging study","volume":"48","author":"Kim","year":"2017","journal-title":"Stroke."},{"key":"B11","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1001\/archneur.1969.00480090076012","article-title":"Cerebrovascular \u201cmoyamoya\u201d disease. 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