A scoring system serving as a simple method of communication among clinicians, such as ASPECTS 17 for acute stroke treatment, would be helpful for the treatment of MMD. 16 In clinical practice, the evaluation of the TTP map is generally qualitative rather than quantitative. 15 Changes in TTP maps after revascularization surgery were reported to be correlated with clinical outcome in patients with MMD. A study comparing MTT measured through DSC MR imaging and the oxygen extraction fraction measured through PET revealed that an MTT delay of 2 seconds (compared with the cerebellum) suggested misery perfusion. 10 ⇓ ⇓ ⇓– 14 Given the adverse effect of radiation, MRP is an efficient, noninvasive tool for evaluation. 9 However, conventional angiography is invasive, and the Matsushima grading system focuses only on the outer aspect of cerebral hemispheres.īrain perfusion studies provide cross-sectional imaging through SPECT, Xe-CT, 15O-H 2O PET, MR perfusion (MRP), and CT perfusion in MMD. Thus far, the evaluation of surgical outcome after revascularization for MMD depends on angiography using the Matsushima grading system. However, only some patients follow this stepwise progression, and the staging is not correlated with the clinical symptoms. Suzuki and Takaku 8 proposed 6 stages of angiographic evolution in MMD. 5 ⇓– 7Įvaluation of MMD severity has largely depended on conventional angiography. 2 ⇓– 4 The effectiveness of indirect revascularization in adult patients with MMD, however, has been supported by clinical and angiographic evaluations. Although the clinical response to surgical treatment appears to be favorable in most cases, there is considerable debate regarding the advantages and disadvantages of direct and indirect revascularizations, particularly for adult patients. 1 Surgical revascularization is the only effective therapy for patients with MMD to reduce their risk of subsequent strokes. The major clinical presentation is ischemic stroke in both children and adults. MMD has 2 age peaks: at approximately 10 years and at 30–40 years. Moyamoya disease (MMD) is a progressive occlusive disease of the supraclinoid segment of the ICA associated with collateral vessel formation at the base of the brain. ABBREVIATIONS: EDAS encephaloduroarteriosynangiosis EPS encephalopericraniosynangiosis MMD Moyamoya disease MRP MR perfusion
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