Hybrid 18F-FDG PET/MRI can Improve the Evaluation of Adult Moyamoya Disease in a “one-stop” Measurement Model

Abstract Background Accurate measurement of cerebral blood flow (CBF), tissue function and viability are particularly significant and important to help neurosurgeons identify MMD patients who would benefit from surgical revascularization. The present study aimed to evaluate the application value of hybrid 18F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (18F-FDG PET/MRI) in adult moyamoya disease (MMD) and its correlation with digital subtraction angiography (DSA) findings. Twenty-seven hospitalized adult MMD patients who underwent both hybrid 18F-FDG PET/MRI and DSA were enrolled in this study. The relative number of abnormal cerebral regional distributions of parameters derived from PET/MRI or DSA, including PET score, “ivy sign” score, ASL-CBF score, DSA irrigation score and the collateral score of each cerebral region in different Suzuki’s stages, were analyzed and compared with GraphPad Prism. The Spearman rank correlation test was performed to show the internal relationships among these parameters. The chi-square test was applied to assess the performance of MRI in the evaluation of collaterals and perfusion status using DSA as a reference method. Log-rank tests were used to identify independent indicators of regional glucose hypometabolism. Results The relative number of regions with a positive “ivy sign”, DSA collaterals, hypometabolism on PET, hypoperfusion on ASL-CBF or deficient DSA irrigation in hemispheres in the mid-stage and late stage were significantly different from those in the early stage (p < 0.05). The “ivy sign” score was positively related to the DSA collateral score (r = 0.6552, p < 0.05). The PET score was positively correlated with the ASL-CBF score (r = 0.685, p < 0.05) and the DSA irrigation score (r = 0.258, p < 0.05). The ASL-CBF score may be an independent indicator of brain regional glucose hypometabolism (p < 0.05). Conclusions Brain hybrid 18F-FDG PET/MRI can improve the evaluation of adult MMD patients in a “one-stop” measurement model. Simultaneously, the accuracy of PET and MRI findings can be validated against one another to provide more convincing objective evidence for the choice of the treatment strategy.