RT Journal Article SR Electronic T1 99mTc-Ethyl cysteinate dimer brain perfusion SPECT in evaluation of patients with moya moya disease and assessment of response to surgery JF Journal of Nuclear Medicine JO J Nucl Med FD Society of Nuclear Medicine SP 1655 OP 1655 VO 59 IS supplement 1 A1 Ashwin Parihar A1 Ashish Aggarwal A1 Shelvin Vadi A1 Apurva Sood A1 Anish Bhattacharya A1 Sunil Gupta A1 Bhagwant Mittal YR 2018 UL http://jnm.snmjournals.org/content/59/supplement_1/1655.abstract AB 1655Objectives: To evaluate the role of 99mTc-Ethyl cysteinate dimer (ECD) brain SPECT in assessment of baseline brain perfusion in patients with moya moya disease and response evaluation post surgical intervention. Methods: Records of 31 patients (16 females, 15 males; mean age 18.7±16.2 years) with proven moya moya disease on CT angiography, who underwent baseline 99mTC-ECD perfusion brain SPECT and were followed up with a repeat brain SPECT post-surgery (re-anastomosis procedure), were retrospectively reviewed. Qualitative assessment of the baseline and post-surgery brain perfusion SPECT was independently performed by two experienced nuclear medicine physicians and the findings were scored for six distinct regions of each cerebral hemisphere (Frontal, temporal, parietal, occipital, basal ganglia, thalamus; Negligible perfusion-4, Severe perfusion defect-3, Moderate defect-2, Mild defect-1, Normal perfusion-0). All the patients underwent encephalo-duro-arterio-myo-synangiosis (EDAMS) and were followed up with a perfusion brain SPECT at median duration of 8 months (range: 2-24 months) post-surgery. Difference was calculated between pre- and post- scores for each region with a positive difference indicating improvement and negative difference indicating deterioration. Paired-t test was used to determine the significance of difference of perfusion scores pre- and post-surgery. Spearman’s correlation was used to determine the association between age at surgery with baseline perfusion score and score difference post-surgery. Results: Baseline brain perfusion SPECT revealed a mean score of 8.9±3.7 (range: 2-17) with maximum defects in the right parietal lobe (summed score 48) and minimum defects in the left basal ganglia (summed score 3). Age at surgery had a positive correlation with baseline perfusion score, which was not statistically significant (r=0.2, P=0.2). Follow-up brain perfusion SPECT revealed a mean score of 6.9±4.6 (range: 1-17). Perfusion scores in 21 patients improved after surgery while those in eight patients remained the same and worsened in two patients. Post-operatively, maximal improvement in perfusion score was noted in the left parietal lobe (summed pre-surgery score 40, summed post-surgery score 27). The difference between the pre- surgery (summed score 273) and post-surgery (summed score 216) perfusion scores was statistically significant (P=0.0001) reflecting significant improvement in brain perfusion after the re-anastomosis procedure. Age at surgery had a statistically significant negative correlation with perfusion score difference (r=-0.55, P=0.001) reflecting that patients having younger age at surgery had better clinical outcome. Conclusion: 99mTc-ECD perfusion brain SPECT proved to be a useful non-invasive modality in assessment of baseline perfusion defects in patients with moya moya disease. It also has an even valuable role in evaluating response to treatment. In the present study, the patients with a younger age at the time of surgery had better outcomes in terms of cerebral re-perfusion which reflects that timely assessment and treatment of the disease entity can substantially reduce patient morbidity. Despite surgical intervention, no improvement in brain perfusion in eight patients and deterioration of perfusion in two patients was noted in the follow-up scans. These findings merit further exploration in future studies with a larger cohort.