Comparison of positron emission tomography study results of cerebral hemodynamics in patients with bleeding- and ischemic-type moyamoya disease.

The purpose of this study was to elucidate the difference in cerebral hemodynamics and metabolic status between patients with bleeding- and ischemic-type moyamoya disease. Regional cerebral blood flow (rCBF), regional cerebral metabolic rate of oxygen (rCMRO2), regional oxygen extraction fraction (rOEF), and regional cerebral blood volume (rCBV) in the cortex of the middle cerebral artery (MCA) territories and rCBV in the striatum were measured using positron emission tomography (PET) in 17 patients with moyamoya disease. Patients were divided into three subgroups according to type of disease manifestation and age: adult bleeding type (five cases), adult ischemic type (10 cases), and childhood ischemic type (two cases). When compared with adult controls, statistically significant reductions in rCBF and rCMRO2, elevation in rOEF in the MCA territories, and elevation of rCBV in the striatum were observed in PET studies for all three subgroups. Between the adult bleeding type and ischemic type, rCBF, rCMRO2, and rOEF in the MCA territories were not different, but rCBV in the striatum was higher in patients with ischemic-type moyamoya disease than in those with the bleeding type. In adult patients with bleeding and ischemic types, rOEF and rCBV in the MCA territories and rCBV in the striatum were significantly lower than in patients with childhood ischemic-type moyamoya disease. In adult patients with bleeding-type moyamoya disease, cerebral hemodynamics were impaired and similar to those in adult ischemic type.