Localized ¹H-MR spectroscopy in moyamoya disease before and after revascularization surgery

Objective: To evaluate, using localized proton magnetic resonance spectroscopy (¹H-MRS), the cerebral metabolic change apparent after revascularization surgery in patients with moyamoya disease. Materials and Methods: Sixteen children with moyamoya disease and eight age-matched normal controls underwent MR imaging, MR angiography, conventional angiography, and ^99mTc- ECD SPECT. Frontal white matter and the basal ganglia of both hemispheres were subjected to localized ¹H-MRS, and after revascularization surgery, four patients underwent follow-up ¹H-MRS. Results: Decreased NAA/Cr ratios (1.35 ± 0.14 in patients vs. 1.55 ± 0.24 in controls) and Cho/Cr ratios (0.96 ± 0.13 in patients vs. 1.10 ± 0.11 in controls) were observed in frontal white matter. After revascularization surgery, NAA/Cr and Cho/Cr ratios in this region increased. In the basal ganglia, there is no abnormal metabolic ratios. Conclusion: Localized 1H-MRS revealed abnormal metabolic change in both hemispheres of children with moyamoya disease. Because of its non-invasive nature, ¹H-MRS is potentially useful for the preoperative evaluation of metabolic abnormalities and their postoperative monitoring.