Background

The vascular cognitive impairment (VCI) is quite common in moyamoya vasculopathy (MMV). However, the abnormality of cerebellar glucose metabolism in MMV and its relationship with patients’ neurocognitive performance were few reported.

Objective

In this study, we aimed to investigate the relationship between neurocognitive performance and cerebellar glucose metabolism. Furthermore, the cerebellar glucose metabolism changes after combined revascularization surgery were also researched.

Methods

We retrospectively analyzed the 2-[¹⁸F]fluoro-2-deoxy-D-glucose positron emission tomography ([¹⁸F]FDG PET) images and their neuropsychological scales in 93 eligible MMV patients by comparing their cerebellar standardized uptake values ratio (SUVR) and metabolic covariant network (MCN) among different neurocognitive groups. Then, forty-two MMV patients with VCI who underwent combined revascularization surgery were prospectively observed. According to their neuropsychological performance at 6-month follow-up, these patients were assigned to cognitive improved group (n = 22) and non-improved group (n = 20). The cerebellar SUVR and MCN changes were also analyzed.

Results

SUVR of right Lobule VI/Crus II/VIII decreased when cognitive impairment progression (P < 0.05, Least-Significant Difference [LSD] post hoc analysis). The cerebellar glucose metabolic pattern can be divided into two parts, in which the cerebellar posterior lobe was positively related to patients’ neurocognitive performance, while the vermis and anterior lobe showed negative relationship with the neurocognitions (P < 0.001). Further MCN analysis expound that the degree of right Lobule VI/Crus II/VIII displayed decreased tendency as cognitive impairment worsened (P < 0.05, LSD post hoc analysis). After revascularization surgery, the SUVR of right cerebellar posterior lobe significantly promoted in improved group (P < 0.001). Besides, we also witnessed the SUVR improvement in left cerebral hemisphere, thalamus, and red nucleus (P < 0.001). The MCN analysis revealed that the posterior connective strength improvement among right Lobule VI and several cerebral regions significantly correlated with memory and executive screening (MES) score (P < 0.001, false discovery rate corrected).

Conclusion

We found that the hypometabolism of cerebellar posterior lobe, especially in the right Lobule VI, was associated with MMV patients’ neuropsychological performance, while the anterior lobe and vermis showed opposites tendencies. Combined revascularization surgery improved the posterior cerebellar metabolism and was associated with favorable neurocognitive outcomes, which might be related to the activation of cortico-rubral-cerebellar pathway.

中文翻译：

---

烟雾病血管病变的小脑葡萄糖代谢及其与脑血运重建手术后神经认知能力的相关性：一项 [18F]FDG PET 研究

 背景

血管认知障碍 （VCI） 在烟雾病血管病变 （MMV） 中很常见。然而，MMV 中小脑葡萄糖代谢的异常及其与患者神经认知能力的关系报道较少。

 目的

在这项研究中，我们旨在探讨神经认知能力与小脑葡萄糖代谢之间的关系。此外，还研究了联合血运重建手术后小脑葡萄糖代谢的变化。

 方法

我们回顾性分析了 93 例符合条件的 MMV 患者的 2-[¹⁸F]氟-2-脱氧-D-葡萄糖正电子发射断层扫描 （[¹⁸F]FDG PET） 图像及其神经心理学量表，比较了不同神经认知组之间的小脑标准化摄取值比 （SUVR） 和代谢协变网络 （MCN）。然后，前瞻性观察 42 例接受联合血运重建手术的 MMV 合并 VCI 患者。根据他们在 6 个月随访时的神经心理学表现，这些患者被分为认知改善组 （n = 22） 和未改善组 （n = 20）。还分析了小脑 SUVR 和 MCN 的变化。

 结果

当认知障碍进展时，右小叶 VI/Crus II/VIII 的 SUVR 降低 （P < 0.05，最小显著性差异 [LSD] 事后分析）。小脑葡萄糖代谢模式可分为两部分，其中小脑后叶与患者的神经认知能力呈正相关，而蚓部和前叶与神经认知呈负相关（P < 0.001）。进一步的 MCN 分析阐明，随着认知障碍的恶化，右小叶 VI/Crus II/VIII 的程度呈下降趋势 （P < 0.05，LSD 事后分析）。血运重建手术后，改善组右小脑后叶 SUVR 显著升高 （P < 0.001）。此外，我们还观察到左大脑半球、丘脑和红核的 SUVR 改善 （P < 0.001）。MCN 分析显示，右侧小叶 VI 和几个大脑区域的后部结缔强度改善与记忆和执行筛查 （MES） 评分显著相关 （P < 0.001，错误发现率校正）。

 结论

我们发现小脑后叶代谢减退，尤其是右叶 VI，与 MMV 患者的神经心理表现相关，而前叶和蚓部表现出相反的趋势。联合血运重建手术改善了小脑后代谢，并与良好的神经认知结局相关，这可能与皮质-红-小脑通路的激活有关。