Preoperative Brain Functional Connectivity Improve Predictive Accuracy of Outcomes After Revascularization in Moyamoya Disease

Abstract

BACKGROUND: In patients with moyamoya disease (MMD), focal impairments in cerebral hemodynamics are often inconsistent with patients' clinical prognoses. Evaluation of entire brain functional networks may enable predicting MMD outcomes after revascularization. OBJECTIVE: To investigate whether preoperative brain functional connectivity could predict outcomes after revascularization in MMD. METHODS: We included 34 patients with MMD who underwent preoperative MRI scanning and combined revascularization surgery. We used region of interest analyses to explore the differences in functional connectivity for 90 paired brain regions between patients who had favorable outcomes 1 year after surgery (no recurrent stroke, with improved preoperative symptoms, or modified Rankin Scale [mRS]) and those who had unimproved outcomes (recurrent stroke, persistent symptoms, or declined mRS). Variables, including age, body mass index, mRS at admission, Suzuki stage, posterior cerebral artery involvement, and functional connectivity with significant differences between the groups, were included in the discriminant function analysis to predict patient outcomes. RESULTS: Functional connectivity between posterior cingulate cortex and paracentral lobule within the right hemisphere, and interhemispheric connection between superior parietal gyrus and middle frontal gyrus, precuneus and middle cingulate cortex, cuneus and precuneus, differed significantly between the groups (P < .001, false discovery rate corrected) and had the greatest discriminant function in the prediction model. Although clinical characteristics of patients with MMD showed great accuracy in predicting outcomes (64.7%), adding information on functional connections improved accuracy to 91.2%. CONCLUSION: Preoperative functional connectivity derived from rs-fMRI may be an early hallmark for predicting patients' prognosis after revascularization surgery for MMD.