CT ANGIO (IC ,EC)

This study aimed to assess the efficacy of early post-operative computed tomographic angiography (CTA) following direct extracranial-intracranial (EC-IC) bypass surgery in patients diagnosed with moyamoya disease. The research, a retrospective analysis spanning from 2013 to 2019, focused on adult moyamoya patients who underwent direct EC-IC bypass surgery at our center. Early post-operative CTA, conducted within 24 hours after surgery, was compared with digital subtraction angiography (DSA) performed 6–12 months post-surgery, serving as the gold standard. Additionally, magnetic resonance time-of-flight angiography (MR-TOF) data at 3 months and 6–12 months post-operation were examined when available. Out of 103 direct EC-IC bypasses evaluated in 63 patients, 53 bypasses in 32 patients met the inclusion criteria for analysis. The early post-operative CTA results suggested definitive bypass patency in 84.9% of cases, uncertainty in 5.7%, and non-patency in 9.4%. MR-TOF showed consistent findings, indicating definitive bypass patency in 86.8% at 3 months and 93.5% at 6–12 months post-surgery. However, the gold standard, DSA performed 6–12 months post-operation, exhibited patency in 98.1% of all bypasses. Notably, the post-operative CTA demonstrated a positive predictive value of 12.5% in detecting occluded bypasses and a robust negative predictive value of 100% for identifying patent bypasses, displaying high sensitivity (100%) and specificity (86.5%). In summary, while early post-operative CTA proves valuable in confirming bypass patency, its tendency towards false positives in detecting occlusions necessitates careful consideration when deciding on subsequent therapeutic interventions