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<meta name="DC.Title" content="Quantitative Assessment of Neovascularization after Indirect Bypass Surgery: Color-Coded Digital Subtraction Angiography in Pediatric Moyamoya Disease" />
<meta name="DC.Identifier" content="10.3174/ajnr.A4614" />
<meta name="DC.Date" content="2016-05-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2016 by American Journal of Neuroradiology" />
<meta name="DC.AccessRights" content="restricted" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: For the postoperative follow-up in pediatric patients with Moyamoya disease, it is essential to evaluate the degree of neovascularization status. Our aim was to quantitatively assess the neovascularization status after bypass surgery in pediatric Moyamoya disease by using color-coded digital subtraction angiography.

MATERIALS AND METHODS: Time-attenuation intensity curves were generated at ROIs corresponding to surgical flap sites from color-coded DSA images of the common carotid artery, internal carotid artery, and external carotid artery angiograms obtained pre- and postoperatively in 32 children with Moyamoya disease. Time-to-peak and area under the curve values were obtained. Postoperative changes in adjusted time-to-peak (ΔTTP) and ratios of adjusted area under the curve changes (ΔAUC ratio) of common carotid artery, ICA, and external carotid artery angiograms were compared across clinical and angiographic outcome groups. To analyze diagnostic performance, we categorized clinical outcomes into favorable and unfavorable groups.

RESULTS: The ΔTTP at the common carotid artery increased among clinical and angiographic outcomes, in that order, with significant differences ( P = .003 and .005, respectively). The ΔAUC ratio at the common carotid artery and external carotid artery also increased, in that order, among clinical and angiographic outcomes with a significant difference (all, P = .000). The ΔAUC ratio of ICA showed no significant difference among clinical and angiographic outcomes ( P = .418 and .424, respectively). The ΔTTP for the common carotid artery of &gt;1.27 seconds and the ΔAUC ratio of &gt;33.5% for the common carotid artery and 504% for the external carotid artery are revealed as optimal cutoff values between favorable and unfavorable groups.

CONCLUSIONS: Postoperative changes in quantitative values obtained with color-coded DSA software showed a significant correlation with outcome scores and can be used as objective parameters for predicting the outcome in pediatric Moyamoya disease, with an additional cutoff value calculated through the receiver operating characteristic curve.

AUC
:   area under the curve
CCA
:   common carotid artery
ΔAUC ratio
:   adjusted area under the curve changes
ΔTTP
:   difference between preoperative and postoperative time-to-peak
ECA
:   external carotid artery
EDAS
:   encephaloduroarteriosynangiosis
MMD
:   Moyamoya disease" />
<meta name="DC.Contributor" content="H.-H. Cho" />
<meta name="DC.Contributor" content="J.-E. Cheon" />
<meta name="DC.Contributor" content="S.-K. Kim" />
<meta name="DC.Contributor" content="Y.H. Choi" />
<meta name="DC.Contributor" content="I.-O. Kim" />
<meta name="DC.Contributor" content="W.S. Kim" />
<meta name="DC.Contributor" content="S.-M. Lee" />
<meta name="DC.Contributor" content="S.K. You" />
<meta name="DC.Contributor" content="S.-M. Shin" />
<meta name="article:published_time" content="2016-05-01" />
<meta name="article:section" content="PEDIATRICS" />
<meta name="citation_title" content="Quantitative Assessment of Neovascularization after Indirect Bypass Surgery: Color-Coded Digital Subtraction Angiography in Pediatric Moyamoya Disease" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;For the postoperative follow-up in pediatric patients with Moyamoya disease, it is essential to evaluate the degree of neovascularization status. Our aim was to quantitatively assess the neovascularization status after bypass surgery in pediatric Moyamoya disease by using color-coded digital subtraction angiography.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Time-attenuation intensity curves were generated at ROIs corresponding to surgical flap sites from color-coded DSA images of the common carotid artery, internal carotid artery, and external carotid artery angiograms obtained pre- and postoperatively in 32 children with Moyamoya disease. Time-to-peak and area under the curve values were obtained. Postoperative changes in adjusted time-to-peak (ΔTTP) and ratios of adjusted area under the curve changes (ΔAUC ratio) of common carotid artery, ICA, and external carotid artery angiograms were compared across clinical and angiographic outcome groups. To analyze diagnostic performance, we categorized clinical outcomes into favorable and unfavorable groups.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;The ΔTTP at the common carotid artery increased among clinical and angiographic outcomes, in that order, with significant differences (&lt;i&gt;P&lt;/i&gt; = .003 and .005, respectively). The ΔAUC ratio at the common carotid artery and external carotid artery also increased, in that order, among clinical and angiographic outcomes with a significant difference (all, &lt;i&gt;P&lt;/i&gt; = .000). The ΔAUC ratio of ICA showed no significant difference among clinical and angiographic outcomes (&lt;i&gt;P&lt;/i&gt; = .418 and .424, respectively). The ΔTTP for the common carotid artery of &amp;gt;1.27 seconds and the ΔAUC ratio of &amp;gt;33.5% for the common carotid artery and 504% for the external carotid artery are revealed as optimal cutoff values between favorable and unfavorable groups.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Postoperative changes in quantitative values obtained with color-coded DSA software showed a significant correlation with outcome scores and can be used as objective parameters for predicting the outcome in pediatric Moyamoya disease, with an additional cutoff value calculated through the receiver operating characteristic curve.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
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<meta name="citation_author" content="H.-H. Cho" />
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<meta name="citation_author_orcid" content="http://orcid.org/0000-0002-4865-2601" />
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<meta name="citation_author_institution" content="bDepartment of Radiology (J.-E.C., Y.H.C., I.-O.K., W.S.K.), Seoul National University College of Medicine, Seoul, Korea" />
<meta name="citation_author_institution" content="cInstitute of Radiation Medicine (J.-E.C., I.-O.K., W.S.K.), Seoul National University Medical Research Center, Seoul, Korea" />
<meta name="citation_author_orcid" content="http://orcid.org/0000-0003-2184-1311" />
<meta name="citation_author" content="S.-M. Lee" />
<meta name="citation_author_institution" content="aFrom the Department of Radiology (H.-H.C., J.-E.C., Y.H.C., I.-O.K., W.S.K., S.-M.L., S.K.Y.), Seoul National University Hospital, Seoul, Korea" />
<meta name="citation_author_orcid" content="http://orcid.org/0000-0002-2073-8198" />
<meta name="citation_author" content="S.K. You" />
<meta name="citation_author_institution" content="aFrom the Department of Radiology (H.-H.C., J.-E.C., Y.H.C., I.-O.K., W.S.K., S.-M.L., S.K.Y.), Seoul National University Hospital, Seoul, Korea" />
<meta name="citation_author_orcid" content="http://orcid.org/0000-0002-1026-5809" />
<meta name="citation_author" content="S.-M. Shin" />
<meta name="citation_author_institution" content="eDepartment of Radiology (S.-M.S.), Seoul Metropolitan Government–Seoul National University, Boramae Medical Center, Seoul, Korea." />
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<meta name="twitter:title" content="Quantitative Assessment of Neovascularization after Indirect Bypass Surgery: Color-Coded Digital Subtraction Angiography in Pediatric Moyamoya Disease" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: For the postoperative follow-up in pediatric patients with Moyamoya disease, it is essential to evaluate the degree of neovascularization status. Our aim was to quantitatively assess the neovascularization status after bypass surgery in pediatric Moyamoya disease by using color-coded digital subtraction angiography.

MATERIALS AND METHODS: Time-attenuation intensity curves were generated at ROIs corresponding to surgical flap sites from color-coded DSA images of the common carotid artery, internal carotid artery, and external carotid artery angiograms obtained pre- and postoperatively in 32 children with Moyamoya disease. Time-to-peak and area under the curve values were obtained. Postoperative changes in adjusted time-to-peak (ΔTTP) and ratios of adjusted area under the curve changes (ΔAUC ratio) of common carotid artery, ICA, and external carotid artery angiograms were compared across clinical and angiographic outcome groups. To analyze diagnostic performance, we categorized clinical outcomes into favorable and unfavorable groups.

RESULTS: The ΔTTP at the common carotid artery increased among clinical and angiographic outcomes, in that order, with significant differences ( P = .003 and .005, respectively). The ΔAUC ratio at the common carotid artery and external carotid artery also increased, in that order, among clinical and angiographic outcomes with a significant difference (all, P = .000). The ΔAUC ratio of ICA showed no significant difference among clinical and angiographic outcomes ( P = .418 and .424, respectively). The ΔTTP for the common carotid artery of &gt;1.27 seconds and the ΔAUC ratio of &gt;33.5% for the common carotid artery and 504% for the external carotid artery are revealed as optimal cutoff values between favorable and unfavorable groups.

CONCLUSIONS: Postoperative changes in quantitative values obtained with color-coded DSA software showed a significant correlation with outcome scores and can be used as objective parameters for predicting the outcome in pediatric Moyamoya disease, with an additional cutoff value calculated through the receiver operating characteristic curve.

AUC
:   area under the curve
CCA
:   common carotid artery
ΔAUC ratio
:   adjusted area under the curve changes
ΔTTP
:   difference between preoperative and postoperative time-to-peak
ECA
:   external carotid artery
EDAS
:   encephaloduroarteriosynangiosis
MMD
:   Moyamoya disease" />
<meta name="og-title" property="og:title" content="Quantitative Assessment of Neovascularization after Indirect Bypass Surgery: Color-Coded Digital Subtraction Angiography in Pediatric Moyamoya Disease" />
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<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: For the postoperative follow-up in pediatric patients with Moyamoya disease, it is essential to evaluate the degree of neovascularization status. Our aim was to quantitatively assess the neovascularization status after bypass surgery in pediatric Moyamoya disease by using color-coded digital subtraction angiography.

MATERIALS AND METHODS: Time-attenuation intensity curves were generated at ROIs corresponding to surgical flap sites from color-coded DSA images of the common carotid artery, internal carotid artery, and external carotid artery angiograms obtained pre- and postoperatively in 32 children with Moyamoya disease. Time-to-peak and area under the curve values were obtained. Postoperative changes in adjusted time-to-peak (ΔTTP) and ratios of adjusted area under the curve changes (ΔAUC ratio) of common carotid artery, ICA, and external carotid artery angiograms were compared across clinical and angiographic outcome groups. To analyze diagnostic performance, we categorized clinical outcomes into favorable and unfavorable groups.

RESULTS: The ΔTTP at the common carotid artery increased among clinical and angiographic outcomes, in that order, with significant differences ( P = .003 and .005, respectively). The ΔAUC ratio at the common carotid artery and external carotid artery also increased, in that order, among clinical and angiographic outcomes with a significant difference (all, P = .000). The ΔAUC ratio of ICA showed no significant difference among clinical and angiographic outcomes ( P = .418 and .424, respectively). The ΔTTP for the common carotid artery of &gt;1.27 seconds and the ΔAUC ratio of &gt;33.5% for the common carotid artery and 504% for the external carotid artery are revealed as optimal cutoff values between favorable and unfavorable groups.

CONCLUSIONS: Postoperative changes in quantitative values obtained with color-coded DSA software showed a significant correlation with outcome scores and can be used as objective parameters for predicting the outcome in pediatric Moyamoya disease, with an additional cutoff value calculated through the receiver operating characteristic curve.

AUC
:   area under the curve
CCA
:   common carotid artery
ΔAUC ratio
:   adjusted area under the curve changes
ΔTTP
:   difference between preoperative and postoperative time-to-peak
ECA
:   external carotid artery
EDAS
:   encephaloduroarteriosynangiosis
MMD
:   Moyamoya disease" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node14513--5" data-node-nid="14513" id="top-node-14513--6522883168" data-pisa="ajnr;37/5/932" data-pisa-master="ajnr;ajnr.A4614" data-apath="/ajnr/37/5/932.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">PEDIATRICS</span></span></div>
  
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      <h1 class="highwire-cite-title" id="page-title">Quantitative Assessment of Neovascularization after Indirect Bypass Surgery: Color-Coded Digital Subtraction Angiography in Pediatric Moyamoya Disease</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">H.-H. Cho</span>, <span class="highwire-citation-author" data-delta="1">J.-E. Cheon</span>, <span class="highwire-citation-author" data-delta="2">S.-K. Kim</span>, <span class="highwire-citation-author" data-delta="3">Y.H. Choi</span>, <span class="highwire-citation-author" data-delta="4">I.-O. Kim</span>, <span class="highwire-citation-author" data-delta="5">W.S. Kim</span>, <span class="highwire-citation-author" data-delta="6">S.-M. Lee</span>, <span class="highwire-citation-author" data-delta="7">S.K. You</span> and <span class="highwire-citation-author" data-delta="8">S.-M. Shin</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">May 2016,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">37 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(5) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">932-938; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A4614 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-14513--6522883168" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">H.-H. Cho </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (H.-H.C., J.-E.C., Y.H.C., I.-O.K., W.S.K., S.-M.L., S.K.Y.), Seoul National University Hospital, Seoul, Korea</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=H.-H.%2BCho%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Cho%20H&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AH.-H.%2BCho%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-4865-2601" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for H.-H. Cho</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">J.-E. Cheon </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (H.-H.C., J.-E.C., Y.H.C., I.-O.K., W.S.K., S.-M.L., S.K.Y.), Seoul National University Hospital, Seoul, Korea</div><div class='author-affiliation'><span class='nlm-sup'>b</span>Department of Radiology (J.-E.C., Y.H.C., I.-O.K., W.S.K.), Seoul National University College of Medicine, Seoul, Korea</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Institute of Radiation Medicine (J.-E.C., I.-O.K., W.S.K.), Seoul National University Medical Research Center, Seoul, Korea</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.-E.%2BCheon%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Cheon%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AJ.-E.%2BCheon%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0003-1479-2064" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J.-E. Cheon</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">S.-K. Kim </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>d</span>Division of Pediatric Neurosurgery (S.-K.K.), Seoul National University Children's Hospital, Seoul, Korea</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.-K.%2BKim%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Kim%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AS.-K.%2BKim%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-0039-0083" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for S.-K. Kim</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">Y.H. Choi </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (H.-H.C., J.-E.C., Y.H.C., I.-O.K., W.S.K., S.-M.L., S.K.Y.), Seoul National University Hospital, Seoul, Korea</div><div class='author-affiliation'><span class='nlm-sup'>b</span>Department of Radiology (J.-E.C., Y.H.C., I.-O.K., W.S.K.), Seoul National University College of Medicine, Seoul, Korea</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Y.H.%2BChoi%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Choi%20Y&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AY.H.%2BChoi%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-1842-9062" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Y.H. Choi</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">I.-O. Kim </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (H.-H.C., J.-E.C., Y.H.C., I.-O.K., W.S.K., S.-M.L., S.K.Y.), Seoul National University Hospital, Seoul, Korea</div><div class='author-affiliation'><span class='nlm-sup'>b</span>Department of Radiology (J.-E.C., Y.H.C., I.-O.K., W.S.K.), Seoul National University College of Medicine, Seoul, Korea</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Institute of Radiation Medicine (J.-E.C., I.-O.K., W.S.K.), Seoul National University Medical Research Center, Seoul, Korea</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=I.-O.%2BKim%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Kim%20I&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AI.-O.%2BKim%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0001-5800-3536" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for I.-O. Kim</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">W.S. Kim </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (H.-H.C., J.-E.C., Y.H.C., I.-O.K., W.S.K., S.-M.L., S.K.Y.), Seoul National University Hospital, Seoul, Korea</div><div class='author-affiliation'><span class='nlm-sup'>b</span>Department of Radiology (J.-E.C., Y.H.C., I.-O.K., W.S.K.), Seoul National University College of Medicine, Seoul, Korea</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Institute of Radiation Medicine (J.-E.C., I.-O.K., W.S.K.), Seoul National University Medical Research Center, Seoul, Korea</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=W.S.%2BKim%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Kim%20W&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AW.S.%2BKim%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0003-2184-1311" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for W.S. Kim</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">S.-M. Lee </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (H.-H.C., J.-E.C., Y.H.C., I.-O.K., W.S.K., S.-M.L., S.K.Y.), Seoul National University Hospital, Seoul, Korea</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.-M.%2BLee%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Lee%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AS.-M.%2BLee%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-2073-8198" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for S.-M. Lee</a></li></ul></div><div class="author-tooltip-7"><div class="author-tooltip-name">S.K. You </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (H.-H.C., J.-E.C., Y.H.C., I.-O.K., W.S.K., S.-M.L., S.K.Y.), Seoul National University Hospital, Seoul, Korea</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.K.%2BYou%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=You%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AS.K.%2BYou%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-1026-5809" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for S.K. You</a></li></ul></div><div class="author-tooltip-8"><div class="author-tooltip-name">S.-M. Shin </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>e</span>Department of Radiology (S.-M.S.), Seoul Metropolitan Government–Seoul National University, Boramae Medical Center, Seoul, Korea.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.-M.%2BShin%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Shin%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AS.-M.%2BShin%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-7250-9573" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for S.-M. 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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article abstract-view "><span class="highwire-journal-article-marker-start"></span><div class="section abstract" id="abstract-1"><h2>Abstract</h2><div id="sec-1" class="subsection"><p id="p-1"><strong>BACKGROUND AND PURPOSE:</strong> For the postoperative follow-up in pediatric patients with Moyamoya disease, it is essential to evaluate the degree of neovascularization status. Our aim was to quantitatively assess the neovascularization status after bypass surgery in pediatric Moyamoya disease by using color-coded digital subtraction angiography.</p></div><div id="sec-2" class="subsection"><p id="p-2"><strong>MATERIALS AND METHODS:</strong> Time-attenuation intensity curves were generated at ROIs corresponding to surgical flap sites from color-coded DSA images of the common carotid artery, internal carotid artery, and external carotid artery angiograms obtained pre- and postoperatively in 32 children with Moyamoya disease. Time-to-peak and area under the curve values were obtained. Postoperative changes in adjusted time-to-peak (ΔTTP) and ratios of adjusted area under the curve changes (ΔAUC ratio) of common carotid artery, ICA, and external carotid artery angiograms were compared across clinical and angiographic outcome groups. To analyze diagnostic performance, we categorized clinical outcomes into favorable and unfavorable groups.</p></div><div id="sec-3" class="subsection"><p id="p-3"><strong>RESULTS:</strong> The ΔTTP at the common carotid artery increased among clinical and angiographic outcomes, in that order, with significant differences (<em>P</em> = .003 and .005, respectively). The ΔAUC ratio at the common carotid artery and external carotid artery also increased, in that order, among clinical and angiographic outcomes with a significant difference (all, <em>P</em> = .000). The ΔAUC ratio of ICA showed no significant difference among clinical and angiographic outcomes (<em>P</em> = .418 and .424, respectively). The ΔTTP for the common carotid artery of &gt;1.27 seconds and the ΔAUC ratio of &gt;33.5% for the common carotid artery and 504% for the external carotid artery are revealed as optimal cutoff values between favorable and unfavorable groups.</p></div><div id="sec-4" class="subsection"><p id="p-4"><strong>CONCLUSIONS:</strong> Postoperative changes in quantitative values obtained with color-coded DSA software showed a significant correlation with outcome scores and can be used as objective parameters for predicting the outcome in pediatric Moyamoya disease, with an additional cutoff value calculated through the receiver operating characteristic curve.</p></div></div><div class="section glossary" id="glossary-1"><h2 class="">ABBREVIATIONS:</h2><dl id="def-list-1"><dt id="def-item-1">AUC<span class="def-item-dt-sep"></span></dt><dd>area under the curve<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">CCA<span class="def-item-dt-sep"></span></dt><dd>common carotid artery<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">ΔAUC ratio<span class="def-item-dt-sep"></span></dt><dd>adjusted area under the curve changes<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">ΔTTP<span class="def-item-dt-sep"></span></dt><dd>difference between preoperative and postoperative time-to-peak<span class="def-item-dd-sep"></span></dd><dt id="def-item-5">ECA<span class="def-item-dt-sep"></span></dt><dd>external carotid artery<span class="def-item-dd-sep"></span></dd><dt id="def-item-6">EDAS<span class="def-item-dt-sep"></span></dt><dd>encephaloduroarteriosynangiosis<span class="def-item-dd-sep"></span></dd><dt id="def-item-7">MMD<span class="def-item-dt-sep"></span></dt><dd>Moyamoya disease</dd></dl></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2016 by American Journal of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="http://ajnr-stage2.stage.highwire.org/content/37/5/932.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 37</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 5 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 May 2016 </div></div>
      
      
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      <div class="highwire-cite-title">Quantitative Assessment of Neovascularization after Indirect Bypass Surgery: Color-Coded Digital Subtraction Angiography in Pediatric Moyamoya Disease</div>  
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    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">May 2016, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">37 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(5) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">932-938; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A4614 </span></div>
  
  
  
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    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">May 2016, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">37 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(5) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">932-938; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A4614 </span></div>
  
  
  
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