To investigate specific microstructural change after the revascularization surgery, we evaluated 13 patients with moyamoya disease and 13 age-sex matched normal controls using multishell diffusion MRI. By NODDI and free-water imaging analysis, preoperative hemispheres showed significant increase of extracellular fluid compared to controls, and subsequent significant decrease after the surgery. Only free-water eliminated parameter (orientation dispersion index) showed significant difference between patients with and without cognitive improvement after the surgery. Increased parenchymal free water observed in moyamoya disease may decrease after the surgery, and free-water elimination might be useful to detect true neuronal change related to postoperative cognitive improvement.
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