High incidence of asymptomatic cerebral microbleeds in patients with hemorrhagic onset-type moyamoya disease: a phase-sensitive MRI study and meta-analysis

Qin, Ying; Ogawa, Toshihide; Fujii, Shinya; Shinohara, Yuki; Kitao, Shinichiro; Miyoshi, Fumito; Takasugi, Marie; Watanabe, Takashi; Kaminou, Toshio

doi:10.1177/0284185114524198

Cited by 26 publications

(22 citation statements)

References 37 publications

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“…However, when comparing our data with pooled data from a recent meta-analysis 13 of 5 publications (of Asian/Japanese populations), 7,10,11,13,21 rather than single studies, a different picture emerges. The pooled number of cMBs in these studies was 76 patients (30.8%) in 246.…”

Section: February 2017mentioning

confidence: 68%

“…24 The Rotterdam Scan study reported the agespecific prevalence of cMBs as 5.4% for the age group of 60 to 69 years rising to 23.3% for the age group of 80 to 97 years. 25 Furthermore, the pooled estimate of the proportion of cMBs in the meta-analysis of Qin et al 13 (one of which was an update of the aforementioned Kikuta study 8 ) in Asian moyamoya patients was ≈30%. Our moyamoya collective has significantly less cMB, supporting the alternative hypothesis that they come from substantially different moyamoya populations.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9][10][11] Furthermore, cMBs are a predictor of future intracerebral hemorrhage. 10,12,13 Although there are several studies, which analyzed the frequency, localization, and association of cMBs with intracerebral hemorrhage in Asian patients with moyamoya, there are no equivalent studies of patients outside of Asia. [7][8][9][10][11][12][13] The present study attempts to provide additional information about the incidence, distribution pattern, and longitudinal course of cMBs in a German cohort based on a retrospective analysis of magnetic resonance imaging (MRI) studies.…”

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confidence: 99%

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Incidence, Locations, and Longitudinal Course of Cerebral Microbleeds in European Moyamoya

Wenz

Maros

et al. 2017

Stroke

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Background and Purpose-Cerebral microbleeds (cMBs) have previously been linked with especially high incidence in Asian patients with moyamoya together with high tendency to bleed. This, presumably, is characteristic of patients with moyamoya. Herein, we, therefore, investigate retrospectively the frequency, location, and longitudinal course of cMBs in a large German cohort. Methods-We included all patients with moyamoya who underwent standard magnetic resonance imaging, including T2*-weighted images, in our department between 1998 and 2015. Two independent readers evaluated magnetic resonance imaging scans to determine the occurrence of cMBs according to the Brain Observer Microbleed Scale. Demographics, initial symptoms leading to hospitalization, and associated diseases were obtained by chart review. Results-Overall, there was a total of 242 T2* studies of 101 included moyamoya patients available with a strong female predominance (69.3%). Eight patients (7.9%) were ≤18 years of age. We detected 25 cMBs within 13 patients (12.9%).One patient <18 of age was presented with a cMB; 2 of 3 patients with an intracranial hemorrhage as initial event demonstrated cMB(s). In 72 of 101 cases, there were 1719 person months of follow-up, with 3 adult patients showing 3 de novo cMBs in the course. The majority of cMBs (64.0%) were located at the cortex/gray-white junction. Conclusions-Although the frequency of cMBs herein is much higher than the expected age-specific incidence, it is still much lower compared with previous reports on cMBs in moyamoya patients of Asian descent. These results might reflect another ethnic-specific difference in patients diagnosed with moyamoya.

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Section: February 2017mentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Incidence, Locations, and Longitudinal Course of Cerebral Microbleeds in European Moyamoya

Wenz

Maros

et al. 2017

Stroke

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“…This finding was consistent with the other previous study. 20 Although our study did not investigate subsequent hemorrhages in patients with MMD with microbleeds, several studies have reported the presence of microbleeds as a predictor of subsequent hemorrhagic stroke in patients with MMD. 12,14,23,26 Microbleeds in patients with MMD have mainly been reported in deep brain areas, such as the periventricular white matter, basal ganglia, or thalami, and they mainly occur in arteries displaying the subependymal-leptomeningeal artery anastomosis pattern.…”

Section: Discussionmentioning

confidence: 89%

“…7,[10][11][12]20 Kikuta et al demonstrated a higher prevalence (44%) of cerebral microbleeds in patients with MMD than in healthy individuals (5.8%). 11 Our detection rate (8.1%) of microbleeds is the first reported in Korean patients with MMD and was rela- tively lower than those in the aforementioned studies.…”

Section: Discussionmentioning

confidence: 99%

Association of apolipoprotein E gene polymorphism with small-vessel lesions and stroke type in moyamoya disease: a preliminary study

Jang

Huh

Lee

2016

JNS

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M oyaMoya disease (MMD) is a progressive cerebrovascular occlusive disorder consisting of bilateral stenosis or occlusion of the supraclinoid internal carotid artery (ICA) and its major branches, with net-like vessels in the area surrounding the circle of Willis. 27 Many studies have demonstrated a higher prevalence of asymptomatic cerebral microbleeds in patients with MMD compared with the normal population.11 In addition, a recent meta-analysis showed that a high incidence of asymptomatic cerebral microbleeds appeared to be correlated with the hemorrhagic onset type in patients with MMD.20 Kikuta et al. 12 identified the presence of multiple microbleeds as a predictor of subsequent hemorrhages in patients with MMD.abbreviatioNs APOE = apolipoprotein E; GRE = gradient-recalled echo; ICA = internal carotid artery; MMD = moyamoya disease; SVL = small-vessel lesion; T2WI = T2*-weighted imaging. obJective The present study was conducted to investigate whether microbleeds or microinfarcts are associated with apolipoprotein E (APOE) gene polymorphisms in patients with moyamoya disease (MMD), and if so, whether APOE gene polymorphisms are also associated with stroke type in patients with MMD. methods This cross-sectional, multicenter study included 86 consecutive patients with MMD who underwent T2*-weighted gradient echo or susceptibility-weighted MR imaging and 83 healthy control volunteers. Baseline clinical and radiological characteristics were recorded at diagnosis, and inter- and intragroup differences in the APOE genotypes were assessed. Multivariate binary logistic regression models were used to determine the association factors for smallvessel lesions (SVLs) and hemorrhagic presentation in patients with MMD. results There was no difference in APOE gene polymorphism and the incidence of SVLs between patients with MMD and healthy controls (p > 0.05). In the MMD group, 7 (8.1%) patients had microbleeds and 32 (37.2%) patients had microinfarcts. Microbleeds were more frequently identified in patients with hemorrhagic-type than in nonhemorrhagictype MMD (p = 0.003). APOE genotypes differed according to the presence of microbleeds (p = 0.024). APOE ε2 or ε4 carriers also experienced microbleeds more frequently than APOE ε3/ε3 carriers (p = 0.013). In the multivariate regression analysis in patients with MMD, microbleeds were significantly related to APOE ε2 or ε4 carrier status (OR 7.86;; p = 0.032) and cerebral aneurysm (OR 17.31; 95% CI 2.09-143.57; p = 0.008). Microinfarcts were independently associated with hypertension (OR 3.01; 95% CI 1.05-7.86; p = 0.007). Hemorrhagic presentation was markedly associated with microbleeds (OR 10.63; 95% CI 1.11-102.0; p = 0.041). coNclusioNs These preliminary results did not show a difference in APOE gene polymorphisms between patients with MMD and healthy persons. However, they imply that APOE gene polymorphisms may play certain roles in the presence of microbleeds but not microinfarcts in patients with MMD. A further confirmatory study is necessary to elucidate the effec...

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Vasculopathy and Vasculitis

Bathla

Moritani

Kirby

et al. 2021

Diffusion-Weighted MR Imaging of the Brain, Head and Neck, and Spine

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High incidence of asymptomatic cerebral microbleeds in patients with hemorrhagic onset-type moyamoya disease: a phase-sensitive MRI study and meta-analysis

Cited by 26 publications

References 37 publications

Incidence, Locations, and Longitudinal Course of Cerebral Microbleeds in European Moyamoya

Incidence, Locations, and Longitudinal Course of Cerebral Microbleeds in European Moyamoya

Association of apolipoprotein E gene polymorphism with small-vessel lesions and stroke type in moyamoya disease: a preliminary study

Vasculopathy and Vasculitis

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