Magnetic Resonance Imaging Markers of Cerebral Small Vessel Disease in Adults with Moyamoya Disease

Sun, Haogeng; Li, Wanjiang; Xia, Chao; Ren, Yaoyao; Ma, Lu; Xiao, Anqi; You, Chao; Wang, Xiaoyu; Tian, Rui; Liu, Yi

doi:10.1007/s12975-021-00973-7

Cited by 10 publications

(10 citation statements)

References 35 publications

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“…Previous studies on WMH in MMD evaluated white matter changes on a gross scale, with little regard for the heterogeneous pathophysiology underlying WMH. 3,4 Recognizing the different pathomechanisms that underpin periventricular and subcortical WMHs, 11 we sought to establish in this study the characteristics of distribution-specific WMHs in patients with MMD and its clinical implications. The consistent association between MMD and periventricular WMH volume in our study may represent hemodynamic instability and chronic ischemic injury in the small vessel border zone in patients with MMD.…”

Section: Discussionmentioning

confidence: 99%

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Characteristics and Clinical Implication of White Matter Lesions in Patients With Adult Moyamoya Disease

et al. 2023

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Background and ObjectivesWhite matter hyperintensities (WMH) are reportedly increased in moyamoya disease (MMD); however, their clinical importance is not well-established owing to their pathophysiological heterogeneity by distribution. This study aimed to evaluate the burden and pattern of WMH and its clinical implications in the MMD trajectory.MethodsAdult MMD patients without significant structural lesions were 1:1 propensity score-matched with healthy controls for sex and vascular risk factors. The total, periventricular, and subcortical WMH volumes were segmented and quantified fully automatically. WMH volumes were detrended by age and compared between the two groups. MMD severity based on Suzuki stage and future ischemic events were assessed for their association with WMH volumes.ResultsA total of 161 pairs of patients with MMD and controls were analyzed. MMD significantly correlated with increased total WMH volume (B [standard error], 0.126 [0.030]; p<0.001), periventricular WMH volume (0.114 [0.027]; p<0.001), and periventricular-to-subcortical ratio (0.090 [0.034]; p=0.009). In the MMD subgroup (n=187), advanced MMD had an independent positive association with the total WMH volume (0.120 [0.035]; p<0.001), periventricular WMH volume (0.110 [0.031]; p<0.001), and periventricular-to-subcortical ratio (0.139 [0.038]; p<0.001). Periventricular WMH volume (adjusted hazard ratio [95% confidence interval], 5.12 [1.26–20.79]) and periventricular-to-subcortical ratio (3.80 [1.51–9.56]) were associated with future ischemic events in medically followed-up MMD patients. However, no demonstrable association was found between subcortical WMH volume and MMD, MMD severity, or future ischemic events.DiscussionPeriventricular WMH, but not subcortical WMH, may represent the main pathophysiology of MMD. Periventricular WMH may be used as a marker for ischemic vulnerability in patients with MMD.

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Section: Discussionmentioning

confidence: 99%

“…1,2 Several studies have addressed the increased WMH volume and disruption of normal-appearing white matter in MMD. [3][4][5][6][7][8][9][10] Because MMD imposes a long-standing hemodynamic compromise with compensatory vasculogenesis in younger adults, the patterns and consequences of WMH might differ from those of aging or vascular risk factor-related WMHs.…”

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confidence: 99%

Characteristics and Clinical Implication of White Matter Lesions in Patients With Adult Moyamoya Disease

et al. 2023

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“…The dPVS burden was evaluated at the level of the centrum semiovale on T2-weighted images. Basal ganglia dPVS (BG-dPVS) was not evaluated in the present study because the accuracy of evaluation of BG-dPVS on axial T2WI is limited due to the presence of characteristic flow voids and lacunes in the basal ganglia in MMD, as mentioned previously (7,11). All 354 hemispheres were categorized into one of three subgroups by severity of CSO-dPVS burden (15) (Figures 1A-C): mild (CSO-dPVS 0-10), moderate (CSO-dPVS 11-20), or severe (CSO-dPVS > 20).…”

Section: Assessment Of Dpvsmentioning

confidence: 99%

“…Patients with the characteristic cerebrovascular features of MMD in the context of a definite underlying risk factor or disease are categorized as having moyamoya syndrome (MMS) ( 10 ). MMD/MMS is considered to be a typical model of intracranial artery stenosis, while several imaging markers of CSVD, including lacunes, WHMs, cerebral microbleeds, and dPVS, are observed in MMD patients ( 11 ). MMD/MMS is thus of great value in the evaluation of the correlation between large artery stenosis and small vessel disease.…”

Section: Introductionmentioning

confidence: 99%

“…MMD/MMS is thus of great value in the evaluation of the correlation between large artery stenosis and small vessel disease. dPVS in MMD patients have previously been found to be associated with female gender, hypertension, vascular stenosis measured by magnetic resonance angiography (MRA), decreased regional blood perfusion, and cerebral atrophy ( 7 , 11 ), but the specific mechanisms underlying these correlations remain ambiguous. The traction of atrophic brain tissue on perivascular tissue is considered to account for the correlation between brain atrophy and basal ganglia dPVS observed in lacunar infarction patients ( 12 ).…”

Section: Introductionmentioning

confidence: 99%

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Burden of dilated perivascular spaces in patients with moyamoya disease and moyamoya syndrome is related to middle cerebral artery stenosis

et al. 2023

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Background and objectiveThe correlation between intracranial large artery disease and cerebral small vessel disease (CSVD) has become a noteworthy issue. Dilated perivascular spaces (dPVS) are an important marker of CSVD, of which cerebral atrophy has been regarded as one of the pathological mechanisms. DPVS has been found to be associated with vascular stenosis in patients with moyamoya disease (MMD), but the underlying mechanism remains unclear. The purpose of our study was to explore the correlation between the middle cerebral artery (MCA) stenosis and dPVS in the centrum semiovale (CSO-dPVS) in patients with MMD/moyamoya syndrome (MMS) and to determine whether brain atrophy plays a mediating role in this relationship.MethodsA total of 177 patients were enrolled in a single-center MMD/MMS cohort. Images of their 354 cerebral hemispheres were divided into three groups according to dPVS burden: mild (dPVS 0–10), moderate (dPVS 11–20), and severe (dPVS > 20). The correlations among cerebral hemisphere volume, MCA stenosis, and CSO-dPVS were analyzed, adjusting for the confounding factors of age, gender, and hypertension.ResultsAfter adjustment for age, gender, and hypertension, the degree of MCA stenosis was independently and positively associated with ipsilateral CSO-dPVS burden (standardized coefficient: β = 0.247, P < 0.001). A stratified analysis found that the subgroup with a severe CSO-dPVS burden exhibited a significantly higher risk of severe stenosis of the MCA [p < 0.001, OR = 6.258, 95% CI (2.347, 16.685)]. No significant correlation between CSO-dPVS and ipsilateral hemisphere volume was found (p = 0.055).ConclusionIn our MMD/MMS cohort, there was a clear correlation between MCA stenosis and CSO-dPVS burden, which may be a direct effect of large vessel stenosis, without a mediating role of brain atrophy.

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White matter hyperintensities in cholinergic pathways correlates of cognitive impairment in moyamoya disease

Xu,

Yu,

et al. 2023

Eur Radiol

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Magnetic Resonance Imaging Markers of Cerebral Small Vessel Disease in Adults with Moyamoya Disease

Cited by 10 publications

References 35 publications

Characteristics and Clinical Implication of White Matter Lesions in Patients With Adult Moyamoya Disease

Characteristics and Clinical Implication of White Matter Lesions in Patients With Adult Moyamoya Disease

Burden of dilated perivascular spaces in patients with moyamoya disease and moyamoya syndrome is related to middle cerebral artery stenosis

White matter hyperintensities in cholinergic pathways correlates of cognitive impairment in moyamoya disease

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