Unraveling Specific Brain Microstructural Damage in Moyamoya Disease Using Diffusion Magnetic Resonance Imaging and Positron Emission Tomography

Hara, Shoko; Hori, Masaaki; Ueda, Ryo; Hayashi, Shihori; Inaji, Motoki; Tanaka, Yoji; Maehara, Taketoshi; Aoki, Shigeki; Nariai, Tadashi

doi:10.1016/j.jstrokecerebrovasdis.2018.12.038

Cited by 21 publications

(27 citation statements)

References 45 publications

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“…We also found that the ODI had a weak but statistically significant correlation with CBF in the hippocampi of the patients after TGA. This is compatible with a previous report stating that cortical blood flow and ODI are correlated 40 . Thus, this may reflect normal physiology.…”

Section: Discussionsupporting

confidence: 93%

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Transient Global Amnesia: A Diffusion and Perfusion MRI study

Shimizu

Hara

Hori

et al. 2020

Journal of Neuroimaging

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BACKGROUND AND PURPOSE: Transient global amnesia (TGA) is a rare clinical entity with a sudden onset of anterograde amnesia that recovers within 24 hours. The underlying pathophysiology is uncertain. Imaging studies are controversial, but diffusion-weighted images often show small diffusion-restricted lesions in the hippocampus, which may suggest ischemic damage. Thus, we conducted the first clinical study using neurite orientation dispersion and density imaging (NODDI) and arterial spin labeling (ASL) to examine whether the microstructure and perfusion status of the hippocampus are influenced by the presence of diffusion-restricted lesions. METHODS: Ten patients with a clinical diagnosis of TGA were evaluated by conventional MRI, NODDI, and ASL. The intracellular volume fraction (ICVF) and orientation dispersion index (ODI) on NODDI and cerebral blood flow (CBF) determined by ASL in the hippocampus were calculated and compared by diffusion-weighted imaging (DWI) positivity. Correlations among ICVF, ODI, and CBF were also analyzed. RESULTS: Three patients had typical unilateral DWI-positive lesions. No significant differences in any of the three parameters were detected between DWI-positive and DWI-negative hippocampi. A statistically significant correlation was detected between the ODI and CBF (R = .51, P = .021). CONCLUSIONS: The first NODDI and ASL study in patients after TGA demonstrated no obvious microstructural or perfusion abnormalities in the hippocampus with typical DWI-positive lesions, which may indicate that TGA does not cause destructive damage or involve baseline microstructure or perfusion abnormalities in the hippocampus in relation to diffusion-restricted lesions.

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Section: Discussionsupporting

confidence: 93%

“…This is compatible with a previous report stating that cortical blood flow and ODI are correlated. 40 Thus, this may reflect normal physiology.…”

Section: Discussionmentioning

confidence: 99%

Transient Global Amnesia: A Diffusion and Perfusion MRI study

Shimizu

Hara

Hori

et al. 2020

Journal of Neuroimaging

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“…42 Additionally, NODDI was reported to have improved sensitivity for detecting microstructural changes in the brain during ischemic stroke compared with DTI and DKI. 43 Beyond usual stroke, Hara et al 44 investigated patients with moyamoya disease, which is a progressive cerebrovascular disease caused by blocked main arteries of the brain, and found that NODDI parameters are significantly correlated with PET and clinical severity.…”

Section: Strokementioning

confidence: 99%

<p>Neurite orientation and dispersion density imaging: clinical utility, efficacy, and role in therapy</p>

Sone¹

2019

RMI

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In the field of diffusion magnetic resonance imaging (MRI) for neuroimaging, white matter tracts have traditionally been analyzed using diffusion tensor imaging (DTI) measures, such as fractional anisotropy. However, recent advances in diffusion MRI have provided further information on brain microstructures using multi-shell protocols of diffusion MRI. Neurite orientation dispersion and density imaging (NODDI) is one such emerging advanced diffusion MRI method that enables investigation of the neurite density and neurite orientation dispersion of brain microstructures. NODDI was developed as a practical and clinically feasible diffusion MRI technique to evaluate the microstructural complexity of dendrites and axons. This review shed light on recent studies on the use of NODDI in human brain. Indeed, a growing number of studies are using NODDI to examine neurological and psychiatric disorders, with most reporting its clinical utility. The time has thus come, for us to seriously consider the clinical use of NODDI.

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“…As discussed above, the decrease in the MVF and the increase in the g-ratio might precede the decrease in the AVF and the decrease in the g-ratio. 7,25 Moreover, in patients with MMD, both the cortex and white matter are affected by chronic ischemia, [5][6][7]27,28 and while direct ischemic damage to white matter might result in more myelin damage than axonal damage, cortical damage must cause both myelin and axonal damage due to the decrease in axonal fibers radiating from the affected cortex. Thus, the presence of axonal damage might reflect more global damage than myelin damage in this disease population.…”

Section: Discussionmentioning

confidence: 99%

“…These results suggest that ischemic damage to myelin and axons in patients with MMD might be, at least partially, irreversible. 6,27 Postoperative improvements in microstructural integrity evaluated by diffusion MR imaging are reported in patients with MMD 28 and carotid artery stenosis, 31 but whether these observed changes are due to an increase in axon integrity, such as remyelination, or a decrease in interstitial fluid 32 remains unclear. Compared with diffusion MR imaging, which indirectly assesses the presence of myelin damage by evaluating increased water diffusion in the brain parenchyma, the MTsat method has the strength of being directly sensitive to myelin.…”

Section: Discussionmentioning

confidence: 99%

Myelin and Axonal Damage in Normal-Appearing White Matter in Patients with Moyamoya Disease

Hara

Hori

Hagiwara

et al. 2020

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Although chronic ischemia is known to induce myelin and axonal damage in animal models, knowledge regarding patients with Moyamoya disease is limited. We aimed to investigate the presence of myelin and axonal damage in Moyamoya disease and their relationship with cognitive performance. MATERIALS AND METHODS: Eighteen patients with Moyamoya disease (16-55 years of age) and 18 age-and sex-matched healthy controls were evaluated with myelin-sensitive MR imaging based on magnetization transfer saturation imaging and 2-shell diffusion MR imaging. The myelin volume fraction, which reflects the amount of myelin sheath; the g-ratio, which represents the ratio of the inner (axon) to the outer (axon plus myelin) diameter of the fiber; and the axon volume fraction, which reflects axonal components, were calculated and compared between the patients and controls. In the patients with Moyamoya disease, the relationship between these parameters and cognitive task-measuring performance speed was also evaluated. RESULTS: Compared with the healthy controls, the patients with Moyamoya disease showed a significant decrease in the myelin and axon volume fractions (P , .05) in many WM regions, while the increases in the g-ratio values were not statistically significant. Correlations with cognitive performance were most frequently observed with the axon volume fraction (r ¼ 0.52-0.54; P , .03 in the right middle and posterior cerebral artery areas) and were the strongest with the g-ratio values in the right posterior cerebral artery region (r ¼ 0.64; P ¼ .004). CONCLUSIONS: Myelin-sensitive MR imaging and diffusion MR imaging revealed that myelin and axonal damage exist in patients with Moyamoya disease. The relationship with cognitive performance might be stronger with axonal damage than with myelin damage. ABBREVIATIONS: ACA ¼ anterior cerebral artery; AVF ¼ axon volume fraction; GRAPPA ¼ generalized autocalibrating partially parallel acquisition; MMD ¼ Moyamoya disease; MVF ¼ myelin volume fraction; MTsat ¼ magnetization transfer saturation; PCA ¼ posterior cerebral artery; V ic ¼ intracellular volume fraction; V iso ¼ isotropic volume fraction; TMT ¼ Trail-Making Test; WAIS ¼ Wechsler Adult Intelligence Scale

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Unraveling Specific Brain Microstructural Damage in Moyamoya Disease Using Diffusion Magnetic Resonance Imaging and Positron Emission Tomography

Cited by 21 publications

References 45 publications

Transient Global Amnesia: A Diffusion and Perfusion MRI study

Transient Global Amnesia: A Diffusion and Perfusion MRI study

<p>Neurite orientation and dispersion density imaging: clinical utility, efficacy, and role in therapy</p>

Myelin and Axonal Damage in Normal-Appearing White Matter in Patients with Moyamoya Disease

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