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Bağcılar Ö, Korkmazer B, Kızılkılıç O, Işlak C. Unusual collaterals through interhemispheric connections in Moyamoya disease. Diagn Interv Radiol 2024; 30:72-73. [PMID: 37017225 PMCID: PMC10773173 DOI: 10.4274/dir.2023.232140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/21/2023] [Indexed: 04/06/2023]
Affiliation(s)
- Ömer Bağcılar
- University of Health Sciences Turkey, Şişli Hamidiye Etfal Training and Research Hospital, Clinic of Radiology, İstanbul, Turkey
| | - Bora Korkmazer
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Radiology, Division of Neuroradiology, İstanbul, Turkey
| | - Osman Kızılkılıç
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Radiology, Division of Neuroradiology, İstanbul, Turkey
| | - Civan Işlak
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Radiology, Division of Neuroradiology, İstanbul, Turkey
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Yamao Y, Funaki T, Yamada H, Okawa M, Mineharu Y, Kikuchi T, Fushimi Y, Kataoka H, Yoshida K, Takahashi JC, Miyamoto S, Arakawa Y. "Transcallosal" periventricular anastomosis in moyamoya disease: the fourth periventricular anastomosis and a potential predictor of hemorrhage. J Stroke Cerebrovasc Dis 2023; 32:107428. [PMID: 37924782 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/09/2023] [Accepted: 10/12/2023] [Indexed: 11/06/2023] Open
Abstract
OBJECTIVES Choroidal anastomosis is a risk factor for hemorrhage in moyamoya disease. One variant of choroidal anastomosis, "transcallosal anastomosis," originates from the medial posterior choroidal artery, and penetrates the corpus callosum to reconstruct the pericallosal artery. We aimed to investigate the prevalence and the bleeding rate of transcallosal anastomosis using sliding thin-slab maximum intensity projection reformatted from magnetic resonance angiography (MRA). MATERIALS AND METHODS This study included 222 patients. We defined transcallosal anastomosis grades (0-2) and the stenosis of the anterior (ACA, 0-2), middle (MCA, 1-3), and posterior cerebral artery (PCA, 0-2) by MRA scores, independently by two coauthors. RESULTS Grade-2 transcallosal anastomosis was detected in 21 patients (9.5 %). There were no correlations of the incidence of transcallosal anastomosis with previous bypass surgery (P = 0.23). Multivariate analysis revealed a significantly higher incidence in hemorrhagic onset and younger age (odds ratio [OR] 3.77, and 0.97). Transcallosal anastomosis had statistically significant correlation with ACA and PCA scores (P = 0.01 and 0.03), but not with MCA scores (P = 0.1). In multivariate analysis, ACA scores 1 and 2 were significantly higher (OR, 15.44 and 11.17), and PCA score 1 was also higher (OR, 3.07), but PCA score 2 was not. Interrater agreement for judgment of transcallosal anastomosis grade was strong (κ = 0.89). Two patients with Grade-2 transcallosal anastomosis had late hemorrhage in the corpus callosum (bleeding rate: 2.5 % per year). CONCLUSIONS Transcallosal anastomosis may be associated with both advanced ACA and moderate PCA stenosis, and cause hemorrhage at the corpus callosum.
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Affiliation(s)
- Yukihiro Yamao
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Takeshi Funaki
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroki Yamada
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masakazu Okawa
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yohei Mineharu
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takayuki Kikuchi
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasutaka Fushimi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroharu Kataoka
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazumichi Yoshida
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Japan
| | - Jun C Takahashi
- Department of Neurosurgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan; Moyamoya Disease Support Center, Kyoto University Hospital, Kyoto, Japan; Stroke Support Center, Kyoto University Hospital, Kyoto, Japan
| | - Yoshiki Arakawa
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Sui B, Sannananja B, Zhu C, Balu N, Eisenmenger L, Baradaran H, Edjlali M, Romero JM, Rajiah PS, Li R, Mossa-Basha M. Report from the society of magnetic resonance angiography: clinical applications of 7T neurovascular MR in the assessment of intracranial vascular disease. J Neurointerv Surg 2023:jnis-2023-020668. [PMID: 37652689 PMCID: PMC10902184 DOI: 10.1136/jnis-2023-020668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 08/16/2023] [Indexed: 09/02/2023]
Abstract
In recent years, ultra-high-field magnetic resonance imaging (MRI) applications have been rapidly increasing in both clinical research and practice. Indeed, 7-Tesla (7T) MRI allows improved depiction of smaller structures with high signal-to-noise ratio, and, therefore, may improve lesion visualization, diagnostic capabilities, and thus potentially affect treatment decision-making. Incremental evidence emerging from research over the past two decades has provided a promising prospect of 7T magnetic resonance angiography (MRA) in the evaluation of intracranial vasculature. The ultra-high resolution and excellent image quality of 7T MRA allow us to explore detailed morphological and hemodynamic information, detect subtle pathological changes in early stages, and provide new insights allowing for deeper understanding of pathological mechanisms of various cerebrovascular diseases. However, along with the benefits of ultra-high field strength, some challenges and concerns exist. Despite these, ongoing technical developments and clinical oriented research will facilitate the widespread clinical application of 7T MRA in the near future. In this review article, we summarize technical aspects, clinical applications, and recent advances of 7T MRA in the evaluation of intracranial vascular disease. The aim of this review is to provide a clinical perspective for the potential application of 7T MRA for the assessment of intracranial vascular disease, and to explore possible future research directions implementing this technique.
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Affiliation(s)
- Binbin Sui
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Bhagya Sannananja
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Chengcheng Zhu
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, Washington, USA
- Vascular Imaging Lab, University of Washington School of Medicine, Seattle, Washington, USA
| | | | - Hediyeh Baradaran
- Department of Radiology & Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
| | | | - Javier M Romero
- Department of Radiology, Division of Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Rui Li
- Center for Biomedical Imaging Research, Tsinghua University, Beijing, China
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington, Seattle, Washington, USA
- Vascular Imaging Lab, University of Washington School of Medicine, Seattle, Washington, USA
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Chen S, Wang B, Wen Y, Wang Z, Long T, Chen J, Zhang G, Li M, Zhang S, Pan J, Feng W, Qi S, Wang G. Ultrasonic hemodynamic changes of superficial temporal artery graft in different angiogenesis outcomes of Moyamoya disease patients treated with combined revascularization surgery. Front Neurol 2023; 14:1115343. [PMID: 36873438 PMCID: PMC9978192 DOI: 10.3389/fneur.2023.1115343] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 01/25/2023] [Indexed: 02/18/2023] Open
Abstract
Objective Combined bypass is commonly used in adult Moyamoya disease (MMD) for revascularization purposes. The blood flow from the external carotid artery system supplied by the superficial temporal artery (STA), middle meningeal artery (MMA), and deep temporal artery (DTA) can restore the impaired hemodynamics of the ischemic brain. In this study we attempted to evaluate the hemodynamic changes of the STA graft and predict the angiogenesis outcomes in MMD patients after combined bypass surgery by using quantitative ultrasonography. Methods We retrospectively studied Moyamoya patients who were treated by combined bypass between September 2017 and June 2021 in our hospital. We quantitatively measured the STA with ultrasound and recorded the blood flow, diameter, pulsatility index (PI) and resistance index (RI) to assess graft development preoperatively and at 1 day, 7 days, 3 months, and 6 months after surgery. All patients received both pre- and post- operative angiography evaluation. Patients were divided into either well- or poorly-angiogenesis groups according to the transdural collateral formation status on angiography at 6 months after surgery (W group or P group). Patients with matshushima grade A or B were divided into W group. Patients with matshushima grade C were divided into P group, indicating a poor angiogenesis development. Results A total of 52 patients with 54 operated hemispheres were enrolled, including 25 men and 27 women with an average age of 39 ± 14.3 years. Compared to preoperative values, the average blood flow of an STA graft at day 1 postoperation increased from 16.06 ± 12.47 to 117.47± 73.77 (mL/min), diameter increased from 1.14 ± 0.33 to 1.81 ± 0.30 (mm), PI dropped from 1.77 ± 0.42 to 0.76 ± 0.37, and RI dropped from 1.77 ± 0.42 to 0.50 ± 0.12. According to the Matsushima grade at 6 months after surgery, 30 hemispheres qualified as W group and 24 hemispheres as P group. Statistically significant differences were found between the two groups in diameter (p = 0.010) as well as flow (p = 0.017) at 3 months post-surgery. Flow also remained significantly different at 6 months after surgery (p = 0.014). Based on GEE logistic regression evaluation, the patients with higher levels of flow post-operation were more likely to have poorly-compensated collateral. ROC analysis showed that increased flow of ≥69.5 ml/min (p = 0.003; AUC = 0.74) or a 604% (p = 0.012; AUC = 0.70) increase at 3 months post-surgery compared with the pre-operative value is the cut-off point which had the highest Youden's index for predicting P group. Furthermore, a diameter at 3 months post-surgery that is ≥0.75 mm (p = 0.008; AUC = 0.71) or 52% (p =0.021; AUC = 0.68) wider than pre-operation also indicates a high risk of poor indirect collateral formation. Conclusions The hemodynamic of the STA graft changed significantly after combined bypass surgery. An increased flow of more than 69.5 ml/min at 3 months was a good predictive factor for poor neoangiogenesis in MMD patients treated with combined bypass surgery.
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Affiliation(s)
- Siyuan Chen
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Baoping Wang
- Department of Ultrasonography, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yunyu Wen
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhibin Wang
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Tinghan Long
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Junda Chen
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Guozhong Zhang
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Mingzhou Li
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shichao Zhang
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jun Pan
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wenfeng Feng
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Songtao Qi
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Gang Wang
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Wang M, Yang Y, Zhang W, Zhou F, Zhang X, Zhang J, Zhang B. Risk Factors for Cerebrovascular Events in Moyamoya Angiopathy Using
4D
Flow
MRI
: A Pilot Study. J Magn Reson Imaging 2022. [DOI: 10.1002/jmri.28522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/21/2022] [Accepted: 10/21/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Maoxue Wang
- Department of Radiology The Affiliated Drum Tower Hospital of Nanjing University Medical School Nanjing Jiangsu China
| | - Yongbo Yang
- Department of Neurosurgery The Affiliated Drum Tower Hospital of Nanjing University Medical School Nanjing Jiangsu China
| | - Wen Zhang
- Department of Radiology The Affiliated Drum Tower Hospital of Nanjing University Medical School Nanjing Jiangsu China
| | - Fei Zhou
- Department of Radiology The Affiliated Drum Tower Hospital of Nanjing University Medical School Nanjing Jiangsu China
| | - Xin Zhang
- Department of Radiology The Affiliated Drum Tower Hospital of Nanjing University Medical School Nanjing Jiangsu China
| | | | - Bing Zhang
- Department of Radiology The Affiliated Drum Tower Hospital of Nanjing University Medical School Nanjing Jiangsu China
- Institute of Medical Imaging and Artificial Intelligence Nanjing University Nanjing Jiangsu China
- Jiangsu Key Laboratory of Molecular Medicine Nanjing Jiangsu China
- Institute of Brain Science Nanjing University Nanjing Jiangsu China
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Xu J, Rajah GB, Zhang H, Han C, Shen X, Li B, Zou Z, Zhao W, Ren C, Liu G, Ding Y, Yang Q, Li S, Ji X. Imaging features of adult moyamoya disease patients with anterior intracerebral hemorrhage based on high-resolution magnetic resonance imaging. J Cereb Blood Flow Metab 2022; 42:2123-2133. [PMID: 35765819 PMCID: PMC9580173 DOI: 10.1177/0271678x221111082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed to identify the high-resolution magnetic resonance imaging (HRMRI) features of moyamoya disease (MMD) patients with anterior intracerebral hemorrhage (ICH) and attempted to reveal potential mechanisms of anterior ICH. Eligible adult MMD patients were consecutively included, and the morphological features of lenticulostriate arteries (LSAs), vessel wall structure of terminal internal carotid artery (ICA) and periventricular anastomosis were evaluated by HRMRI. 78 MMD patients containing 21 patients with anterior ICH, 31 ischemic patients and 26 asymptomatic patients were included. The mean value of total length of LSAs in anterior ICH group (90.79 ± 37.00 mm) was distinctively lower (p < 0.001) compared with either ischemic group (138.04 ± 46.01 mm) or asymptomatic group (170.50 ± 39.18 mm). Lumen area of terminal ICA was significantly larger (p < 0.001) in hemorrhagic group (4.33 ± 2.02 mm2) compared with ischemic group (2.29 ± 1.17 mm2) or asymptomatic group (3.00 ± 1.34 mm2). Multivariate analysis revealed the total length of LSAs (OR 0.689, 95%CI, 0.565-0.840; p < 0.001) and lumen area of terminal ICA (OR 2.085, 95%, 1.214-3.582; p = 0.008) were significantly associated with anterior ICH. Coexistence of reduced LSAs and relatively preserved lumen area of terminal ICA with an AUC of 0.901 (95%CI, 0.812-0.990) could be a potential predictor of anterior ICH in MMD patients.
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Affiliation(s)
- Jiali Xu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
| | - Gary B Rajah
- Department of Neurosurgery, Munson Medical Center, Traverse City, MI, USA
| | - Houdi Zhang
- Department of Neurosurgery, the 307th Hospital of the Chinese People's Liberation Army, The Fifth Medical Center of Chinese PLA General Hospital, Academy of Military Medical Science, Beijing, China
| | - Cong Han
- Department of Neurosurgery, the 307th Hospital of the Chinese People's Liberation Army, The Fifth Medical Center of Chinese PLA General Hospital, Academy of Military Medical Science, Beijing, China
| | - Xuxuan Shen
- 307 Clinical College of Anhui Medical University, Hefei, China
| | - Bin Li
- Department of Neurosurgery, the 307th Hospital of the Chinese People's Liberation Army, The Fifth Medical Center of Chinese PLA General Hospital, Academy of Military Medical Science, Beijing, China
| | - Zhengxing Zou
- Department of Neurosurgery, the 307th Hospital of the Chinese People's Liberation Army, The Fifth Medical Center of Chinese PLA General Hospital, Academy of Military Medical Science, Beijing, China
| | - Wenbo Zhao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Changhong Ren
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Hypoxic Conditioning Translational Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Guiyou Liu
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- Department of Neurosurgery, Wayne State University, Detroit, MI, USA
| | - Qi Yang
- Department of Radiology, Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Sijie Li
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Hypoxic Conditioning Translational Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xunming Ji
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
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Wei N, Zhang X, An J, Zhuo Y, Zhang Z. A Processing Pipeline for Quantifying Lenticulostriate Artery Vascular Volume in Subcortical Nuclei. Front Neurol 2021; 12:700476. [PMID: 34484103 PMCID: PMC8415791 DOI: 10.3389/fneur.2021.700476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/08/2021] [Indexed: 11/23/2022] Open
Abstract
Lenticulostriate arteries (LSAs) supply blood to the basal ganglia region. Its lesion causes lacunar stroke and resulting neurological syndromes. However, due to its small caliber and large individual variance, the evaluation of LSAs was limited to descriptive and objective measurements. In this study, we aimed to develop a post-processing method to quantify LSAs in subcortical regions and compare their vascular volume to conventional LSA measurements. A processing pipeline was designed to extract subcortical areas in individual spaces while screening out vessels. The vascular volume of LSAs in the subcortical region was calculated from time-of-flight-magnetic resonance angiography (TOF-MRA) at 7 Tesla. The reproducibility was tested to be good for the vascular volume (n = 5, ICCA = 0.84). Comparing the results to conventional measurements, the vascular volume was significantly correlated with the number of branches (r = 0.402, p < 0.001) and the length (r = 0.246, p = 0.032) of LSAs. By applying the method to a group of healthy volunteers (n = 40), we found that most LSAs crossing through the putamen which thereby has the highest vascular density among subcortical nuclei. In general, we proposed a semi-automated processing pipeline for quantifying the vascular volume of LSAs in subcortical regions. The novel method was tested to be robust and provided reasonable results. This method revealed spatial relationships among the perforating arteries and basal ganglia. The vascular volume can be used to evaluated blood supply of subcortical regions, benefiting the radiologic evaluation of neurodegenerative diseases caused by small vascular lesions.
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Affiliation(s)
- Ning Wei
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | | | - Jing An
- Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, China
| | - Yan Zhuo
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Zihao Zhang
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
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Abstract
Background and purpose Little is known about the angiographic presentation of Moyamoya angiopathy (MMA) in non-Asian patients. Methods Conventional cerebral angiograms from 155 Caucasian patients diagnosed as MMA were analyzed with respect to extracranial champagne bottle neck sign, Suzuki stages, collateral status, as well as presence of aneurysms and posterior cerebral artery stenosis. Results In 84 of 155 angiograms, the extracranial carotid artery was visualized, in 65 of them (77.4%), a champagne bottle neck sign was noted. Of the 278 analyzable hemispheres, 13.7%,11.2%, 37.8%, 27.3%, 8.6%, and 1.4% were classified as Suzuki stage I, stage II, stage III, stage IV, stage V, and stage VI, respectively. Among 280 hemispheres, in 53 hemispheres (18.9%) isolated basal collaterals (pathway I) and in 104 hemispheres (37.1%) choroidal and pericallosal collaterals (including basal collaterals, pathway II) were found. In 74 hemispheres (26.4%) ethmoidal collaterals (pathways III), and in 17 hemispheres (6.1%) vault collaterals were visualized. Patients with higher Suzuki stages IV–VI (p = 0.008) and ethmoidal collaterals (p < 0.001) suffered more often from cerebral hemorrhage. Transient ischemic attacks occurred more frequently in patients with Suzuki stage I to III (p < 0.001). In 10 of 155 patients (6.5%), the angiogram revealed a cerebral aneurysm. In 13 patients (8.4%), a stenotic P1 segment of the posterior cerebral artery was found. Conclusions This is so far the largest observational study about angiography in Caucasian European MMA patients. A comparison with Asian data indicates similarity of disease in Caucasian and Asian patients.
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Affiliation(s)
- Sara Pilgram-Pastor
- Department of Neuroradiology, Alfried Krupp Hospital, Essen, Germany
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - René Chapot
- Department of Neuroradiology, Alfried Krupp Hospital, Essen, Germany
| | - Markus Kraemer
- Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
- Department of Neurology, Alfried Krupp Von Bohlen Und Halbach Hospital, Alfried-Krupp-Str. 21, 45117, Essen, Germany.
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Lim RP, Hecht EM, Desmond PM. Noncontrast Magnetic Resonance Angiography in the Era of Nephrogenic Systemic Fibrosis and Gadolinium Deposition. J Comput Assist Tomogr 2021; 45:37-51. [PMID: 32976265 DOI: 10.1097/RCT.0000000000001074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
ABSTRACT Gadolinium-based contrast agents for clinical magnetic resonance imaging are overall safe. However, the discovery of nephrogenic systemic fibrosis in patients with severe renal impairment and gadolinium deposition in patients receiving contrast have generated developments in contrast-free imaging of the vasculature, that is, noncontrast magnetic resonance angiography. This article presents an update on noncontrast magnetic resonance angiography techniques, with comparison to other imaging alternatives. Potential benefits and challenges to implementation, and evidence to date for various clinical applications are discussed.
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10
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Miyakoshi A, Funaki T, Fushimi Y, Nakae T, Okawa M, Kikuchi T, Kataoka H, Yoshida K, Mineharu Y, Matsuhashi M, Nakatani E, Miyamoto S. Cortical Distribution of Fragile Periventricular Anastomotic Collateral Vessels in Moyamoya Disease: An Exploratory Cross-Sectional Study of Japanese Patients with Moyamoya Disease. AJNR Am J Neuroradiol 2020; 41:2243-2249. [PMID: 33154076 DOI: 10.3174/ajnr.a6861] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 08/06/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Collateral vessels in Moyamoya disease represent potential sources of bleeding. To test whether these cortical distributions vary among subtypes, we investigated cortical terminations using both standardized MR imaging and MRA. MATERIALS AND METHODS Patients with Moyamoya disease who underwent MR imaging with MRA in our institution were enrolled in this study. MRA was spatially normalized to the Montreal Neurological Institute space; then, collateral vessels were measured on MRA and classified into 3 types of anastomosis according to the parent artery: lenticulostriate, thalamic, and choroidal. We also obtained the coordinates of collateral vessel outflow to the cortex. Differences in cortical terminations were compared among the 3 types of anastomosis. RESULTS We investigated 219 patients with Moyamoya disease, and a total of 190 collateral vessels (lenticulostriate anastomosis, n = 72; thalamic anastomosis, n = 21; choroidal anastomosis, n = 97) in 46 patients met the inclusion criteria. We classified the distribution patterns of collateral anastomosis as follows: lenticulostriate collaterals outflowing anteriorly (P < .001; 95% CI, 67.0-87.0) and medially (P < .001; 95% CI, 11.0-24.0) more frequently than choroidal collaterals; lenticulostriate collaterals outflowing anteriorly more frequently than thalamic collaterals (P < .001; 95% CI, 34.0-68.0); and choroidal collaterals outflowing posteriorly more frequently than thalamic collaterals (P < .001; 95% CI, 14.0-34.0). Lenticulostriate anastomoses outflowed to the superior or inferior frontal sulcus and interhemispheric fissure. Thalamic anastomoses outflowed to the insular cortex and cortex around the central sulcus. Choroidal anastomoses outflowed to the cortex posterior to the central sulcus and the insular cortex. CONCLUSIONS Cortical distribution patterns appear to differ markedly among the 3 types of collaterals.
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Affiliation(s)
- A Miyakoshi
- From the Department of Neurosurgery (A.M., T.F., M.O., T.K., H.K., K.Y., Y.M., S.M.)
- Department of Neurosurgery (A.M.)
| | - T Funaki
- From the Department of Neurosurgery (A.M., T.F., M.O., T.K., H.K., K.Y., Y.M., S.M.)
| | - Y Fushimi
- Diagnostic Imaging and Nuclear Medicine (Y.F.)
| | - T Nakae
- Department of Neurosurgery (T.N.), Shiga General Hospital, Shiga, Japan
| | - M Okawa
- From the Department of Neurosurgery (A.M., T.F., M.O., T.K., H.K., K.Y., Y.M., S.M.)
| | - T Kikuchi
- From the Department of Neurosurgery (A.M., T.F., M.O., T.K., H.K., K.Y., Y.M., S.M.)
| | - H Kataoka
- From the Department of Neurosurgery (A.M., T.F., M.O., T.K., H.K., K.Y., Y.M., S.M.)
| | - K Yoshida
- From the Department of Neurosurgery (A.M., T.F., M.O., T.K., H.K., K.Y., Y.M., S.M.)
| | - Y Mineharu
- From the Department of Neurosurgery (A.M., T.F., M.O., T.K., H.K., K.Y., Y.M., S.M.)
| | - M Matsuhashi
- Epilepsy, Movement Disorders and Physiology (M.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - E Nakatani
- Division of Statistical Analysis (E.N.), Shizuoka General Hospital, Shizuoka, Japan
| | - S Miyamoto
- From the Department of Neurosurgery (A.M., T.F., M.O., T.K., H.K., K.Y., Y.M., S.M.)
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Das S, Dubey S, Acharya M, Ghosh R, Chatterjee S, Hazra A, Lahiri D, Segupta S, Chatterjee S, Das G, Sarkar N, Ray BK, Kraemer M. The disease presentation of Moyamoya angiopathy in Eastern India. J Stroke Cerebrovasc Dis 2020; 29:104957. [PMID: 32689603 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104957] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 04/18/2020] [Accepted: 05/12/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Clinical spectrum of Moyamoya angiopathy (MMA) differs across populations with different ethnicity. This study, the largest one done among Indian population was undertaken to assess clinico-radiological profile of MMA patients in eastern India. METHODS A single centre cross-sectional study was undertaken among 76 MMA cases. Each patient was evaluated for epidemiological, clinical and radiological characteristics. SPSS 25 was used for statistical analysis. P < 0.05 was taken as statistically significant. RESULTS 36 (47.4%) were children without gender preponderance. There were female predominance among adults (male:female = 1:2.33). Mean age at onset of first neurological symptoms for children was 4.2 ± 2.0years, followed by 34.9 ± 58.2months of latency with final diagnosis at the mean age of 7.4 ± 3.5years. For adults, mean age of onset of first neurological symptoms was 31.5 ± 12.3years, followed by 14.7 ± 41.7months time gap and diagnosed at the mean age of 33.5 ± 12.5years. There was a statistically significant difference between child and adult regarding the diagnostic latency (p = 0.035). Fixed motor weakness (FMW) was the predominant symptom across the whole disease course. Among children predominant first neurological symptom was fixed motor weakness (FMW) (52.8%), followed by seizures (22.2%). FMW was predominant (55%) first neurological complaint, followed by headache (22.5%) among adults. Seizure was more prevalent among children both as first (p = 0.002) and presenting symptom at the time of diagnosis (p = 0.048). Over the course of the disease seizure was more common among children (p = 0.001), while headache was more common among adults (p = 0.017). Recurrence of symptoms was more common among children (p = 0.059). Infarcts were more common among children (91.7%) than adults (72.5%), while hemorrhage was seen only among adults (25%) (p = 0.004). Isolated cerebral cortex was involved more commonly among children (59.4%) than adults (36.1%), while isolated subcortical involvement was seen only among adults (19.4%) (p = 0.016). Majority of the MMA cases were of Suzuki stage 4 (39.5%) and 5 (27.6%). Brain atrophy was associated with diagnostic latency (p = 0.009). CONCLUSION Indian Moyamoya presents similar to disease presentation in Caucasian and Japanese patients. It is a frequently overlooked cause of stroke in young, often with various non-motor presentations, failure to recognize which leads to delay in diagnosis. Radiological burden disproportionate to number of acute vascular events, with subtle neurological manifestations like headache or seizure, often with cognitive decline, should raise suspicion of MMA.
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Affiliation(s)
- Shambaditya Das
- Department of Neuromedicine, Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education and Research& SSKM Hospital, Kolkata, West Bengal, India
| | - Souvik Dubey
- Department of Neuromedicine, Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education and Research& SSKM Hospital, Kolkata, West Bengal, India
| | - Mrinal Acharya
- Department of Neurology, Malda Medical College and Hospital, Malda, West Bengal, India
| | - Ritwik Ghosh
- Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - Subhankar Chatterjee
- Department of General Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Avijit Hazra
- Department of Pharmacology, Institute of Post Graduate Medical Education and Research & SSKM Hospital, Kolkata, West Bengal, India
| | - Durjoy Lahiri
- Department of Neuromedicine, R.G. Kar Medical College & Hospital, Kolkata, West Bengal, India
| | - Samya Segupta
- Department of Medicine, Apollo Gleneagles Hospital, Kolkata, West Bengal, India
| | - Subham Chatterjee
- Institute of Psychiatry, Institute of Post Graduate Medical Education and Research & SSKM Hospital, Kolkata, West Bengal, India
| | - Goutam Das
- Department of Neuromedicine, Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education and Research& SSKM Hospital, Kolkata, West Bengal, India
| | - Niladri Sarkar
- Department of General Medicine, Institute of Post Graduate Medical Education and Research & SSKM Hospital, Kolkata, West Bengal, India
| | - Biman Kanti Ray
- Department of Neuromedicine, Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education and Research& SSKM Hospital, Kolkata, West Bengal, India.
| | - Markus Kraemer
- Department of Neurology, Alfried Krupp Von Bohlen Und Halbach Hospital, Alfried-Krupp-Str. 21, 45117, Essen, Germany and Heinrich Heine University of Duesseldorf, Medical Faculity, Duesseldorf, Germany
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Hou K, Li G, Guo Y, Xu B, Xu K, Yu J. Angiographic study of the transdural collaterals at the anterior cranial fossa in patients with Moyamoya disease. Int J Med Sci 2020; 17:1974-1983. [PMID: 32788876 PMCID: PMC7415394 DOI: 10.7150/ijms.48308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 07/12/2020] [Indexed: 01/31/2023] Open
Abstract
Unlike its parietal, temporal, and occipital counterparts, the frontal lobe has a broad basal surface directly facing the anterior cranial fossa dura mater which could permit establishment of transdural collaterals (TDCs) with the frontal lobe. Studies on the TDCs from the anterior cranial fossa in moyamoya disease (MMD) are scarce and inadequately investigated. A retrospective study of 100 hemispheres in 50 patients who were diagnosed with MMD by catheter angiography between January 2015 and June 2019 was performed in our institution. TDCs through the anterior ethmoid artery (AEA) or posterior ethmoid artery (PEA) were divided into 3 types respectively based on their respective angioarchitecture. Furthermore, we also studied TDCs to the temporal, parietal, and occipital lobes and collaterals from the posterior circulation to the territory of the anterior cerebral artery. TDCs through the AEA and PEA were identified in 89 (89/100, 89%) and 73 (73/100, 73%) of the hemispheres. The vascularization state of the frontal lobe was good in 89 (89/100, 89%) hemispheres. Rete mirabile and TDCs through the PEA were statistically different among patients with different Suzuki stages. No statistical difference was noted in TDCs through the AEA, frontal TDCs from other sources, and the vascularization state of the frontal lobe with regard to different Suzuki stages. TDCs through the AEA and PEA at the anterior cranial fossa play a very important role in compensating the ischemic frontal lobe. The frontal lobe could be well compensated in most of the patients with TDCs at the anterior cranial fossa.
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Affiliation(s)
- Kun Hou
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, 130021, China
| | - Guichen Li
- Department of Neurology, The First Hospital of Jilin University, Changchun, 130021, China
| | - Yunbao Guo
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, 130021, China
| | - Baofeng Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, 130021, China
| | - Kan Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, 130021, China
| | - Jinlu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, 130021, China
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Das S, Dubey S, Acharya M, Chatterjee S, Lahiri D, Das G, Ray BK, Kraemer M. Thalassemia and Moyamoya syndrome: unfurling an intriguing association. J Neurol 2019; 266:2838-47. [PMID: 31422456 DOI: 10.1007/s00415-019-09497-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/04/2019] [Accepted: 08/05/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Moyamoya angiopathy (MMA) is a rare cerebrovascular disease with progressive bilateral narrowing of intracranial parts of the internal carotid artery and proximal parts of the anterior and middle cerebral artery resulting in recurrent hemodynamic ischemic attacks, strokes and hemorrhages. If associated with other diseases, it is called Moyamoya syndrome (MMS). Until now, MMS has rarely been described with thalassemia. METHODS Of the 75 cases of MMA collected in our Indian center in the last 3 years, 4 new patients with the rare cooccurence of thalassemia and MMS were found. Thalassemia cases were confirmed by hemoglobin electrophoresis and MMA was diagnosed on the basis of MR angiography. Other known secondary causes of MMA were ruled out by relevant investigations. Thirteen previously reported cases of thalassemia and MMA were retrieved by literature search in PubMed and Google Scholar using the keywords "Moyamoya" AND "thalassemia". Subsequently all the data were analyzed and compared by using descriptive statistics. RESULTS Analysis of our 4 cases and those 13 found in the literature showed early childhood diagnosis of thalassemia and in most cases later manifestation of MMS in the age of 14.5 + 10.72 years (mean + SD) in our cases and with 10.97 + 6.47 years in previous cases. While 9 out of the former 13 and 3 of our 4 cases showed obvious infarcts in brain imaging, 1 case with HbE-β-thalassemia presented with intracerebral hemorrhage. Hemiplegia/hemiparesis was present among all of our 4 cases, while it was present in 69.23% cases of the previous 13 reports. Neither transfusion dependence nor the history of splenectomy was found to be associated with MMA development. CONCLUSION These four new cases of MMS in thalassemia enlarged our knowledge about MMS in patients with thalassemia. MMS is a relevant complication in patients with thalassemia and early detection is essential to avoid disability.
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Kraemer M, Keyvani K, Berlit P, Diesner F, Marquardt M. Histopathology of Moyamoya angiopathy in a European patient. J Neurol 2019; 266:2258-2262. [DOI: 10.1007/s00415-019-09406-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 05/25/2019] [Accepted: 05/28/2019] [Indexed: 10/26/2022]
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Kraemer M, Karakaya R, Matsushige T, Graf J, Albrecht P, Hartung HP, Berlit P, Laumer R, Diesner F. Efficacy of STA-MCA bypass surgery in moyamoya angiopathy: long-term follow-up of the Caucasian Krupp Hospital cohort with 81 procedures. J Neurol 2018; 265:2425-2433. [PMID: 30155735 DOI: 10.1007/s00415-018-9031-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 08/18/2018] [Accepted: 08/20/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Despite the consensus on the efficacy of revascularizing surgery in moyamoya angiopathy (MA) in Asia, the indication in Caucasian moyamoya patients is controversially discussed. OBJECTIVE The efficacy of revascularizing surgery in adult European patients with MA should be clarified. METHODS This study retrospectively analyzed the rate of further strokes and hemorrhages as well as MRI and Duplex ultrasound features during long-term follow up after STA-MCA bypass. RESULTS Eighty-one STA-MCA bypass procedures in 54 patients with MA operated in one single German institution were analyzed. All 54 patients (100%) were Caucasians. After two diffusion restricted spots in MRI perioperatively (2.5%) and short-lasting symptoms directly after surgery, no patient experienced further new symptoms related to stroke or hemorrhages nor no new gliotic scars or microbleeds on MRI for 38.2 months. Duplex ultrasound 3 months after surgery documented bypass patency in 100% and sonographic sign for good relevance of the bypass in 96.2%. In addition, the diameter of the donor vessel had increased in 89.9% as an indicator for the relevance of the bypass. Semi-quantitative analysis of perfusion changes in the operated hemispheres demonstrated an increase in perfusion in the MCA territory in 56 of 74 (75.7%) hemispheres 36.7 months after surgery. In MRA images, a reduction of typical moyamoya collaterals was found in 65 of 79 hemispheres (82.3%) after a mean of 37.2 months. CONCLUSION Direct STA-MCA bypass is an effective therapy in Caucasian patients with hemodynamically compromised MA.
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Affiliation(s)
- Markus Kraemer
- Department of Neurology, Alfried Krupp von Bohlen und Halbach Hospital, Alfried-Krupp-Strasse 21, 45117, Essen, Germany. .,Department of Neurology, Medical Faculty, Heinrich Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany.
| | - Rusen Karakaya
- Department of Neurology, Alfried Krupp von Bohlen und Halbach Hospital, Alfried-Krupp-Strasse 21, 45117, Essen, Germany
| | - Toshinori Matsushige
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Jonas Graf
- Department of Neurology, Medical Faculty, Heinrich Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Philipp Albrecht
- Department of Neurology, Medical Faculty, Heinrich Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Peter Berlit
- Department of Neurology, Alfried Krupp von Bohlen und Halbach Hospital, Alfried-Krupp-Strasse 21, 45117, Essen, Germany
| | - Rudolf Laumer
- Department of Neurosurgery, Alfried Krupp Hospital, Alfried-Krupp-Strasse 21, 45130, Essen, Germany
| | - Frank Diesner
- Department of Neurosurgery, Alfried Krupp Hospital, Alfried-Krupp-Strasse 21, 45130, Essen, Germany
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