Brain Perfusion and Hemodynamic Changes in Moyamoya Disease
##plugins.themes.bootstrap3.article.sidebar##
##plugins.themes.bootstrap3.article.main##
Abstract
Moyamoya disease (MMD) – is a chronic progressive disorder of the unknown etiology with the development of the critical stenoses in internal carotid arteries and abnormal vascular net formation at the basal cerebrum to compensate the hemodynamic insufficiency and further development of the ischemic attacks, strokes, hematomas.
The objective: to study the cerebral hemodynamic parameters and brain perfusion in patients with moyamoya disease.
Materials and methods. We performed retrospective analysis of the cerebral angiography and cerebral perfusion investigations results of 6 patients with moyamoya desease, who were hospitalized in the State Institution «Romodanov Neurosurgery Institute of NAMS of Ukraine» in 2016–2020. All patients underwent a comprehensive examination, which included neuropsychological testing, the head and neck vessels duplex scanning, multispiral computed tomography (MSCT), selective cerebral angiography (SCA), and MSCT-angiography. The assessment of myamoya vessels was done by the Suzuki angiographic scale. Cerebral hemodynamics was studied by perfusion MSCT (PMSCT).
Results. The diagnosis of moyamoya desease was confirmed in all patients by SCA and MSCT angiography. The clinical manifestation of the disease was represented by ischemic (n=5; 83.3%) and hemorrhagic (n=1; 16.7%) strokes. Stage 3, Stage 4 and Stage 6 has been diagnosed by Suzuki angiographic scale. Changes of the cerebral perfusion were more significant at Stage 4 / Stage 6: CBV was increased up to 20%, CBF was decreased > 30% with MTT time > 6 sec. The most significant changes were founed ipsilaterally in the territories of the MCA, moderate – in the territories of the ACA and PCA.
Conclusion. In patients with moyamoya disease we have found the restructuring of the cerebral angioarchitectonics which has been matching the decrease of cerebral perfusion. Perfusion MSCT allows to get identification of the areas with an increased risk of ischemia and provides a decisive quantitative assessment of cerebral hemodynamics changes to establish indications for surgical treatment.
##plugins.themes.bootstrap3.article.details##
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain the copyright and grant the journal the first publication of original scientific articles under the Creative Commons Attribution 4.0 International License, which allows others to distribute work with acknowledgment of authorship and first publication in this journal.
References
Suzuki J., Kodama N. Moyamoya disease – a review. Stroke. 1983;14(1):104–9.
Larson A.S., Lehman V.T., Savastano L.E. Implementation and Rationale for a Unified Clinical and Imaging Protocol for Evaluation and Treatment of Moyamoya Angiopathy: A Single Institutional Experience. Frontiers in neurology. 2021;12:662393.
Yamamoto S., Kashiwazaki D., Uchino H. Clinical and Radiological Features of Childhood Onset Adult Moyamoya Disease: Implication for Hemorrhagic Stroke. Neurologia medico-chirurgica. 2020;60(7):360–67.
Karakama J., Nariai T., Hara S. Unique Angiographic Appearances of Moyamoya Disease Detected with 3-Dimensional Rotational Digital Subtraction Angiography Imaging Showing the Hemodynamic Status. Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association. 2018;27(8):2147–57.
Shi Z., Ma G., Zhang D. Haemodynamic analysis of adult patients with moyamoya disease: CT perfusion and DSA gradings. Stroke and vascular neurology. 2021;6(1):41–47.
Yin H., Liu X., Zhang D. A Novel Staging System to Evaluate Cerebral Hypoperfusion in Patients With Moyamoya Disease. Stroke. 2018;49(12):2837–843.
Research Committee on the Pathology and Treatment of Spontaneous Occlusion of the Circle of Willis, & Health Labour Sciences Research Grant for Research on Measures for Infractable Diseases. Guidelines for diagnosis and treatment of moyamoya disease (spontaneous occlusion of the circle of Willis). Neurologia medico-chirurgica. 2012;52(5):245–66.
Suzuki J., Takaku A. Cerebrovascular «moyamoya» disease. Disease showing abnormal net-like vessels in base of brain. Archives of neurology. 1969;20(3):288–99.
Hervé D., Ibos-Augé N., Calvière L. Predictors of clinical or cerebral lesion progression in adult moyamoya angiopathy. Neurology. 2019;93(4):e388–e397.
Kim J.E., Jeon J.S. An update on the diagnosis and treatment of adult Moyamoya disease taking into consideration controversial issues. Neurological research. 2014;36(5):407–16.
Shang S., Zhou D., Ya J. Progress in moyamoya disease. Neurosurgical review. 2020;43(2):371–82.
Gibbs J.M., Wise R.J., Leenders K.L., Jones T. Evaluation of cerebral perfusion reserve in patients with carotid-artery occlusion. Lancet (London, England). 1984;1(8372):310–14.
Togao O., Mihara F., Yoshiura T. Cerebral hemodynamics in Moyamoya disease: correlation between perfusionweighted MR imaging and cerebral angiography. AJNR. American journal of neuroradiology. 2006; 27(2):391–7.
Piao R., Oku N., Kitagawa K. Cerebral hemodynamics and metabolism in adult moyamoya disease: comparison of angiographic collateral circulation. Annals of nuclear medicine. 2004;18(2):115–21.
