Haemodynamic analysis of adult patients with moyamoya disease: CT perfusion and DSA gradings

Prediction of the mean transit time using machine learning models based on radiomics features from digital subtraction angiography in moyamoya disease or moyamoya syndrome-a development and validation model study

Background

Digital subtraction angiography (DSA) is an important technique for diagnosis of moyamoya disease (MMD) or moyamoya syndrome (MMS), and computed tomography perfusion (CTP) is essential for assessing intracranial blood supply. The aim of this study was to assess whether radiomics features based on images of DSA could predict the mean transit time (MTT; outcome of CTP) using machine learning models.

Methods

The DSA images and MTT values of adult patients with MMD or MMS, according to the diagnostic guidelines for MMD, as well as control cases, were retrospectively collected in the Guangdong Provincial People's Hospital between January 2018 and December 2020. A total of 93 features were extracted from the images of each case through 3-dimensional (3D) slicer. After features preprocessing and filtering, 3-4 features were selected by the least absolute shrinkage and selection operator (LASSO) regression algorithm. Prediction models were established using random forest (RF) and support vector machine (SVM) for MTT values. Single-factor receiver operating characteristic (ROC) curve analysis and partial-dependence (PD) profiles were conducted to investigate selected features and prediction models.

Results

Our results showed that prediction models based on RF models had the best performance in frontal lobe {area under the curve (AUC) [95% confidence interval (CI)] =1.000 (1.000-1.000)], parietal lobe [AUC (95% CI) =1.000 (1.000-1.000)], and basal ganglia/thalamus [AUC (95% CI) =0.922 (0.797-1.000)] in the test set, whereas the SVM model performed the best in the temporal lobe [AUC (95% CI) =0.962 (0.876-1.000)] in the test set. The AUC values in the test set were greater than 0.9. The PD profiles showed good robustness and consistency.

Conclusions

Prediction models based on radiomics features extracted from DSA images demonstrate excellent performance in predicting MTT in patients with MMD or MMS, which may provide guidance for future clinical practice.

Clinical features, surgical treatment, and long-term outcomes of moyamoya disease in a single institution of Fujian, Southeast China: A retrospective study

At present, detailed demographic and clinical data of moyamoya disease (MMD) in the population of Southeast China are lacking. Therefore, this study aimed to evaluate the epidemiological and clinical features of MMD in Southeast China. Our cohort included 170 patients diagnosed with MMD over the preceding 5 years. Clinical characteristics were obtained through a retrospective chart review, while follow-up information and outcomes were obtained through clinical visits and imaging. The median age at symptom onset was 49 years (range 4-73), with a peak in the age distribution observed at 41 to 60 years. The female-to-male ratio was 1.125 (90/80), and the ratio of the ischemic type to the hemorrhagic type was 2.33 (119/50). The most common initial symptom was an ischemic event. The 5-year Kaplan-Meier risk of stroke was 4.9% for all patients treated with surgical revascularization. Of all patients, 83.9% were able to live independently with no significant disability, and 89.8% showed improved cerebral hemodynamics. Our study provided detailed demographic and clinical data on Southeastern Chinese patients with MMD, which was consistent with findings in other parts of China. Raising clinical awareness of MMD in primary hospitals is important to facilitate early diagnosis and timely treatment of MMD patients.

Three-Dimensional Arterial Spin Labeling for the Evaluation of the Cerebral Hemodynamics in Ischemic and Hemorrhagic Moyamoya Disease

INTRODUCTION

Moyamoya disease (MMD) is a vascular disease with significant risk of mortality due to ischemia or hemorrhage in the brain. The goal of the study was to explore three-dimensional arterial spin labeling (3D-ASL) to improve evaluation of cerebral hemodynamics in patients with MMD.

METHODS

Our study included 54 cases of ischemic MMD and 42 cases of hemorrhagic MMD. Dynamic susceptibility contrast-enhanced perfusion-weighted imaging (DSC-PWI) and 3D-ASL were performed at 3.0 T. Based on these scans, cerebral blood flow (CBF), mean transit time (MTT), and time to peak (TTP) were calculated and compared between patients with different disease subtypes. Receiver operating characteristics analysis was used to assess the diagnostic sensitivity and specificity of different imaging procedures and parameters.

RESULTS

Our data suggested that CBF in the lesion area was more severely reduced in patients with hemorrhagic MMD than in those with ischemic MMD. The CBF parameter in 3D-ASL diagnosed hemorrhagic and ischemic MMD with a significant sensitivity and specificity of 80.59% and 57.41%, respectively, with an area under the curve (AUC) of 0.75. We also found that the relative CBF of 3D-ASL was more pronounced decreased and the relative MTT and TTP of DSC-PWI were significantly increased in patients with hemorrhagic MMD than those with ischemic MMD. Specificity and sensitivity and AUC of 3D-ASL were better than the comparison of absolute values from DSC-PWI scans.

CONCLUSION

Our study indicated that 3D-ASL is powerful in differentiating patients with cerebral ischemic or hemorrhagic MMD, providing another diagnostic tool that could potentially improve precision medicine to monitoring MMD patients.

Predictive value of CT perfusion-derived parameters in Moyamoya disease

OBJECTIVE

To explore the applicability of CT perfusion-derived parameters and collateral index in prediction of functional and clinical outcomes in patients with Moyamoya disease (MMD) who have not been treated surgically.

METHODS

All hemispheres were categorized into four groups: those with ischemic (IS) lesions, hemorrhagic (HE) lesions, subarachnoid hemorrhage (SAH) and normal hemisphere (NH). The clinical review included primary outcomes (whether a patient survived the cerebrovascular event) and secondary outcomes (the modified Rankin scale [mRS] and Katz-activity of daily living [ADL] scale). CTP-derived parameters of the frontal, temporal lobe and basal ganglia were calculated. Collateral index of the hypointensity ratio (HIR) was defined as a volume of Tmax >10 s/ Tmax >4 s.

RESULTS

Between December 2020 and December 2021, 21 MMD patients (15 bilateral cases and 6 unilateral cases, for a total of 36 hemispheres) were retrospectively included. Compared with the NH group, the IS group showed obviously abnormal hemodynamics. As for the primary outcomes, HIR showed an excellent area under the curve of 0.955 (95 % CI: 0.886-1.000, p < 0.001). Significant correlations were found between CTP-derived parameters and secondary outcomes. Furthermore, HIR was significantly correlated with mRS (r = 0.576, p = 0.001) and ADL scores (r = 0.644, p < 0.001).

CONCLUSION

Among different imaging types, IS hemispheres were characterized by distinct changes of hemodynamic parameters. Collateral index of HIR could be considered a clinically accessible and promising indictor of functional and clinical outcomes in MMD.

Risk factors of postoperative cerebral hyperperfusion syndrome and its relationship with clinical prognosis in adult patients with moyamoya disease

BACKGROUND

To investigate the incidence, risk factors, and clinical prognosis of cerebral hyperperfusion syndrome (CHS) after superficial temporal artery-middle cerebral artery anastomosis combined with encephalo-duro-arterio-synangiosis (STA-MCA/EDAS) in adult patients with moyamoya disease (MMD).

METHODS

The clinical data of 160 adult patients with MMD treated by STA-MCA/EDAS from January 2016 to January 2017 were retrospectively analyzed. According to CHS diagnosis, MMD patients were divided into CHS and non-CHS group. Univariate and multivariate analysis of risk factors and Kaplan-Meier curve of stroke-free survival for CHS were performed.

RESULTS

A total of 12 patients (7.5%) developed postoperative CHS, of which 4 patients (2.5%) presented with cerebral hemorrhage. Univariate and multivariate analysis showed moyamoya vessel on the surgical hemisphere (OR = 3.04, 95% CI = 1.02-9.03, P = 0.046) and left operated hemisphere (OR = 5.16, 95% CI = 1.09-21.34, P = 0.041) were independent risk factors for CHS. The other variables, such as age, gender, presentation, hypertension, diabetes, smoking, mean mRS score on admission, modified Suzuki stage and pre-infarction stage on surgical hemisphere, and bypass patency, had no association with postoperative CHS (P > 0.05). At final follow-up with average 38 months, there were 18 out of 133 patients (13.5%, 4.91% per person year) presented with newly developed complications. There was no significant difference between newly developed complications, mean mRS scores, and Kaplan-Meier curve of stroke-free survival in patients with and without CHS (P > 0.05).

CONCLUSION

The concentration of moyamoya vessels and left operated hemisphere was independent risk factors for CHS, which could not affect the clinical prognosis if treated timely and properly. The current study offers a new perspective of moyamoya vessels and supporting data for choosing MMD candidates on cerebral revascularization.

Computational Modelling of Cerebral Blood Flow Rate at Different Stages of Moyamoya Disease in Adults and Children

Moyamoya disease is a cerebrovascular disorder which causes a decrease in the cerebral blood flow rate. In this study, a lumped parameter model describing the pressures and flow rates in the heart chambers, circulatory system, and cerebral circulation with the main arteries in the circle of Willis, pial circulation, cerebral capillaries, and veins was used to simulate Moyamoya disease with and without coarctation of the aorta in adults and children. Cerebral blood flow rates were 724 mL/min and 1072 mL/min in the healthy adult and child cardiovascular system models. The cerebral blood flow rates in the adult and child cardiovascular system models simulating Moyamoya disease were 676 mL/min and 1007 mL/min in stage 1, 627 mL/min and 892 mL/min in stage 2, 571 mL/min and 831 in stage 3, and 444 and 537 mL/min in stage 4. The cerebral blood flow rates were 926 mL/min and 1421 mL/min in the adult and child cardiovascular system models simulating coarctation of the aorta. Furthermore, the cerebral blood flow rates in the adult and child cardiovascular system model simulating Moyamoya disease with coarctation of the aorta were 867 mL/min and 1341 mL/min in stage 1, 806 mL/min and 1197 mL/min in stage 2, 735 mL/min and 1121 in stage 3, and 576 and 741 mL/min in stage 4. The numerical model utilised in this study can simulate the advancing stages of Moyamoya disease and evaluate the associated risks with Moyamoya disease.

Ultrasonic hemodynamic changes of superficial temporal artery graft in different angiogenesis outcomes of Moyamoya disease patients treated with combined revascularization surgery

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.

Diabetes or calcium channel blocker contribute to cerebral hemodynamics after bypass surgery in adult patients with moyamoya disease

Background

Moyamoya disease (MMD) is a teratogenic and lethal disease. However, existing studies do not sufficiently indicate the impact factors. Therefore, we investigated the different impact factors on cerebral hemodynamics after revascularization in patients with MMD.

Methods

We retrospectively collected the clinical data of 233 adult patients with MMD who underwent revascularization surgery in the Department of Neurosurgery, Renmin Hospital of Wuhan University, from January 2015 to June 2021 for this retrospective cohort study. We analyzed the effects on hemodynamic improvement of age, sex, stroke type, early symptoms, Suzuki stage, history of hypertension, history of diabetes, and history of hyperlipidemia in patients with MMD. We also evaluated the efficacy of different revascularization strategies and we verified the effect of computed tomography perfusion (CTP) in evaluating cerebral hemodynamics.

Results

The CTP values demonstrated that δ cerebral blood volume (CBV) values were significantly higher in the combined group [1.01 (0.87-1.75)] relative to those in the indirect group [1.34 (1.01-1.63); P=0.027]. There was no statistical significance in the improvement of clinical symptoms and clinical prognosis between the indirect and combined groups. Patients with MMD with diabetes [δ mean transit time (MTT), 0.49 (0.35-0.70) vs. 0.72 (0.52-0.87); P<0.001] or calcium channel blocker (CCB) [δCBV, 1.46 (1.10-1.83) vs. 1.12 (0.93-1.54); P=0.001] had better cerebral hemodynamics than patients in non-diabetic group or non-CCB group after revascularization.

Conclusions

We didn't find differences in clinical outcome between indirect and combined revascularization in patients with MMD. we demonstrated that CTP values can be used as a way to detect postoperative cerebral hemodynamic changes in MMD patients. Interestingly, we found that MMD patients with diabetes or CCB showed better cerebral perfusion after revascularization.

Baseline Hemodynamic Impairment and Revascularization Outcome in Newly Diagnosed Adult Moyamoya Disease Determined by Pseudocontinuous Arterial Spin Labeling

OBJECTIVE

The study aimed to investigate the hemodynamic features and independent predictors of neoangiogenesis after revascularization in moyamoya disease (MMD) by pseudocontinuous arterial spin labeling magnetic resonance imaging (pCASL MRI).

METHODS

Thirty-nine MMD patients were categorized into infarction group, hemorrhagic group, and atypical group. All patients underwent combined bypass surgery and pCASL MRI with postlabeling delays (PLD) of 1525 ms and 2525 ms. Absolute CBF_MCA (cerebral blood flow in middle cerebral artery territory), relative CBF_MCA (CBF_MCA 2525 ms/CBF_MCA 1525 ms), and spatial coefficient of variation of MCA (CoV_MCA) were analyzed. Relationships between CBF_MCA and the following clinical parameters were assessed: Suzuki stage, modified Rankin scale (mRS), cerebrovascular accident lesion score, and deep medullary veins score. Potential predictors for favorable neoangiogenesis and hemodynamic changes were explored as well.

RESULTS

Preoperative CBF_MCA differed among MMD patients with variable clinical presentations, Matsushima stages, modified Rankin Scale scores, CVA scores, and deep medullary vein scores. After bypass surgery, mean CBF_MCA increased significantly in the infarction group (P = 0.027) and decreased in the hemorrhagic group (P = 0.043), while spatial CoV_MCA was observed to decline in all groups. Higher preoperative relative CBF_MCA and spatial CoV_MCA were independent predictors for robust neoangiogenesis after bypass. The cutoff value of 0.330 of spatial CoV_MCA at long PLD yielded the best sensitivity at 82.1% and specificity at 81.8%. Furthermore, both preoperative relative CBF_MCA and spatial CoV_MCA showed mild positive correlations with ΔmRS in MMD patients.

CONCLUSIONS

pCASL-MRI with multiple PLDs could reflect preoperative hemodynamic impairment and predict the neoangiogenesis after combined bypass surgery in moyamoya patients.

CT perfusion-based delta-radiomics models to identify collateral vessel formation after revascularization in patients with moyamoya disease

Purpose

To build CT perfusion (CTP)-based delta-radiomics models to identify collateral vessel formation after revascularization in patients with moyamoya disease (MMD).

Methods

Fifty-three MMD patients who underwent CTP and digital subtraction angiography (DSA) examination were retrospectively enrolled. Patients were divided into good and poor groups based on postoperative DSA. CTP parameters, such as mean transit time (MTT), time to drain (TTD), time to maximal plasma concentration (Tmax), and flow extraction product (FE), were obtained. CTP efficacy in evaluating surgical treatment were compared between the good and poor groups. The changes in the relative CTP parameters (ΔrMTT, ΔrTTD, ΔrTmax, and ΔrFE) were calculated to evaluate the differences between pre- and postoperative CTP values. CTP parameters were selected to build delta-radiomics models for identifying collateral vessel formation. The identification performance of machine learning classifiers was assessed using area under the receiver operating characteristic curve (AUC).

Results

Of the 53 patients, 36 (67.9%) and 17 (32.1%) were divided into the good and poor groups, respectively. The postoperative changes of ΔrMTT, ΔrTTD, ΔrTmax, and ΔrFE in the good group were significantly better than the poor group (p < 0.05). Among all CTP parameters in the perfusion improvement evaluation, the ΔrTTD had the largest AUC (0.873). Eleven features were selected from the TTD parameter to build the delta-radiomics model. The classifiers of the support vector machine and k-nearest neighbors showed good diagnostic performance with AUC values of 0.933 and 0.867, respectively.

Conclusion

The TTD-based delta-radiomics model has the potential to identify collateral vessel formation after the operation.

Construction of Diagnosis Model of Moyamoya Disease Based on Convolution Neural Network Algorithm

Objective

The convolutional neural network (CNN) was used to improve the accuracy of digital subtraction angiography (DSA) in diagnosing moyamoya disease (MMD), providing a new method for clinical diagnosis of MMD.

Methods

A total of 40 diagnosed with MMD by DSA in the neurosurgery department of our hospital were included. At the same time, 40 age-matched and sex-matched patients were selected as the control group. The 80 included patients were divided into training set (n = 56) and validation set (n = 24). The DSA image was preprocessed, and the CNN was used to extract features from the preprocessed image. The precision and accuracy of the preprocessed image results were evaluated.

Results

There was no significant difference in baseline data between the training set and validation set (P > 0.05). The precision and accuracy of the images before processing were 79.68% and 81.45%, respectively. After image processing, the precision and accuracy of the model are 96.38% and 97.59%, respectively. The area under the curve of the CNN algorithm model was 0.813 (95% CI: 0.718-0.826).

Conclusion

This diagnostic method based on CNN performs well in MMD detection.

Caveolin-1 Promoted Collateral Vessel Formation in Patients With Moyamoya Disease

Background

Caveolin-1 (Cav-1) plays pivotal roles in the endothelial function and angiogenesis postischemia. Moyamoya disease (MMD) is characterized by progressive artery stenosis with unknown etiology. We aim to determine whether serum Cav-1 levels of patients with MMD were associated with collateral vessel formation after bypass surgery.

Methods

We studied serum Cav-1 levels of 130 patients with MMD (16 with RNF213 p.R4810K mutation and 114 without RNF213 p.R4810K mutation), 15 patients with acute stroke, and 33 healthy controls. Cerebral perfusion and collateral circulation were evaluated preoperation and at 6 months after operation using pseudocontinuous arterial spin labeling MRI (pCASL-MRI) and digital subtraction angiography (DSA), respectively. Endothelial expression of Cav-1 was verified in the superficial temporal artery (STA) wall of patients with MMD by immunofluorescence double staining. We also investigated whether overexpression of Cav-1 affects cell migration and tube formation using human microvascular endothelial cells (HMECs).

Results

The serum Cav-1 level of patients with MMD intermediated between the stroke group and healthy controls and it was enhanced after the bypass surgery (681.87 ± 311.63 vs. 832.91 ± 464.41 pg/ml, p = 0.049). By 6 months after bypass surgery, patients with MMD with better collateral compensation manifested higher postoperative/preoperative Cav-1 ratio (rCav-1) than bad compensation patients. Consistently, cerebral blood flow (CBF) determined by pCASL-MRI (nCBF_MCA ratio) was positively in line with rCav-1 ratio (r = 0.8615, p < 0.0001). Cav-1 was expressed in the endothelial cells of the STA vessels of patients with MMD. Overexpression of Cav-1 by plasmid transfection in HMECs promoted tube formation and cell migration.

Conclusion

This study indicated that Cav-1 may be a potential driver to promote angiogenesis and collateral formation after bypass surgery in patients with MMD, providing a better understanding of MMD pathophysiology and potential non-surgical targets of MMD.

A Pilot Study of Radiomic Based on Routine CT Reflecting Difference of Cerebral Hemispheric Perfusion

Background

To explore the effectiveness of radiomics features based on routine CT to reflect the difference of cerebral hemispheric perfusion.

Methods

We retrospectively recruited 52 patients with severe stenosis or occlusion in the unilateral middle cerebral artery (MCA), and brain CT perfusion showed an MCA area with deficit perfusion. Radiomics features were extracted from the stenosis side and contralateral of the MCA area based on precontrast CT. Two different region of interest drawing methods were applied. Then the patients were randomly grouped into training and testing sets by the ratio of 8:2. In the training set, ANOVA and the Elastic Net Regression with fivefold cross-validation were conducted to filter and choose the optimized features. Moreover, different machine learning models were built. In the testing set, the area under the receiver operating characteristic (AUC) curve, calibration, and clinical utility were applied to evaluate the predictive performance of the models.

Results

The logistic regression (LR) for the triangle-contour method and artificial neural network (ANN) for the semiautomatic-contour method were chosen as radiomics models for their good prediction efficacy in the training phase (AUC = 0.869, 0.873) and the validation phase (AUC = 0.793, 0.799). The radiomics algorithms of the triangle-contour and semiautomatic-contour method were implemented in the whole training set (AUC = 0.870, 0.867) and were evaluated in the testing set (AUC = 0.760, 0.802). According to the optimal cutoff value, these two methods can classify the vascular stenosis side class and normal side class.

Conclusion

Radiomic predictive feature based on precontrast CT image could reflect the difference of cerebral hemispheric perfusion to some extent.

High-Resolution Vessel Wall MR Imaging in Diagnosis and Length Measurement of Cerebral Arterial Thrombosis: A Feasibility Study

BACKGROUND

Detecting and measuring intraluminal thrombus has prognostic and therapeutic implications for stroke patients.

PURPOSE

To investigate the feasibility of 3D isotropic high-resolution T1w-CUBE imaging to detect and measure intraluminal thrombus in stroke patients.

STUDY TYPE

Retrospective.

SUBJECTS

A total of 93 patients with acute (N = 39) and subacute (N = 54) stroke.

FIELD STRENGTH/SEQUENCE

A 3.0 T/spin-echo echo-planar diffusion-weighted imaging (DWI), high-resolution T1w-CUBE imaging and 3D flow compensated gradient-echo susceptibility-weighted imaging (SWI).

ASSESSMENT

Data assessment was performed by three neuroradiologists with 11, 13, and 20 years of clinical experience. The accuracy of T1W-CUBE and SWI in diagnosing thrombosis was compared by using digital subtraction angiography (DSA) as the reference. For thrombus length measurement, the image quality of proximal and distal thrombus of T1w-CUBE images was first evaluated with a 4-point rating system. Then, the proximal and distal positions to lesions were determined on T1w-CUBE images and compared with those from DSA acquired during endovascular reperfusion therapy. If comparable both locations were found between CUBE and DSA, CUBE imaging can thus be considered for accurate measurement of thrombus length.

STATISTICAL TESTS

Fleiss' Kappa; the area under the receiver operating characteristic (ROC) curve (AUC); Pearson's chi-squared test with Yates' continuity correction.

RESULTS

Moderate-to-good interobserver agreements were validated with all Kappa coefficients higher than 0.40 in thrombus diagnosis and measurement. CUBE imaging showed higher clinical efficacy than SWI (AUC: 0.966 vs. 0.850) in thrombus diagnosis. Additionally, high quality of CUBE imaging was confirmed with 3 or 4 points rated by all three observers. Compared to intraoperative DSA, T1w CUBE showed consistent proximal and distal positions of thrombi in 16 of the 18 patients, validating the accuracy of T1w-CUBE in measuring thrombus length.

DATA CONCLUSION

T1w-CUBE imaging has potential to facilitate diagnosis and measurement of intraluminal thrombus.

EVIDENCE LEVEL

4 TECHNICAL EFFICACY: Stage 2.

Predictors of preoperative cognitive dysfunction in adults with Moyamoya disease: a preliminary research

OBJECTIVE

To explore potential risk factors of preoperative cognitive dysfunction in adult patients with moyamoya disease (MMD) and discuss significance of moyamoya vessels.

METHODS

The author reviewed adult MMD patients harboring no parenchymal infarction or hemorrhage underwent a standardized neuropsychological assessment test battery from December 2018 to May 2019. The authors defined patients with cognitive dysfunction as cognitive impairment shown on 3 or more neuropsychological tests. According to the presence of cerebral angiography, arterial stenosis, moyamoya vessels, and compensatory arteries were conducted. Univariate and multivariate analyses were performed to identify predictors for cognitive dysfunction before surgery. Subgroup analyses by onset type and Suzuki stage were carried out to identify specific predictors for preoperative cognitive dysfunction.

RESULTS

In total, 29 of 92 (31.52%) patients had cognitive dysfunction. Multivariate analysis showed that moyamoya vessels generating from left hemisphere was recognized as independent predictor for cognitive dysfunction (P = 0.025, OR [95%CI], 0.085 [0.012-0.874]). For patients in left ICA-moyamoya subgroup, 19 of 45 (42.22%) cases with sparse moyamoya vessels had cognitive dysfunction (P = 0.031), while 22 (91.67%) of patients with dense moyamoya vessels had normal cognition (P = 0.004). Moyamoya vessels arising from ophthalmic artery had no significant association with cognitive dysfunction (P = 0.111). Multivariate analysis found that moyamoya vessels originating from left ICA was recognized as independent predictors for preoperative cognitive dysfunction (P = 0.048, OR [95%CI], 0.394 [0.132-0.926]).

CONCLUSIONS

Moyamoya vessels arising from left hemisphere was a risk factor for the preoperative cognitive dysfunction in adult patients with MMD, with the denser moyamoya vessels, the less cognitive dysfunction. The current study offers a new perspective of moyamoya vessels and supporting data for choosing MMD candidates on cerebral revascularization.

Brain perfusion and hemodynamic changes in moyamoya desease

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