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Optimized System for Cerebral Perfusion Monitoring in the Rat Stroke Model of Intraluminal Middle Cerebral Artery Occlusion
Published on: February 17, 2013
Perfusion characteristics of Moyamoya disease: an anatomically and clinically oriented analysis and comparison
Gerrit Alexander Schubert1, Marcus Czabanka, Marcel Seiz
1From the Department of Neurosurgery, Uniklinik RWTH Aachen, Aachen, Germany (G.A.S.); Department of Neurosurgery, Universitätsmedizin Mannheim, University of Heidelberg, Heidelberg, Germany (G.A.S., M.S.); Department of Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany (M.C., P.V.); Department of Neurosurgery, Dr. Horst Schmidt Klinik (HSK), Wiesbaden, Germany (P.H.); and Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria (C.T.).
Background And Purpose:
Moyamoya disease (MMD) is characterized by unique angiographic features of collateralization. However, a detailed quantification as well as comparative analysis with cerebrovascular atherosclerotic disease (CAD) and healthy controls have not been performed to date.
Methods:
We reviewed 67 patients with MMD undergoing Xenon-enhanced computed tomography, as well as 108 patients with CAD and 5 controls. In addition to cortical, central, and infratentorial regions of interest, particular emphasis was put on regions that are typically involved in MMD (pericallosal territory, basal ganglia). Cerebral blood flow (CBF), cerebrovascular reserve capacity (CVRC), and hemodynamic stress distribution were calculated.
Results:
MMD is characterized by a significant, ubiquitous decrease in CVRC and a cortical but not pericallosal decrease in CBF when compared with controls. Baseline perfusion is maintained within the basal ganglia, and hemodynamic stress distribution confirmed a relative preservation of central regions of interest in MMD, indicative for its characteristic proximal collateralization pattern. In MMD and CAD, cortical and central CBF decreased significantly with age, whereas CVRC and hemodynamic stress distribution are relatively unaffected by age. No difference in CVRC of comparable regions of interest was seen between MMD and CAD, but stress distribution was significantly higher in MMD, illustrating the functionality of the characteristic rete mirabilis.
Conclusions:
Our data provide quantitative support for a territory-specific perfusion pattern that is unique for MMD, including central preservation of CBF compared with controls and patients with CAD. This correlates well with its characteristic feature of proximal collateralization. CVRC and hemodynamic stress distribution seem to be more robust parameters than CBF alone for assessment of disease severity.
Insights
Moyamoya disease (MMD) shows unique brain blood flow patterns, with preserved central perfusion unlike cerebrovascular atherosclerotic disease (CAD). Hemodynamic stress and reserve capacity are key indicators of MMD severity.
Area of Science:
- Neuroscience
- Radiology
- Cerebrovascular Diseases
Background:
- Moyamoya disease (MMD) presents distinct angiographic collateralization patterns.
- Quantitative analysis comparing MMD to cerebrovascular atherosclerotic disease (CAD) and controls is lacking.
Purpose of the Study:
- To quantitatively analyze and compare cerebral blood flow (CBF), cerebrovascular reserve capacity (CVRC), and hemodynamic stress distribution in MMD versus CAD and controls.
- To investigate the relationship between these hemodynamic parameters and age in MMD and CAD.
- To correlate hemodynamic findings with the characteristic collateralization patterns in MMD.
Main Methods:
- Retrospective review of 67 MMD patients, 108 CAD patients, and 5 controls using Xenon-enhanced computed tomography.
- Calculation of CBF, CVRC, and hemodynamic stress distribution in cortical, central, infratentorial, pericallosal, and basal ganglia regions.
- Comparative analysis of hemodynamic parameters across patient groups and with respect to age.
Main Results:
- MMD exhibits a global decrease in CVRC and cortical CBF reduction compared to controls, with preserved basal ganglia perfusion.
- Age significantly impacts cortical and central CBF in both MMD and CAD, but not CVRC or hemodynamic stress distribution.
- MMD and CAD show similar CVRC, but MMD has higher hemodynamic stress, reflecting its unique collateral network (rete mirabilis).
Conclusions:
- MMD demonstrates a unique territory-specific perfusion pattern, notably preserved central CBF, correlating with proximal collateralization.
- CVRC and hemodynamic stress distribution are more sensitive indicators of disease severity than CBF alone in MMD.
- Quantitative hemodynamic analysis aids in understanding MMD pathophysiology and differentiating it from CAD.
