Related Experiment Video
Updated: Mar 21, 2026
Permanent Cerebral Vessel Occlusion via Double Ligature and Transection
Published on: July 21, 2013
Non-moyamoya vessel network formation along steno-occlusive middle cerebral artery
Yu-Yuan Xu1, Ming-Li Li1, Shan Gao1
1From the Departments of Neurology (Y.-Y.X., S.G., W.-H.X.) and Radiology (M.-L.L., B.H., Z.-Y.S., H.-L.Z., F.F.), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Objective:
In this study, we sought to examine the prevalence and clinical relevance of deep tiny flow voids (DTFV) in patients with steno-occlusive middle cerebral artery (MCA) disease on high-resolution MRI (HRMRI).
Methods:
We retrospectively reviewed the HRMRI and clinical data of 477 patients with MCA steno-occlusive disease. The presence and distribution of DTFV, defined as 3 or more flow voids along the affected MCA on at least 2 consecutive T2-weighted image slices on HRMRI, were observed. The relationships among DTFV, the degree of stenosis (mild <50%, moderate 50%-70%, severe 70%-99%, and occlusion), and infarctions were analyzed. To clarify the difference between DTFV and moyamoya collaterals, we compared the HRMRI findings of the patients with DTFV and 102 patients with moyamoya disease.
Results:
The prevalence of DTFV was 1.4% in mild stenosis, 12.8% in moderate stenosis, 40.6% in severe stenosis, and 50.7% in MCA occlusions. Of the 112 patients with DTFV, 57 (50.9%) had all 4 quadrants (superior, inferior, dorsal, and ventral sides) of the MCA involved. DTFV were more common in asymptomatic patients than in symptomatic patients with severe stenosis (49.3% vs 30.9%, p = 0.025) and occlusions (68.0% vs 41.7%, p = 0.033). Obvious flow voids in the basal ganglia region were observed in 58 patients (56.9%) with moyamoya disease but in none of the patients with DTFV (p < 0.001).
Conclusions:
DTFV are common in patients with severe steno-occlusive MCA disease, especially in asymptomatic patients. We hypothesize that DTFV originate from new vessel network formation in response to chronic cerebral ischemia.
Insights
Deep tiny flow voids (DTFV) are common in severe middle cerebral artery (MCA) steno-occlusive disease, particularly in asymptomatic individuals. These findings suggest DTFV may indicate new vessel formation due to chronic ischemia.
Area of Science:
- Neuroradiology
- Cerebrovascular Diseases
- Medical Imaging
Background:
- Steno-occlusive disease of the middle cerebral artery (MCA) poses a significant risk for stroke.
- High-resolution MRI (HRMRI) allows detailed visualization of cerebral vasculature.
- Deep tiny flow voids (DTFV) are a potential imaging marker requiring further investigation in MCA disease.
Purpose of the Study:
- To determine the prevalence and clinical relevance of DTFV in patients with MCA steno-occlusive disease using HRMRI.
- To analyze the association between DTFV, degree of MCA stenosis, and infarction.
- To differentiate DTFV from moyamoya collaterals.
Main Methods:
- Retrospective review of HRMRI and clinical data from 477 patients with MCA steno-occlusive disease.
- Definition of DTFV: ≥3 flow voids along affected MCA on ≥2 consecutive T2-weighted HRMRI slices.
- Comparison of DTFV findings with 102 patients diagnosed with moyamoya disease.
Main Results:
- DTFV prevalence increased with MCA stenosis severity: 1.4% (mild), 12.8% (moderate), 40.6% (severe), 50.7% (occlusion).
- DTFV were more frequent in asymptomatic patients with severe stenosis (49.3%) and occlusions (68.0%) compared to symptomatic patients.
- No DTFV were observed in patients with moyamoya disease, distinguishing them from basal ganglia flow voids seen in moyamoya.
Conclusions:
- DTFV are frequently observed in severe MCA steno-occlusive disease, particularly in asymptomatic individuals.
- The presence of DTFV may suggest a developing collateral network in response to chronic cerebral ischemia.
- DTFV represent a distinct imaging finding differentiating from moyamoya disease.
Related Concept Videos
01:10The Arch of Aorta
Encircling the heart, the coronary arteries form a ring-like structure before...
01:26Arteries of the Head and Neck
The internal carotid arteries supply blood to the anterior portion of the cerebrum. They enter the...