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Moyamoya Disease With Initial Ischemic or Hemorrhagic Attack Shows Different Brain Structural and Functional
Junwen Hu1, Yin Li1, Yun Tong2
1Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Objective:
Cerebral ischemia and intracranial hemorrhage are the two main phenotypes of moyamoya disease (MMD). However, the pathophysiological processes of these two MMD phenotypes are still largely unknown. Here, we aimed to use multimodal neuroimaging techniques to explore the brain structural and functional differences between the two MMD subtypes.
Methods:
We included 12 patients with ischemic MMD, 10 patients with hemorrhagic MMD, and 10 healthy controls (HCs). Each patient underwent MRI scans and cognitive assessment. The cortical thickness of two MMD subtypes and HC group were compared. Arterial spin labeling (ASL) and diffusion tensor imaging (DTI) were used to inspect the cerebral blood flow (CBF) of cortical regions and the integrity of related white matter fibers, respectively. Correlation analyses were then performed among the MRI metrics and cognitive function scores.
Results:
We found that only the cortical thickness in the right middle temporal gyrus (MTG) of hemorrhagic MMD was significantly greater than both ischemic MMD and HC (p < 0.05). In addition, the right MTG showed higher ASL-CBF, and its associated fiber tract (arcuate fasciculus, AF) exhibited higher fractional anisotropy (FA) values in hemorrhagic MMD. Furthermore, the cortical thickness of the right MTG was positively correlated with its ASL-CBF values (r = 0.37, p = 0.046) and the FA values of right AF (r = 0.67, p < 0.001). At last, the FA values of right AF were found to be significantly correlated with cognitive performances within patients with MMD.
Conclusions:
Hemorrhagic MMD shows increased cortical thickness on the right MTG in comparison with ischemic MMD and HCs. The increased cortical thickness is associated with the higher CBF values and the increased integrity of the right AF. These findings are important to understand the clinical symptoms and pathophysiology of MMD and further applied to clinical practice.
Insights
Hemorrhagic moyamoya disease (MMD) shows increased right middle temporal gyrus (MTG) thickness, higher cerebral blood flow (CBF), and better white matter integrity compared to ischemic MMD. These factors correlate with cognitive performance in MMD patients.
Area of Science:
- Neuroimaging
- Neurology
- Radiology
Background:
- Moyamoya disease (MMD) presents with cerebral ischemia or intracranial hemorrhage, but underlying pathophysiology remains unclear.
- Understanding structural and functional brain differences between MMD subtypes is crucial for diagnosis and treatment.
Purpose of the Study:
- To investigate brain structural and functional variations between ischemic MMD, hemorrhagic MMD, and healthy controls (HCs) using multimodal neuroimaging.
- To explore correlations between neuroimaging findings and cognitive function in MMD patients.
Main Methods:
- Included 12 ischemic MMD, 10 hemorrhagic MMD, and 10 HCs undergoing MRI and cognitive assessment.
- Cortical thickness, cerebral blood flow (CBF) via arterial spin labeling (ASL), and white matter integrity via diffusion tensor imaging (DTI) were analyzed.
- Correlation analyses examined relationships between MRI metrics and cognitive scores.
Main Results:
- Hemorrhagic MMD exhibited significantly greater right middle temporal gyrus (MTG) cortical thickness compared to ischemic MMD and HCs.
- The right MTG showed higher ASL-CBF, and its associated arcuate fasciculus (AF) had higher fractional anisotropy (FA) in hemorrhagic MMD.
- Right MTG thickness correlated positively with ASL-CBF and right AF FA; right AF FA correlated with MMD cognitive performance.
Conclusions:
- Hemorrhagic MMD is characterized by increased right MTG cortical thickness, linked to elevated CBF and enhanced right AF integrity.
- These findings offer insights into MMD pathophysiology and clinical manifestations, potentially aiding clinical practice.
