Angioarchitectural Characterization of Target Collateral Vessels in Periventricular Hemorrhagic Moyamoya Disease: A
Tiansheng Qian1, Jian Wang1, Yujun Liao1
1From the Department of Neurosurgery (T.Q., Y.L., Q.J., B.X.), Institute of Science and Technology for Brain-inspired Intelligence (Z.C.), MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Z.C.), Fudan University, Shanghai, P.R. China; Clinical Medical Center of Neurosurgery (T.Q., Y.L., Q.J., B.X.), Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, P.R. China; Department of Neurosurgery (J.W., Y.Q.), The Third Affiliated Hospital of Nanjing Medical University, Changzhou Second People's Hospital, Changzhou, Jiangsu 213003, P.R. China; Department of Neurosurgery (A.K.), Arkansas Neuroscience Institute, Little Rock, Arkansas, USA and The Second Department of Vascular Intervention (Q.L.), Handan Central Hospital, Hebei Province, China.
Objective:
The goal of this study was to visualize and characterize the angioarchitecture of the target collateral vessels (TCVs) responsible for periventricular hemorrhage in patients with moyamoya disease (MMD) using a multimodal approach combining ultrahigh-field 5.0T magnetic resonance angiography (MRA) and digital subtraction angiography (DSA).
Methods:
This cross-sectional study included consecutive patients with periventricular hemorrhagic MMD who were admitted for surgical treatment between July 2024 and July 2025. All patients underwent 5.0T time-of-flight (TOF) MRA, susceptibility-weighted imaging (SWI), and DSA. In hemorrhagic hemispheres, TCVs were analyzed to determine arterial origin, distal anastomotic pattern, and hemorrhage-site microangioarchitectural features. In contralateral non-hemorrhagic hemispheres, all visible periventricular collateral arteries were screened using the same imaging workflow. Paired hemispheric comparison was performed using the exact McNemar test, and artery-level comparisons were considered exploratory.
Results:
In 29 patients initially screened, 26 met the eligibility criteria and were included. The three observed microangioarchitectural features were present in 24 of 26 hemorrhagic hemispheres and in 5 of 20 eligible contralateral non-hemorrhagic hemispheres (92.3% vs 25.0%; P < 0.001). At the artery level, the observed microangioarchitectural features were present in 24/24 hemorrhagic TCVs and 5/37 contralateral non-hemorrhagic periventricular collateral arteries. Among hemorrhagic TCVs, the observed features included abrupt focal narrowing with proximal and distal preservation/dilation (15/24, 62.5%), focal narrowing with progressive distal tapering (7/24, 29.2%), and peripheral aneurysmal change (2/24, 8.3%). The choroidal arteries were the predominant source of hemorrhagic TCVs (17/24, 70.8%). The interobserver and intraobserver agreement for classification was excellent (κ > 0.80).
Conclusion:
Combined 5.0T TOF-MRA and DSA can be used to delineate the angioarchitecture of TCVs. We identified three TCV patterns associated with periventricular hemorrhage in patients with MMD that require further validation with longitudinal studies.
