A Miyakoshi1,2, T Funaki3, Y Fushimi4, T Nakae5, M Okawa3, T Kikuchi3, H Kataoka3, K Yoshida3, Y Mineharu3, M Matsuhashi6, E Nakatani7, S Miyamoto3. 1. From the Department of Neurosurgery (A.M., T.F., M.O., T.K., H.K., K.Y., Y.M., S.M.) myks-knr@umin.ac.jp. 2. Department of Neurosurgery (A.M.). 3. From the Department of Neurosurgery (A.M., T.F., M.O., T.K., H.K., K.Y., Y.M., S.M.). 4. Diagnostic Imaging and Nuclear Medicine (Y.F.). 5. Department of Neurosurgery (T.N.), Shiga General Hospital, Shiga, Japan. 6. Epilepsy, Movement Disorders and Physiology (M.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan. 7. Division of Statistical Analysis (E.N.), Shizuoka General Hospital, Shizuoka, Japan.
Abstract
BACKGROUND AND PURPOSE: Collateral vessels in Moyamoya disease represent potential sources of bleeding. To test whether these cortical distributions vary among subtypes, we investigated cortical terminations using both standardized MR imaging and MRA. MATERIALS AND METHODS: Patients with Moyamoya disease who underwent MR imaging with MRA in our institution were enrolled in this study. MRA was spatially normalized to the Montreal Neurological Institute space; then, collateral vessels were measured on MRA and classified into 3 types of anastomosis according to the parent artery: lenticulostriate, thalamic, and choroidal. We also obtained the coordinates of collateral vessel outflow to the cortex. Differences in cortical terminations were compared among the 3 types of anastomosis. RESULTS: We investigated 219 patients with Moyamoya disease, and a total of 190 collateral vessels (lenticulostriate anastomosis, n = 72; thalamic anastomosis, n = 21; choroidal anastomosis, n = 97) in 46 patients met the inclusion criteria. We classified the distribution patterns of collateral anastomosis as follows: lenticulostriate collaterals outflowing anteriorly (P < .001; 95% CI, 67.0-87.0) and medially (P < .001; 95% CI, 11.0-24.0) more frequently than choroidal collaterals; lenticulostriate collaterals outflowing anteriorly more frequently than thalamic collaterals (P < .001; 95% CI, 34.0-68.0); and choroidal collaterals outflowing posteriorly more frequently than thalamic collaterals (P < .001; 95% CI, 14.0-34.0). Lenticulostriate anastomoses outflowed to the superior or inferior frontal sulcus and interhemispheric fissure. Thalamic anastomoses outflowed to the insular cortex and cortex around the central sulcus. Choroidal anastomoses outflowed to the cortex posterior to the central sulcus and the insular cortex. CONCLUSIONS: Cortical distribution patterns appear to differ markedly among the 3 types of collaterals.
BACKGROUND AND PURPOSE: Collateral vessels in Moyamoya disease represent potential sources of bleeding. To test whether these cortical distributions vary among subtypes, we investigated cortical terminations using both standardized MR imaging and MRA. MATERIALS AND METHODS:Patients with Moyamoya disease who underwent MR imaging with MRA in our institution were enrolled in this study. MRA was spatially normalized to the Montreal Neurological Institute space; then, collateral vessels were measured on MRA and classified into 3 types of anastomosis according to the parent artery: lenticulostriate, thalamic, and choroidal. We also obtained the coordinates of collateral vessel outflow to the cortex. Differences in cortical terminations were compared among the 3 types of anastomosis. RESULTS: We investigated 219 patients with Moyamoya disease, and a total of 190 collateral vessels (lenticulostriate anastomosis, n = 72; thalamic anastomosis, n = 21; choroidal anastomosis, n = 97) in 46 patients met the inclusion criteria. We classified the distribution patterns of collateral anastomosis as follows: lenticulostriate collaterals outflowing anteriorly (P < .001; 95% CI, 67.0-87.0) and medially (P < .001; 95% CI, 11.0-24.0) more frequently than choroidal collaterals; lenticulostriate collaterals outflowing anteriorly more frequently than thalamic collaterals (P < .001; 95% CI, 34.0-68.0); and choroidal collaterals outflowing posteriorly more frequently than thalamic collaterals (P < .001; 95% CI, 14.0-34.0). Lenticulostriate anastomoses outflowed to the superior or inferior frontal sulcus and interhemispheric fissure. Thalamic anastomoses outflowed to the insular cortex and cortex around the central sulcus. Choroidal anastomoses outflowed to the cortex posterior to the central sulcus and the insular cortex. CONCLUSIONS: Cortical distribution patterns appear to differ markedly among the 3 types of collaterals.
Authors: T Funaki; A Miyakoshi; H Kataoka; J C Takahashi; Y Takagi; K Yoshida; T Kikuchi; Y Mineharu; M Okawa; Y Yamao; Y Fushimi; S Miyamoto Journal: AJNR Am J Neuroradiol Date: 2022-08-25 Impact factor: 4.966