From the Department of Neurosurgery (A.M., T.F., M.O., T.K., H.K., K.Y., Y.M., S.M.)
Department of Neurosurgery (A.M.).
AJNR Am J Neuroradiol. 2020 Dec;41(12):2243-2249. doi: 10.3174/ajnr.A6861. Epub 2020 Nov 5.
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.
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.
We investigated 219 patients with Moyamoya disease, and a total of 190 collateral vessels (lenticulostriate anastomosis, = 72; thalamic anastomosis, = 21; choroidal anastomosis, = 97) in 46 patients met the inclusion criteria. We classified the distribution patterns of collateral anastomosis as follows: lenticulostriate collaterals outflowing anteriorly (< .001; 95% CI, 67.0-87.0) and medially (< .001; 95% CI, 11.0-24.0) more frequently than choroidal collaterals; lenticulostriate collaterals outflowing anteriorly more frequently than thalamic collaterals (< .001; 95% CI, 34.0-68.0); and choroidal collaterals outflowing posteriorly more frequently than thalamic collaterals (< .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.
Cortical distribution patterns appear to differ markedly among the 3 types of collaterals.
烟雾病中的侧支血管代表了潜在的出血源。为了测试这些皮质分布是否因亚型而异，我们使用标准化的磁共振成像和 MRA 对皮质终止进行了研究。
本研究纳入了在我院行磁共振成像和 MRA 的烟雾病患者。MRA 被空间标准化到蒙特利尔神经学研究所空间；然后，在 MRA 上测量侧支血管，并根据供血动脉将其分为 3 种吻合类型：纹状体、丘脑和脉络膜。我们还获得了侧支血管向皮质的流出坐标。比较了 3 种吻合类型之间皮质终止的差异。
我们研究了 219 例烟雾病患者，其中 46 例患者的 190 条侧支血管（纹状体吻合，72 条；丘脑吻合，21 条；脉络膜吻合，97 条）符合纳入标准。我们将侧支吻合的分布模式分类如下：纹状体侧支向前（<0.001；95%置信区间，67.0-87.0）和向内侧（<0.001；95%置信区间，11.0-24.0）流出的频率高于脉络膜侧支；纹状体侧支向前流出的频率高于丘脑侧支（<0.001；95%置信区间，34.0-68.0）；脉络膜侧支向后流出的频率高于丘脑侧支（<0.001；95%置信区间，14.0-34.0）。纹状体吻合流出至额上或额下沟和大脑半球间裂。丘脑吻合流出至岛叶皮质和中央沟周围皮质。脉络膜吻合流出至中央沟后部和岛叶皮质后的皮质。
3 种侧支的皮质分布模式似乎存在明显差异。
