Zhu Huan, Zhu Chenyu, Liu Tong, Wang Peijiong, Li Wenjie, Zhang Qihang, Zhao Yahui, Yu Tao, Liu Xingju, Zhang Qian, Zhao Jizong, Zhang Yan
Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Transl Stroke Res. 2024 Sep 9. doi: 10.1007/s12975-024-01296-z.
The glymphatic system is crucial for clearing metabolic waste from the brain, maintaining neural health and cognitive function. This study explores the glymphatic system's role in Moyamoya disease (MMD), characterized by progressive cerebral artery stenosis and brain structural lesions. We assessed 33 MMD patients and 21 healthy controls using diffusion tensor imaging along the perivascular space (DTI-ALPS) and global cortical gray matter-cerebrospinal fluid (CSF) coupling indices (gBOLD-CSF), which are indirect measurements of the glymphatic system. Cerebral perfusion in patients was evaluated via computed tomography perfusion imaging. We also measured the peak width of skeletonized mean diffusivity (PSMD), white matter hyperintensity (WMH) burden, and cognitive function. MMD patients exhibited lower ALPS and gBOLD-CSF coupling indices compared to controls (P < 0.01), indicating disrupted glymphatic function. Significant cognitive impairment was also observed in MMD patients (P < 0.01). ALPS indices varied with cerebral perfusion stages, being higher in earlier ischemic stages (P < 0.05). Analysis of brain structure showed increased CSF volume, PSMD index, and higher WMH burden in MMD patients (P < 0.01). The ALPS index positively correlated with white matter volume and cognitive scores, and negatively correlated with CSF volume, PSMD, and WMH burden (P < 0.05). Mediation analysis revealed the number of periventricular WMH significantly mediated the relationship between glymphatic dysfunction and cognitive impairment. In summary, MMD patients exhibit significant glymphatic system impairments, associated with brain structural changes and cognitive deficits.
类淋巴系统对于清除大脑中的代谢废物、维持神经健康和认知功能至关重要。本研究探讨类淋巴系统在烟雾病（MMD）中的作用，烟雾病的特征是进行性脑动脉狭窄和脑结构病变。我们使用沿血管周围间隙的扩散张量成像（DTI-ALPS）和全脑皮质灰质-脑脊液（CSF）耦合指数（gBOLD-CSF）评估了33例MMD患者和21名健康对照，这两项指标是对类淋巴系统的间接测量。通过计算机断层扫描灌注成像评估患者的脑灌注情况。我们还测量了骨架化平均扩散率的峰宽（PSMD）、白质高信号（WMH）负荷和认知功能。与对照组相比，MMD患者的ALPS和gBOLD-CSF耦合指数较低（P < 0.01），表明类淋巴功能受损。在MMD患者中也观察到明显的认知障碍（P < 0.01）。ALPS指数随脑灌注阶段而变化，在早期缺血阶段较高（P < 0.05）。脑结构分析显示，MMD患者的脑脊液体积、PSMD指数增加，WMH负荷更高（P < 0.01）。ALPS指数与白质体积和认知评分呈正相关，与脑脊液体积、PSMD和WMH负荷呈负相关（P < 0.05）。中介分析显示，脑室周围WMH的数量显著介导了类淋巴功能障碍与认知障碍之间的关系。总之，MMD患者存在明显的类淋巴系统损伤，与脑结构变化和认知缺陷有关。
