Han Guangsong, Fan Xiaoyuan, Hong Yuehui, Yao Ming, Zhou Lixin, Zhu Yicheng, Feng Feng, Ni Jun
Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No 1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.
Jpn J Radiol. 2025 Apr 16. doi: 10.1007/s11604-025-01784-8.
Various clinical classifications of Moyamoya angiopathy (MMA) have different characteristics of collateral compensation. Advancements in 5 T MRI have made it possible to non-invasively assess vascular collateralization using 4-dimensional MR angiography (4DMRA). The objective of this study is to analyze collateral compensation in MMA patients using 4DMRA and determine variations among different clinical classifications.
Collateral compensation of posterior cerebral artery (PCA) to anterior circulation was evaluated using 4DMRA at 5 T MRI. After adjusting for confounding factors, multivariate analyses were conducted to compare the distribution of PCA collateral compensation among patients with different clinical classifications of MMA.
85 MMA patients were enrolled in the study. Among the 158 hemispheres evaluated, 100 were asymptomatic, 7 were hemorrhagic, 50 were ischemic, and 1 had a combination of hemorrhagic and ischemic stroke. Multivariate logistic regression analysis revealed a statistically significant difference in total PCA collateral compensation scores between asymptomatic and ischemic hemispheres (P < 0.001, 95% CI [0.614, 0.839]). Subgroup analysis revealed a clear distinction between asymptomatic hemispheres and ischemic hemispheres (P = 0.001, 95% CI [0.193, 0.677]) in terms of PCA compensation to middle cerebral artery through the parieto-occipital branch. However, no notable differences were observed in other compensation pathways.
The collateral compensation of PCA to the anterior circulation in MMA patients, assessed by 4DMRA at 5 T MRI, is significantly associated with ischemic MMA. The parieto-occipital branch may be the most important compensatory pathway. 4DMRA can potentially serve as a valuable tool for evaluating the risk of ischemic stroke in patients with MMA.
烟雾病血管病（MMA）的各种临床分类具有不同的侧支循环代偿特征。5T磁共振成像（MRI）的进展使得使用四维磁共振血管造影（4DMRA）无创评估血管侧支循环成为可能。本研究的目的是使用4DMRA分析MMA患者的侧支循环代偿情况，并确定不同临床分类之间的差异。
在5T MRI上使用4DMRA评估大脑后动脉（PCA）向前循环的侧支循环代偿情况。在调整混杂因素后，进行多变量分析以比较不同临床分类的MMA患者之间PCA侧支循环代偿的分布情况。
85例MMA患者纳入本研究。在评估的158个半球中，100个为无症状性，7个为出血性，50个为缺血性，1个为出血性和缺血性卒中合并。多变量逻辑回归分析显示，无症状半球和缺血半球之间的总PCA侧支循环代偿评分存在统计学显著差异（P < 0.001，95%置信区间[0.614, 0.839]）。亚组分析显示，在通过顶枕支向大脑中动脉的PCA代偿方面，无症状半球和缺血半球之间存在明显差异（P = 0.001，95%置信区间[0.193, 0.677]）。然而，在其他代偿途径中未观察到显著差异。
在5T MRI上通过4DMRA评估的MMA患者中，PCA向前循环的侧支循环代偿与缺血性MMA显著相关。顶枕支可能是最重要的代偿途径。4DMRA有可能成为评估MMA患者缺血性卒中风险的有价值工具。
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