Sun Lisa R, Guryildirim Melike, Gatti John R, Ahmad Syed Ameen, Ziai Wendy, Gottesman Rebecca F, Jordan Lori C, Xu Risheng, Tekes Aylin, Yedavalli Vivek
Department of Neurology, The Johns Hopkins School of Medicine, Baltimore, MD, USA.
Department of Radiology, Division of Pediatric Radiology and Pediatric Neuroradiology, The Johns Hopkins School of Medicine, Baltimore, MD, USA.
Clin Neurol Neurosurg. 2025 Jun;253:108889. doi: 10.1016/j.clineuro.2025.108889. Epub 2025 Apr 14.
In individuals with moyamoya arteriopathy, transcranial Doppler (TCD) may be a useful complement to MRI because of its safety, cost effectiveness, and ability to be performed without anesthesia in children. We evaluated associations between various MR-based moyamoya biomarkers and cerebral blood flow velocity (CBFV) as measured by TCD in individuals with moyamoya.
Participants ≤ 26-years-old with moyamoya who had not had surgical revascularization underwent TCDs within 14 days of surveillance brain MRIs. Associations between MRI parameters (Suzuki scores, cerebrovascular stenosis score, ivy sign, brush sign) and CBFV of the MCA and ICA were assessed.
Twenty-six TCD-MRI pairs from 16 participants were analyzed. Median participant age was 7.3 (IQR 5.9-8.9) years. No associations between CBFV and Suzuki score or cerebrovascular stenosis score were identified. There was a significant positive association between MCA CBFV and degree of MCA stenosis between 0 % and 99 % stenosis (p = 0.02). Hemispheres without ivy sign had higher MCA CBFV compared with hemispheres with ivy sign (144 cm/s v. 105 cm/s, p = 0.02). Hemispheres with brush sign had higher CBFV compared with hemispheres without brush sign in both the MCA (232 cm/s v. 122 cm/s, p = 0.009) and ICA (213 cm/s v. 131 cm/s, p = 0.03).
In this cohort of children and young adults with moyamoya, higher MCA CBFV were associated with higher degrees of stenosis (but not complete occlusion), the presence of a brush sign, and the absence of the ivy sign. TCD may have an important role as an adjunct to traditional neuroimaging in moyamoya arteriopathy.
在烟雾病患者中，经颅多普勒（TCD）因其安全性、成本效益以及能够在儿童无需麻醉的情况下进行，可能是磁共振成像（MRI）的有用补充。我们评估了烟雾病患者中各种基于MRI的烟雾病生物标志物与通过TCD测量的脑血流速度（CBFV）之间的关联。
年龄≤26岁且未接受手术血运重建的烟雾病参与者在监测脑MRI的14天内接受了TCD检查。评估了MRI参数（铃木评分、脑血管狭窄评分、常春藤征、刷状征）与大脑中动脉（MCA）和颈内动脉（ICA）的CBFV之间的关联。
分析了来自16名参与者的26对TCD-MRI数据。参与者的年龄中位数为7.3岁（四分位间距5.9 - 8.9岁）。未发现CBFV与铃木评分或脑血管狭窄评分之间存在关联。在MCA狭窄程度为0%至99%时，MCA的CBFV与狭窄程度之间存在显著正相关（p = 0.02）。没有常春藤征的半球与有常春藤征的半球相比，MCA的CBFV更高（144 cm/s对105 cm/s，p = 0.02）。有刷状征的半球在MCA（232 cm/s对122 cm/s，p = 0.009）和ICA（213 cm/s对131 cm/s，p = 0.03）中与没有刷状征的半球相比，CBFV更高。
在这个烟雾病儿童和年轻成人队列中，较高的MCA CBFV与更高程度的狭窄（但不是完全闭塞）、刷状征的存在以及常春藤征的缺失有关。TCD在烟雾病中作为传统神经影像学的辅助手段可能具有重要作用。
