Characteristics of brain magnetic resonance images at symptom onset in children with moyamoya disease

Jung, Min Young; Kim, Young Ok; Yoon, Woong; Joo, Sung‐Pil; Woo, Young Jong

doi:10.1016/j.braindev.2014.06.008

Cited by 12 publications

(14 citation statements)

References 23 publications

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“…9,11,15,19 Using the radiographic markers of higher Suzuki grade and ivy sign, we found that the presence of transdural collaterals correlated with markers of worsening ischemia. 3,7,8,10,27,29 Analysis of our patient population also revealed that the presence of spontaneous transdural collaterals preoperatively significantly correlated with better postoperative angiographic results at 1 year after surgery, as measured by the Matsushima grade. 17,18 Taken together, these data support the hypothesis that cerebral ischemia stimulates the development of collateral development, both spontaneously and after surgical revacularization.…”

Section: Association Of Collaterals With Ischemia and Relevance To Anmentioning

confidence: 58%

Preoperative transdural collateral vessels in moyamoya as radiographic biomarkers of disease

Storey¹,

Scott²,

Robertson

et al. 2017

PED

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OBJECTIVE The prevalence of angiographically evident preoperative transdural collateral vessels in moyamoya is not well documented. The authors hypothesized that transdural collaterals could be used as radiographic biomarkers of disease, and that their presence is associated with more advanced moyamoya arteriopathy at diagnosis, which is a harbinger of more frequent operative complications and a predictor of better long-term angiographic results following surgery. METHODS The study consists of a single-institution case series of patients with moyamoya who underwent pial synangiosis between 2005 and 2013. RESULTS Moyamoya was diagnosed in a total of 204 patients (n = 121 [59%] female, 83 [41%] male); the average age at surgery was 9.5 years (range 0.4–35 years). Radiographically, 154 (75%) had bilateral disease for a total of 308 affected hemispheres; 152 (75%) had radiographic stroke; and 190 (93%) had “ivy sign” on FLAIR MRI, indicating slow flow. Of the 358 hemispheres, 324 were treated operatively. On preoperative angiography, 107 patients (52%) had transdural collaterals in 176 affected hemispheres (49%). The Suzuki stage was higher in patients with collaterals (3.4 vs 3.0, p = 0.002). Of 324 treated hemispheres, 84 (26%) had collaterals within the surgical field. Complications included 12 strokes (3.7% stroke rate/hemisphere), with 5 (42%) directly attributable to interruption of transdural collaterals. On 1-year postoperative arteriograms available in 222 hemispheres, Matsushima grades trended better in patients with preoperative collaterals (1.5 vs 1.8 [A = 1, B = 2, C = 3]; p < 0.003). CONCLUSIONS Transdural collaterals are present in nearly half of all preoperative arteriograms in patients with moyamoya. These collaterals are more common in advanced disease, are associated with stroke as a perioperative complication, and may suggest increased capacity to produce surgical collaterals postoperatively. These data support the utility of preoperative arteriography.

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Section: Association Of Collaterals With Ischemia and Relevance To Anmentioning

confidence: 58%

Preoperative transdural collateral vessels in moyamoya as radiographic biomarkers of disease

Storey¹,

Scott²,

Robertson

et al. 2017

PED

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“…MRI sequences that are particularly useful in moyamoya include fluid-attenuated inversion recovery images to assess chronic infarct burden and areas of slow flow (as evidenced by the so-called ivy sign, or serpentine sulcal hyperintensity, present in ≈80% of cases) and MRA to visualize the circle of Willis. 177,179,200,201,[258][259][260][261][262] Advances in vessel wall imaging can help to distinguish between vasculitis and moyamoya. 263 DSA is important for surgical planning to avoid disruption of natural collaterals from the external carotid circulation.…”

Section: Stroke Prevention In Children With Moyamoyamentioning

confidence: 99%

Management of Stroke in Neonates and Children: A Scientific Statement From the American Heart Association/American Stroke Association

Ferriero¹,

Fullerton²,

Bernard³

et al. 2019

Stroke

428

462

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Purpose-Much has transpired since the last scientific statement on pediatric stroke was published 10 years ago. Although stroke has long been recognized as an adult health problem causing substantial morbidity and mortality, it is also an important cause of acquired brain injury in young patients, occurring most commonly in the neonate and throughout childhood. This scientific statement represents a synthesis of data and a consensus of the leading experts in childhood cardiovascular disease and stroke. Methods-Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statement Oversight Committee and the American Heart Association's Manuscript Oversight Committee and were chosen to reflect the expertise of the subject matter. The writers used systematic literature reviews, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and to indicate gaps in current knowledge. This scientific statement is based on expert consensus considerations for clinical practice. Results-Annualized pediatric stroke incidence rates, including both neonatal and later childhood stroke and both ischemic and hemorrhagic stroke, range from 3 to 25 per 100 000 children in developed countries. Newborns have the highest risk ratio: 1 in 4000 live births. Stroke is a clinical syndrome. Delays in diagnosis are common in both perinatal and childhood stroke but for different reasons. To develop new strategies for prevention and treatment, disease processes and risk factors that lead to pediatric stroke are discussed here to aid the clinician in rapid diagnosis and treatment. The many important differences that affect the pathophysiology and treatment of childhood stroke are discussed in each section. Conclusions-Here we provide updates on perinatal and childhood stroke with a focus on the subtypes, including arterial ischemic, venous thrombotic, and hemorrhagic stroke, and updates in regard to areas of childhood stroke that have not received close attention such as sickle cell disease. Each section is highlighted with considerations for clinical practice, attendant controversies, and knowledge gaps. This statement provides the practicing provider with much-needed updated information in this field. (Stroke. 2019;50:e00-e00.

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“…7 According to the guideline, the criteria for diagnosing MMD with MRI and MRA are as follows: 1) stenosis or occlusion at the terminal portion of the ICA and/or at the proximal portion of the ACA and/or the MCA; 2) an abnormal vascular network in the basal ganglia (an abnormal vascular network can be diagnosed when more than 2 flow voids are seen on 1 side of the basal ganglion on MRI); and 3) bilateral appearance of Criteria 1 and 2. 9,18 In this study, we used 2 methods to evaluate flow voids in basal ganglia. One traditional way is to count the flow void signals on T2-weighted axial MR images ( Fig.…”

Section: Image Analysismentioning

confidence: 99%

Comparison of 7.0- and 3.0-T MRI and MRA in ischemic-type moyamoya disease: preliminary experience

Deng

Zhang

et al. 2016

JNS

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abbreviatioNs ACA = anterior cerebral artery; AUC = area under the curve; DSA = digital subtraction angiography; ICA = internal carotid artery; ICC = interclass correlation coefficient; MCA = middle cerebral artery; MIP = maximum-intensity projection; MMD = moyamoya disease; MMV = moyamoya vessel; MRA = MR angiography; PCA = posterior cerebral artery; PCoA = posterior communicating artery; ROC = receiver operating characteristic; STA = superficial temporal artery; TOF = time of flight. obJective The authors compared the image quality and diagnostic sensitivity and specificity of 7.0-T and 3.0-T MRI and time-of-flight (TOF) MR angiography (MRA) in patients with moyamoya disease (MMD). methods MR images of 15 patients with ischemic-type MMD (8 males, 7 females; age 13-48 years) and 13 healthy controls (7 males, 6 females; age 19-28 years) who underwent both 7.0-T and 3.0-T MRI and MRA were studied retrospectively. The main intracranial arteries were assessed by using the modified Houkin's grading system (MRA score). Moyamoya vessels (MMVs) were evaluated by 2 grading systems: the MMV quality score and the MMV area score. Two diagnostic criteria for MMD were used: the T2 criteria, which used flow voids in the basal ganglion on T2-weighted images, and the TOF criteria, which used the high-intensity areas in the basal ganglion on source images from TOF MRA. All data were evaluated by 2 independent readers who were blinded to the strength field and presence or absence of MMD. Using conventional angiography as the gold standard, the sensitivity and specificity of 7.0-T and 3.0-T MRI/MRA in the diagnosis of MMD were calculated. The differences between 7.0-T and 3.0-T MRI and MRA were statistically compared. results No significant differences were observed between 7.0-T and 3.0-T MRA in MRA score (p = 0.317) or MRA grade (p = 0.317). There was a strong correlation between the Suzuki's stage and MRA grade in both 3.0-T (r s = 0.930; p < 0.001) and 7.0-T (r s = 0.966; p < 0.001) MRA. However, MMVs were visualized significantly better on 7.0-T than on 3.0-T MRA, suggested by both the MMV quality score (p = 0.001) and the MMV area score (p = 0.001). The correlation between the Suzuki's stage and the MMV area score was moderate in 3.0-T MRA (r s = 0.738; p = 0.002) and strong in 7.0-T MRA (r s = 0.908; p < 0.001). Moreover, 7.0-T MR images showed a greater capacity for detecting flow voids in the basal ganglion on both T2-weighted MR images (p < 0.001) and TOF source images (p < 0.001); 7.0-T MRA also revealed the subbranches of superficial temporal arteries much better. Receiver operating characteristic curve analysis showed that, according to the T2 criteria, 7.0-T MRI/MRA was more sensitive (sensitivity 1.000; specificity 0.933) than 3.0-T MRI/MRA (sensitivity 0.692; specificity 0.933) in diagnosing MMD; based on the TOF criteria, 7.0-T MRI/MRA was more sensitive (1.000 vs 0.733, respectively) and more specific (1.000 vs 0.923, respectively) than 3.0-T MRI/MRA. coNclusioNs Compared with 3.0-T MRI/MRA, 7.0-T MRI/MRA detecte...

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Characteristics of brain magnetic resonance images at symptom onset in children with moyamoya disease

Cited by 12 publications

References 23 publications

Preoperative transdural collateral vessels in moyamoya as radiographic biomarkers of disease

Preoperative transdural collateral vessels in moyamoya as radiographic biomarkers of disease

Management of Stroke in Neonates and Children: A Scientific Statement From the American Heart Association/American Stroke Association

Comparison of 7.0- and 3.0-T MRI and MRA in ischemic-type moyamoya disease: preliminary experience

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