Affordable Access

deepdyve-link
Publisher Website

Early Diffusion Magnetic Resonance Imaging Changes in Normal-Appearing Brain in Pediatric Moyamoya Disease.

Authors
  • Quon, Jennifer L1
  • Kim, Lily H1
  • MacEachern, Sarah J2
  • Maleki, Maryam3
  • Steinberg, Gary K1
  • Madhugiri, Venkatesh1
  • Edwards, Michael S B1, 4
  • Grant, Gerald A1, 4
  • Yeom, Kristen W3
  • Forkert, Nils D5
  • 1 Department of Neurosurgery, Stanford University School of Medicine, Stanford, California.
  • 2 Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada. , (Canada)
  • 3 Division of Pediatric Neuroradiology, Department of Radiology, Lucile Packard Children's Hospital, Stanford, California.
  • 4 Division of Pediatric Neurosurgery, Lucile Packard Children's Hospital, Stanford, California.
  • 5 Division of Image Science, Department of Radiology, University of Calgary, Calgary, Canada. , (Canada)
Type
Published Article
Journal
Neurosurgery
Publication Date
Apr 01, 2020
Volume
86
Issue
4
Pages
530–537
Identifiers
DOI: 10.1093/neuros/nyz230
PMID: 31245817
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Moyamoya disease often leads to ischemic strokes visible on diffusion-weighted imaging (DWI) and T2-weighted magnetic resonance imaging (MRI) with subsequent cognitive impairment. In adults with moyamoya, apparent diffusion coefficient (ADC) is correlated with regions of steal phenomenon and executive dysfunction prior to white matter changes. To investigate quantitative global diffusion changes in pediatric moyamoya patients prior to explicit structural ischemic damage. We retrospectively reviewed children (<20 yr old) with moyamoya disease and syndrome who underwent bypass surgery at our institution. We identified 29 children with normal structural preoperative MRI and without findings of cortical infarction or chronic white matter ischemic changes. DWI datasets were used to calculate ADC maps for each subject as well as for 60 age-matched healthy controls. Using an atlas-based approach, the cerebral white matter, cerebral cortex, thalamus, caudate, putamen, pallidum, hippocampus, amygdala, nucleus accumbens, and brainstem were segmented in each DWI dataset and used to calculate regional volumes and ADC values. Multivariate analysis of covariance using the regional ADC and volume values as dependent variables and age and gender as covariates revealed a significant difference between the groups (P < .001). Post hoc analysis demonstrated significantly elevated ADC values for children with moyamoya in the cerebral cortex, white matter, caudate, putamen, and nucleus accumbens. No significant volume differences were found. Prior to having bypass surgery, and in the absence of imaging evidence of ischemic stroke, children with moyamoya exhibit cerebral diffusion changes. These findings could reflect microstructural changes stemming from exhaustion of cerebrovascular reserve. Copyright © 2019 by the Congress of Neurological Surgeons.

Report this publication

Statistics

Seen <100 times