Spatial Relationship between Cerebral Microbleeds, Moyamoya Vessels, and Hematoma in Moyamoya Disease.
Spatial Relationship between Cerebral Microbleeds, Moyamoya Vessels, and Hematoma in Moyamoya Disease.
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烟雾病中脑微出血、烟雾血管和血肿之间的空间关系。
DOI：
10.1016/j.jstrokecerebrovasdis.2013.12.007
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发表时间：
2014
期刊：
影响因子：
--
通讯作者：
Houkin K.
中科院分区：
文献类型：
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作者：
Kazumata K;Shinbo D;Ito M;Shichinohe H;Kuroda S;Nakayama N;Houkin K.
背景已知成人烟雾病（MMD）具有很高的脑微出血（cMB）发生率；然而，其临床意义仍不清楚。我们调查了大量患者中 cMB 的频率，并分析了与血肿和烟雾血管位置相关的 MB 分布模式。方法我们使用前瞻性收集的数据库研究了 259 名连续的 MMD 患者。一百九十一名患者符合本研究的条件，并进行了回顾性图像分析。使用梯度回波 T2* 加权序列 (1.5 T) 确定 cMB 和出血残留的存在。根据飞行时间磁共振血管造影的源图像评估烟雾病血管的发育。该分析包括对 cMB、出血残留和烟雾血管之间的空间关系的描述性评估。进行统计分析以计算 cMB 存在与出血残留（大血肿）、发病年龄和伴随烟雾血管存在相关的相对风险比。结果在 20 名成人 MMD 患者中观察到 30 个 MB（16.9%）。 MB 主要位于脑室周围白质 (63.3%)，其次是基底节/丘脑 (20%)。比较患有 cMB 的患者与未患有 cMB 的患者，血肿在患有 cMB 的患者中更常见（比值比 [OR] 4.29；95% 置信区间 [CI] 1.58-11.62；P= .0062）。与儿童发病的患者 (4.1%) 相比，成人发病的患者更有可能表现出 cMB (14.4%)（OR 3.93；95% CI 1.11-13.91）。烟雾血管出现在三角区的外侧部分，脑室周围白质与 cMB 的存在显着相关（三角区的外侧部分；OR 3.29 [1.59-6.82]，P= .0019，侧脑室体的室周；OR 2.40 [1.20-4.79]，P= .0214）。 23 个 (76.7%) 病变中 cMB 伴随动脉。室管膜下-软脑膜动脉吻合是最常见的模式（n = 20，66.7%）。结论烟雾血管与血管周围含铁血黄素沉积之间存在空间关系，特别是在室管膜下-软脑膜吻合周围，提示了烟雾病中cMBs发展的机制。目前的研究进一步支持了之前的发现，即 cMB 可能作为 MMD 中易出血的微血管病的标志物。本研究的意义在于选择最佳的手术候选者，以防止 cMB 的存在导致未来出血，而目前依赖缺血程度的手术指征常常无法检测到未来出血的患者。
BackgroundAdult moyamoya disease (MMD) is known to have high incidence of cerebral microbleeds (cMBs); however, the clinical significance still remains unclear. We investigated the frequency of cMBs in a large number of patients and analyzed the patterns of MB distribution in association with the location of the hematoma and moyamoya vessels.MethodsWe studied 259 consecutive patients with MMD using prospectively collected database. One hundred ninety-one patients were eligible for the present study, and image analysis was performed retrospectively. The presence of cMBs and remains of hemorrhage were determined using gradient-echo T2*-weighted sequence (1.5 T). The development of moyamoya vessels was assessed on source images of time-of-flight magnetic resonance angiography. The analysis consists of descriptive assessment of the spatial relationship between cMB, remains of hemorrhage, and moyamoya vessels. Statistical analysis was performed to calculate relative risk ratio in the presence of cMBs in relation to the remains of hemorrhage (macrohematoma), age of onset, and the presence of concomitant moyamoya vessels.ResultsThirty MBs were observed in 20 adult MMD patients (16.9%). MBs were located predominantly in the periventricular white matter (63.3%) followed by the basal ganglia/thalami (20%). Comparing the patients with cMBs from those without, hematoma was more frequently observed in patients with cMBs (odds ratio [OR] 4.29; 95% confidence interval [CI] 1.58-11.62;P= .0062). Patients with adult onset was more likely to demonstrate cMBs (14.4%) compared with the patients with pediatric onset (4.1%) (OR 3.93; 95% CI 1.11-13.91). Moyamoya vessels appeared in the lateral part of the trigon, and the periventricular white matter was significantly associated with the presence of cMBs (lateral part of the trigon; OR 3.29 [1.59-6.82],P= .0019, periventricle of the body of lateral ventricle; OR 2.40 [1.20-4.79],P= .0214, respectively). cMBs accompanied concomitant arteries in 23 (76.7%) lesions. The subependymal–leptomeningeal artery anastomosis was the most common pattern (n = 20, 66.7%).ConclusionsSpatial relationship was demonstrated between the moyamoya vessels and perivascular hemosiderin deposition particularly around the subependymal–leptomeningeal anastomosis, suggesting the mechanism for the development of cMBs in MMD. Present study further supports previous findings that cMBs potentially serve as a marker for the bleeding-prone microangiopathy in MMD. The significance of the present study lies in selecting optimal surgical candidate for preventing future hemorrhage by the presence of the cMBs, whereas current surgical indication relying on the degree of ischemia frequently fails to detect patients with future hemorrhage.