Abstract
Objective: To investigate the hemodynamic changes using ultrasound according to digital subtraction angiography (DSA) findings and explore the association between ultrasound parameters and clinical symptoms of moyamoya disease (MMD).Methods: Hemodynamic parameters of extracranial internal carotid artery (EICA) and posterior cerebral artery (PCA) were evaluated by ultrasound. According to DSA findings, EICA parameters among Suzuki stages (stage I-II, III-IV, and V-VI), and PCA parameters among leptomeningeal system scores (score 0–2, 3–4, and 5–6) were compared, respectively. ROC analysis was performed based on the ultrasound parameters to distinguish stroke from non-stroke patients.Results: Forty patients with MMD were included in our study (16 men; median age, 37 years). The diameter (D), peak systolic velocity (PSV), end diastolic velocity (EDV) and flow volume (FV) of EICA decreased as the Suzuki stage advanced (D: P < 0.001; PSV: P < 0.001; EDV: P < 0.001; FV: P < 0.001). The PSV and EDV of PCA increased as the leptomeningeal system scores advanced (PSV: P < 0.001; EDV: P < 0.001). ROC analysis showed that the area under the curves (AUCs) based on the D and FV of EICA, the PSV and EDV of PCA and their combination were 0.688, 0.670, 0.727, 0.684, and 0.772, respectively, to distinguish stroke from non-stroke patients.Conclusions: Ultrasound parameters were related to Suzuki stages and leptomeningeal system scores. Ultrasound may be useful in predicting the occurrence of stroke in patients with MMD. Future prospective studies with large sample sizes and long-term follow-up are needed to confirm our preliminary findings.
Highlights
Moyamoya disease (MMD) is a rare disease of unknown etiology, it is characterized by progressive stenosis of the bilateral terminal portions of internal carotid arteries, and their main branches with compensatory abnormal vascular networks at the base of the brain [1]
We investigated the hemodynamic changes of the extracranial ICA (EICA) and posterior cerebral artery (PCA) using ultrasound according to the Digital subtraction angiography (DSA) findings of Suzuki stage and grading score of leptomeningeal system from the PCA territory to the anterior cerebral artery (ACA) and middle cerebral artery (MCA) territory in patients with MMD
The D, peak systolic velocity (PSV), end-diastolic velocity (EDV), and flow volume (FV) of EICA decreased as the Suzuki stage advanced, the PSV and EDV of PCA increased as the leptomeningeal system scores advanced
Summary
Moyamoya disease (MMD) is a rare disease of unknown etiology, it is characterized by progressive stenosis of the bilateral terminal portions of internal carotid arteries, and their main branches with compensatory abnormal vascular networks at the base of the brain [1]. The incidence of moyamoya disease is high in East Asia countries such as Japan and Korea. In Japan, the annual incidence was 0.35 per 100,000. MMD is an important cause of stroke in children and adults. Affected first-degree relatives and those who cannot receive revascularization surgery for a period of time, undergoing imaging at regular intervals can reduce the risk of permanent disability caused by stroke and improve long-term prognosis [6, 7]
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