Cortical Distribution of Fragile Periventricular Anastomotic Collateral Vessels in Moyamoya Disease: An Exploratory Cross-Sectional Study of Japanese Patients with Moyamoya Disease.

A Miyakoshi,M Matsuhashi,H Kataoka,T Nakae,S Miyamoto,T Funaki,M Okawa,Y Mineharu,E Nakatani,T Kikuchi,Y Fushimi,K Yoshida

doi:10.3174/ajnr.a6861

Abstract

Collateral vessels in Moyamoya disease represent potential sources of bleeding. To test whether these cortical distributions vary among subtypes, we investigated cortical terminations using both standardized MR imaging and MRA. Patients with Moyamoya disease who underwent MR imaging with MRA in our institution were enrolled in this study. MRA was spatially normalized to the Montreal Neurological Institute space; then, collateral vessels were measured on MRA and classified into 3 types of anastomosis according to the parent artery: lenticulostriate, thalamic, and choroidal. We also obtained the coordinates of collateral vessel outflow to the cortex. Differences in cortical terminations were compared among the 3 types of anastomosis. We investigated 219 patients with Moyamoya disease, and a total of 190 collateral vessels (lenticulostriate anastomosis, n = 72; thalamic anastomosis, n = 21; choroidal anastomosis, n = 97) in 46 patients met the inclusion criteria. We classified the distribution patterns of collateral anastomosis as follows: lenticulostriate collaterals outflowing anteriorly (P < .001; 95% CI, 67.0-87.0) and medially (P < .001; 95% CI, 11.0-24.0) more frequently than choroidal collaterals; lenticulostriate collaterals outflowing anteriorly more frequently than thalamic collaterals (P < .001; 95% CI, 34.0-68.0); and choroidal collaterals outflowing posteriorly more frequently than thalamic collaterals (P < .001; 95% CI, 14.0-34.0). Lenticulostriate anastomoses outflowed to the superior or inferior frontal sulcus and interhemispheric fissure. Thalamic anastomoses outflowed to the insular cortex and cortex around the central sulcus. Choroidal anastomoses outflowed to the cortex posterior to the central sulcus and the insular cortex. Cortical distribution patterns appear to differ markedly among the 3 types of collaterals.

Highlights

BACKGROUND AND PURPOSECollateral vessels in Moyamoya disease represent potential sources of bleeding
We classified the distribution patterns of collateral anastomosis as follows: lenticulostriate collaterals outflowing anteriorly (P, .001; 95% CI, 67.0–87.0) and medially (P, .001; 95% CI, 11.0–24.0) more frequently than choroidal collaterals; lenticulostriate collaterals outflowing anteriorly more frequently than thalamic collaterals (P, .001; 95% CI, 34.0–68.0); and choroidal collaterals outflowing posteriorly more frequently than thalamic collaterals (P, .001; 95% CI, 14.0–34.0)
Thalamic anastomoses outflowed to the insular cortex and cortex around the central sulcus

Summary

Introduction

Collateral vessels in Moyamoya disease represent potential sources of bleeding. To test whether these cortical distributions vary among subtypes, we investigated cortical terminations using both standardized MR imaging and MRA. Cortical distributions of each type of collateral on the standard brain surface model are depicted in Figs 3 and 4. Lenticulostriate anastomoses developed from LSAs and showed outflow mainly to the superior and inferior frontal sulcus and cingulate sulcus (interhemispheric fissure) via medullary arteries. Thalamic anastomoses developed from PcomA perforators and showed outflow to the insular cortex and sulcus around the central sulcus via medullary arteries. Choroidal anastomoses developed from the anterior and posterior choroidal arteries and showed outflow to the sulci posterior to the central sulcus and the insular cortex via the medullary arteries

Methods

Results

Discussion

Conclusion