Abstract
BackgroundEnlarged perivascular spaces (EPVS) are often observed with magnetic resonance imaging in patients with small vessel disease. However, the risk factors, radiological features, and clinical relevance of EPVS in patients with moyamoya disease are poorly understood. The purpose of this study was to evaluate EPVS, the risk factors of many EPVS, and the pathophysiology of EPVS in adult patients with moyamoya disease.MethodsOne hundred cerebral hemispheres of 50 adult patients with moyamoya disease were examined. The control group consisted of 50 age/sex-matched patients without ischemic disease. The numbers of EPVS at the level of the centrum semiovale per hemisphere were compared between the moyamoya disease and control groups. In each hemisphere, the total numbers of EPVS were categorized into five grades (0–4), and the clinical and radiological characteristics of the predictive factors in patients in the high EPVS grade group (EPVS grade = 4) were assessed.ResultsThe EPVS counts and grades were significantly higher in the moyamoya disease group. Analyses of the background characteristics of the patients with moyamoya disease revealed that significantly higher prevalence of high EPVS grades were associated with the female sex, hypertension, high magnetic resonance angiography scores, high numbers of flow voids in the basal ganglia, high brain atrophy scores, ivy signs, and white matter lesions. A logistic multivariate analysis of the patients with high EPVS grades revealed significant associations with the female sex, hypertension, and flow voids in the basal ganglia.ConclusionsIncreased EPVS were confirmed in adult patients with moyamoya disease, and the associated clinical and radiological factors were identified. The presence of hypertension, the female sex, and flow voids in the basal ganglia were important for predicting high EPVS grades in patients with moyamoya disease. Reductions in arterial pulsations with steno-occlusive changes can inhibit the flow of interstitial fluid, which can increase the number of EPVS in patients with moyamoya disease. Other clinical factors, such as the female sex and hypertension, may promote secondary brain damage in patients with moyamoya disease. Further evaluations of EPVS in patients with moyamoya disease are needed to better understand their pathophysiological importance.
Highlights
Enlarged perivascular spaces (EPVS) are often observed with magnetic resonance imaging in patients with small vessel disease
Moyamoya disease is a cerebrovascular disease that is characterized by chronic progressive stenosis of the terminal portion of the internal carotid artery (ICA) on both sides of the brain, which results in an abnormal vascular network of the collateral pathways at the base of the brain [1, 2]
Comparing the moyamoya disease group and the control group, the prevalence of hypertension was significantly higher in the high EPVS grade group (p = 0.043), though the prevalence of type 2 diabetes mellitus and hyperlipidemia was not significant
Summary
Enlarged perivascular spaces (EPVS) are often observed with magnetic resonance imaging in patients with small vessel disease. The risk factors, radiological features, and clinical relevance of EPVS in patients with moyamoya disease are poorly understood. The purpose of this study was to evaluate EPVS, the risk factors of many EPVS, and the pathophysiology of EPVS in adult patients with moyamoya disease. In patients with chronic hypoperfusion, ischemic injury to the white matter causes axonal destruction and glial proliferation [4]. White matter lesions are observed in these patients on T2weighted magnetic resonance imaging (MRI) and fluidattenuated inversion recovery (FLAIR) imaging [5]. The deep white matter imaging findings in patients with moyamoya disease resemble those associated with patients with small vessel disease [7]
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