title: Specific Shrinkage of Carotid Forks in Moyamoya Disease: A Novel Key Finding for Diagnosis.
abstract: This study was aimed to analyze the outer diameter of the involved arteries in moyamoya disease, using three-dimensional (3D) constructive interference in steady state (CISS) and direct surgical inspection. Radiological evaluation was performed in 64 patients with moyamoya disease. As the controls, six patients with severe middle cerebral artery (MCA) stenosis and 17 healthy subjects were also recruited. On 3D-CISS, the outer diameter was quantified in the supraclinoid portion of internal carotid artery (C1), the horizontal portions of MCA (M1) and anterior cerebral artery (A1), and basilar artery. The involved carotid fork was directly observed during surgery in another series of three adult patients with moyamoya disease. In 53 adult patients with moyamoya disease, the outer diameters of C1, M1, and A1 segments were 2.3 ± 0.7 mm, 1.3 ± 0.5 mm, and 1.0 ± 0.4 mm in the involved side (n = 91), being significantly smaller than the control (n = 17), severe M1 stenosis (n = 6), and non-involved side in moyamoya disease (n = 15, P < 0.01). There were significant correlations between Suzuki's angiographical stage and the outer diameters of C1, M1, and A1 (P < 0.001). The laterality ratio of C1 and M1 was significantly smaller in unilateral moyamoya disease (n = 20) than the controls and severe MCA stenosis (P < 0.01). Direct observations revealed a marked decrease in the outer diameter of the carotid fork (n = 3). These findings strongly suggest specific shrinkage of the involved arteries in moyamoya disease, which may provide essential information to distinguish moyamoya disease from other intracranial arterial stenosis and shed light on the etiology and novel diagnosis cue of moyamoya disease.
authors.affiliation: Department of Neurosurgery, Graduate School of Medicine and Pharmacological Sciences, University of Toyama.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kuroda
authors.forename: Daina
authors.initials: D
authors.lastname: Kashiwazaki
authors.forename: Naoki
authors.initials: N
authors.lastname: Akioka
authors.forename: Masaki
authors.initials: M
authors.lastname: Koh
authors.forename: Emiko
authors.initials: E
authors.lastname: Hori
authors.forename: Manabu
authors.initials: M
authors.lastname: Nishikata
authors.forename: Kimiko
authors.initials: K
authors.lastname: Umemura
authors.forename: Yukio
authors.initials: Y
authors.lastname: Horie
authors.forename: Kyo
authors.initials: K
authors.lastname: Noguchi
authors.forename: Naoya
authors.initials: N
authors.lastname: Kuwayama
mesh_terms: D000328:Adult; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000601:surgery; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D009072:Moyamoya Disease / Q000150:complications*