title: Periventricular anastomosis in moyamoya disease: detecting fragile collateral vessels with MR angiography.
abstract: OBJECT The authors' aim in this paper was to determine whether periventricular anastomosis, a novel term for the abnormal collateral vessels typical of moyamoya disease, is reliably measured with MR angiography and is associated with intracranial hemorrhage. METHODS This cross-sectional study sampled consecutive patients with moyamoya disease or moyamoya syndrome at a single institution. Periventricular anastomoses were detected using MR angiography images reformatted as sliding-thin-slab maximum-intensity-projection coronal images and were scored according to 3 subtypes: lenticulostriate, thalamic, and choroidal types. The association between periventricular anastomosis and hemorrhagic presentation at onset was evaluated using multivariate analyses. RESULTS Of 136 eligible patients, 122 were analyzed. Eighteen (14.8%) patients presented with intracranial hemorrhage with neurological symptoms at onset. Intra- and interrater agreement for rating of the periventricular anastomosis score was good (κw = 0.65 and 0.70, respectively). The prevalence of hemorrhagic presentation increased with the periventricular anastomosis score: 2.8% for Score 0, 8.8% for Score 1, 18.9% for Score 2, and 46.7% for Score 3 (p < 0.01 for trend). Univariate analysis revealed that age (p = 0.02) and periventricular anastomosis score (p < 0.01) were factors tentatively associated with hemorrhagic presentation. The score remained statistically significant after adjustment for age (OR 3.38 [95% CI 1.84-7.00]). CONCLUSIONS The results suggest that periventricular anastomosis detected with MR angiography can be scored with good intra- and interrater reliability and is associated with hemorrhagic presentation at onset in moyamoya disease. The clinical utility of periventricular anastomosis as a predictor for hemorrhage should be validated in further prospective studies.
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Funaki
authors.affiliation: Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Jun C
authors.initials: JC
authors.lastname: Takahashi
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Kazumichi
authors.initials: K
authors.lastname: Yoshida
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Takagi
authors.affiliation: Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto; and.
authors.forename: Yasutaka
authors.initials: Y
authors.lastname: Fushimi
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Kikuchi
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Mineharu
authors.affiliation: Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto; and.
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Okada
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Morimoto
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Susumu
authors.initials: S
authors.lastname: Miyamoto
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D020300:Intracranial Hemorrhages / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D009072:Moyamoya Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D015999:Multivariate Analysis; D016017:Odds Ratio; D015995:Prevalence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D055815:Young Adult
keywords: MRA = MR angiography; STS-MIP = sliding-thin-slab maximum-intensity projection; cerebral hemorrhage; magnetic resonance angiography; moyamoya disease; periventricular anastomosis; reproducibility; sensitivity and specificity; vascular disorders