title: Reversibility of White Matter Hyperintensity by Revascularization Surgery in Moyamoya Disease.
abstract: BACKGROUND
  White matter lesions (WMLs) indicate progressive cerebral small vessel disease and are frequently observed in aging people and stroke patients. The purpose of this study was to evaluate WMLs and the influence of revascularization surgery for WMLs in patients with moyamoya disease.
  
  
  METHODS
  A total of 42 hemispheres in 21 patients with moyamoya disease were included in this analysis. WMLs were detected on fluid-attenuated inversion recovery (FLAIR) imaging in 24 hemispheres. The distribution pattern of WMLs was categorized. WMLs were measured by manually creating a region of interest, and the total WML volume in the hemisphere was estimated and compared with the control group. Clinical features of patients with WMLs and postoperative changes were analyzed.
  
  
  RESULTS
  The total WML volume in moyamoya disease was significantly higher than that of controls (P = .014). WMLs were observed in the internal watershed zone, especially in the watershed zone between the anterior cerebral artery and the middle cerebral artery. Patients with WMLs had significantly higher magnetic resonance angiography scores compared with controls (P = .015). A given patient's total WML volume per hemisphere was significantly decreased after surgery (P = .001).
  
  
  CONCLUSIONS
  WMLs on FLAIR imaging increase in patients with moyamoya disease and are reversible by revascularization surgery. Improvement of cerebral blood flow is partly related to the decrease in WMLs. The present results provide insight into the potential role of revascularization surgery.
authors.affiliation: Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan.
authors.forename: Katsuya
authors.initials: K
authors.lastname: Komatsu
authors.affiliation: Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Mikami
authors.affiliation: Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan.
authors.forename: Shouhei
authors.initials: S
authors.lastname: Noshiro
authors.affiliation: Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Miyata
authors.affiliation: Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Wanibuchi
authors.affiliation: Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan. Electronic address: mikunin@sapmed.ac.jp.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Mikuni
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D056784:Leukoencephalopathies / Q000000981:diagnostic imaging / Q000209:etiology*; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009072:Moyamoya Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D019635:Neurosurgical Procedures; D055420:Perfusion Imaging / Q000379:methods; D011237:Predictive Value of Tests; D012074:Remission Induction; D012189:Retrospective Studies; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome; D066127:White Matter / Q000000981:diagnostic imaging*; D055815:Young Adult
keywords: Magnetic resonance imaging; chronic ischemia; revascularization surgery; stroke