title: Infarct Pattern and Collateral Status in Adult Moyamoya Disease: A Multimodal Magnetic Resonance Imaging Study.
abstract: Moyamoya disease (MMD) is a unique cerebrovascular disease characterized by the progressive stenosis of large intracranial arteries and a hazy network of basal collaterals, called moyamoya vessels. Although hemodynamic studies have been applied in MMD patients, the mechanisms of stroke in MMD are still unclear. The present study evaluated the infarct pattern and collateral status using multimodal magnetic resonance imaging in MMD patients.
  
  
  
  Adult MMD patients with acute ischemic stroke were prospectively recruited, and infarct pattern on diffusion-weighted imaging was evaluated. A collateral flow map, derived from magnetic resonance perfusion-weighted imaging data, was generated through automatic postprocessing, and collateral status was assigned into 3 grades. Transcranial Doppler monitoring was performed to detect microembolic signals in selected patients.
  
  
  
  A total of 67 hemispheres (31 patients with bilateral and 5 patients with unilateral MMD) were analyzed. Most patients (83.7%) showed embolic pattern and rarely deep (9.3%) or hemodynamic infarct pattern (7.0%) on diffusion-weighted imaging. Most cases (86%) showed good collateral status, and few patients with acute infarcts of embolic pattern showed poor collateral status (n=7). One third (31.6%) of patients who underwent transcranial Doppler monitoring showed microembolic signals.
  
  
  
  In the studied population of adult MMD patients, embolic phenomenon played an important role in ischemic stroke. Therapeutic strategies against thromboembolism, as well as collateral enhancing strategies targeting improvement of hemodynamic status or increased washout of emboli, are warranted.
authors.affiliation: From the Departments of Neurology (D.Y.K., G.-M.K., O.Y.B.) and Neurosurgery (J.Y.Y., J.-S.K., S.-C.H.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; and Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea (J.P.S., O.Y.B.).
authors.forename: Dong Yeop
authors.initials: DY
authors.lastname: Kim
authors.affiliation: From the Departments of Neurology (D.Y.K., G.-M.K., O.Y.B.) and Neurosurgery (J.Y.Y., J.-S.K., S.-C.H.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; and Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea (J.P.S., O.Y.B.).
authors.forename: Jeong Pyo
authors.initials: JP
authors.lastname: Son
authors.affiliation: From the Departments of Neurology (D.Y.K., G.-M.K., O.Y.B.) and Neurosurgery (J.Y.Y., J.-S.K., S.-C.H.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; and Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea (J.P.S., O.Y.B.).
authors.forename: Je Young
authors.initials: JY
authors.lastname: Yeon
authors.affiliation: From the Departments of Neurology (D.Y.K., G.-M.K., O.Y.B.) and Neurosurgery (J.Y.Y., J.-S.K., S.-C.H.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; and Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea (J.P.S., O.Y.B.).
authors.forename: Gyeong-Moon
authors.initials: GM
authors.lastname: Kim
authors.affiliation: From the Departments of Neurology (D.Y.K., G.-M.K., O.Y.B.) and Neurosurgery (J.Y.Y., J.-S.K., S.-C.H.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; and Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea (J.P.S., O.Y.B.).
authors.forename: Jong-Soo
authors.initials: JS
authors.lastname: Kim
authors.affiliation: From the Departments of Neurology (D.Y.K., G.-M.K., O.Y.B.) and Neurosurgery (J.Y.Y., J.-S.K., S.-C.H.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; and Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea (J.P.S., O.Y.B.).
authors.forename: Seung-Chyul
authors.initials: SC
authors.lastname: Hong
authors.affiliation: From the Departments of Neurology (D.Y.K., G.-M.K., O.Y.B.) and Neurosurgery (J.Y.Y., J.-S.K., S.-C.H.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; and Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea (J.P.S., O.Y.B.). ohyoung.bang@samsung.com.
authors.forename: Oh Young
authors.initials: OY
authors.lastname: Bang
mesh_terms: D000328:Adult; D002560:Cerebrovascular Circulation / Q000502:physiology; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009072:Moyamoya Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D064847:Multimodal Imaging; D011446:Prospective Studies; D017585:Ultrasonography, Doppler, Transcranial
keywords: Moyamoya disease; cerebral infarction; collateral; diffusion-weighted imaging; embolism