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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Spatial relationship between cerebral microbleeds, moyamoya vessels, and hematoma in moyamoya disease
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Spatial relationship between cerebral microbleeds, moyamoya vessels, and hematoma in moyamoya disease

机译：烟雾病中脑微出血，烟雾病脉管与血肿的空间关系

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Background Adult moyamoya disease (MMD) is known to have high incidence of cerebral microbleeds (cMBs); however, the clinical significance still remains unclear. We investigated the frequency of cMBs in a large number of patients and analyzed the patterns of MB distribution in association with the location of the hematoma and moyamoya vessels. Methods We studied 259 consecutive patients with MMD using prospectively collected database. One hundred ninety-one patients were eligible for the present study, and image analysis was performed retrospectively. The presence of cMBs and remains of hemorrhage were determined using gradient-echo T2*-weighted sequence (1.5 T). The development of moyamoya vessels was assessed on source images of time-of-flight magnetic resonance angiography. The analysis consists of descriptive assessment of the spatial relationship between cMB, remains of hemorrhage, and moyamoya vessels. Statistical analysis was performed to calculate relative risk ratio in the presence of cMBs in relation to the remains of hemorrhage (macrohematoma), age of onset, and the presence of concomitant moyamoya vessels. Results Thirty MBs were observed in 20 adult MMD patients (16.9%). MBs were located predominantly in the periventricular white matter (63.3%) followed by the basal ganglia/thalami (20%). Comparing the patients with cMBs from those without, hematoma was more frequently observed in patients with cMBs (odds ratio [OR] 4.29; 95% confidence interval [CI] 1.58-11.62; P =.0062). Patients with adult onset was more likely to demonstrate cMBs (14.4%) compared with the patients with pediatric onset (4.1%) (OR 3.93; 95% CI 1.11-13.91). Moyamoya vessels appeared in the lateral part of the trigon, and the periventricular white matter was significantly associated with the presence of cMBs (lateral part of the trigon; OR 3.29 [1.59-6.82], P =.0019, periventricle of the body of lateral ventricle; OR 2.40 [1.20-4.79], P =.0214, respectively). cMBs accompanied concomitant arteries in 23 (76.7%) lesions. The subependymal-leptomeningeal artery anastomosis was the most common pattern (n = 20, 66.7%). Conclusions Spatial relationship was demonstrated between the moyamoya vessels and perivascular hemosiderin deposition particularly around the subependymal- leptomeningeal anastomosis, suggesting the mechanism for the development of cMBs in MMD. Present study further supports previous findings that cMBs potentially serve as a marker for the bleeding-prone microangiopathy in MMD. The significance of the present study lies in selecting optimal surgical candidate for preventing future hemorrhage by the presence of the cMBs, whereas current surgical indication relying on the degree of ischemia frequently fails to detect patients with future hemorrhage.
机译：背景技术成人烟雾病（MMD）已知脑微出血（cMBs）的发生率很高。但是，临床意义仍然不清楚。我们调查了大量患者中cMB的频率，并分析了MB分布的模式以及血肿和烟雾病血管的位置。方法我们使用前瞻性收集的数据库研究了259例连续MMM患者。 191例患者符合本研究的条件，并进行了回顾性图像分析。使用梯度回波T2 *加权序列（1.5 T）确定cMB的存在和出血残留。在飞行时间磁共振血管造影的原始图像上评估烟雾弥漫性血管的发育。该分析包括对cMB，出血残留和Moyamoya血管之间的空间关系的描述性评估。进行统计分析以计算存在cMBs时相对于出血（大血肿）的残留，发病年龄和伴有烟雾病血管的相对风险比。结果20例成人MMD患者中观察到30 MB，占16.9％。 MBs主要位于脑室周围白质中（63.3％），其次是基底神经节/丘脑（20％）。将具有cMBs的患者与没有cMBs的患者进行比较，在具有cMBs的患者中更经常观察到血肿（几率[OR] 4.29; 95％置信区间[CI] 1.58-11.62; P = .0062）。与小儿发作的患者（4.1％）相比，成年发作的患者更有可能表现出cMBs（14.4％）（OR 3.93; 95％CI 1.11-13.91）。 Moyamoya血管出现在三角形的外侧部分，并且脑室周围白质与cMBs的存在（三角形的外侧部分; OR 3.29 [1.59-6.82]，P = .0019，外侧脑室的周围）显着相关心室;或2.40 [1.20-4.79]，P = .0214）。 cMBs在23个（76.7％）病变中伴有动脉。室管膜下-皮脑膜下动脉吻合是最常见的模式（n = 20，66.7％）。结论烟雾分子与血管周铁血黄素沉积之间存在空间关系，尤其是在室管膜下-脑膜下皮膜吻合周围，这提示了MMD中cMBs的发展机制。本研究进一步支持了先前的发现，即cMBs可能是MMD中易出血的微血管病的标志物。本研究的意义在于通过cMBs的存在选择最佳的手术候选物来预防将来的出血，而依靠局部缺血程度的当前手术适应症常常无法检测到将来有出血的患者。

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