MRI hypoperfusion as a determinant of cognitive impairment in adults with Moyamoya angiopathy.

IF 5.8 3区医学 Q1 CLINICAL NEUROLOGY

European Stroke Journal Pub Date : 2024-09-01 Epub Date: 2024-03-19 DOI:10.1177/23969873241240829

Marine Giroud, Mélanie Planton, Jean Darcourt, Nicolas Raposo, Pierre Brandicourt, Hélène Mirabel, Dominique Hervé, Alain Viguier, Jean-François Albucher, Jérémie Pariente, Jean Marc Olivot, Fabrice Bonneville, Patrice Péran, Lionel Calviere

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引用次数: 0

Abstract

Introduction: In Moyamoya angiopathy (MMA), mechanisms underlying cognitive impairment remain debated. We aimed to assess the association of cognitive impairment with the degree and the topography of cerebral hypoperfusion in MMA.

Methods: A retrospective analysis of neuropsychological and perfusion MRI data from adults with MMA was performed. Ischemic and haemorrhagic lesion masks were created to account for cerebral lesions in the analysis of cerebral perfusion. Whole brain volume of hypoperfused parenchyma was outlined on perfusion maps using different Tmax thresholds from 4 to 12 s. Regional analysis produced mean Tmax values at different regions of interest. Analyses compared perfusion ratios in patients with and without cognitive impairment, with multivariable logistic regression analysis to identify predictive factors.

Results: Cognitive impairment was found in 20/48 (41.7%) patients. Attention/processing speed and memory were equally impaired (24%) followed by executive domain (23%). After adjustment, especially for lesion volume, hypoperfused parenchyma volume outlined by Tmax > 4 s or Tmax > 5 s thresholds was an independent factor of cognitive impairment (OR for Tmax > 4 s = 1.06 [CI 95% 1.008-1.123]) as well as attention/processing speed (OR for Tmax > 4 s = 1.07 [CI 95% 1.003-1.133]) and executive domains (OR for Tmax > 5 s = 1.08 [CI 95% 1.004-1.158]). Regarding cognitive functions, patients with processing speed and flexibility impairment had higher frontal Tmax compared to other ROIs and to patients with normal test scores.

Discussion: Cerebral hypoperfusion emerged as an independent factor of cognitive impairment in MMA particularly in attention/processing speed and executive domains, with a strong contribution of frontal areas.

Conclusion: Considering this association, revascularization surgery could improve cognitive impairment.

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MRI 低灌注是成人 Moyamoya 血管病患者认知功能障碍的决定因素。

导言：在莫亚莫亚血管病（MMA）中，认知障碍的潜在机制仍存在争议。我们的目的是评估认知障碍与 MMA 脑灌注不足的程度和形貌之间的关联：方法：我们对成人 MMA 患者的神经心理学和灌注 MRI 数据进行了回顾性分析。在分析脑灌注时，创建了缺血性和出血性病变掩膜，以考虑脑部病变。使用 4 至 12 秒的不同 Tmax 阈值在灌注图上勾勒出低灌注实质的整个脑容量。区域分析得出不同感兴趣区域的平均 Tmax 值。分析比较了有认知障碍和无认知障碍患者的灌注比率，并通过多变量逻辑回归分析确定了预测因素：20/48（41.7%）名患者存在认知障碍。注意力/处理速度和记忆力同样受损（24%），其次是执行领域（23%）。经过调整，特别是对病变体积进行调整后，Tmax > 4 s 或 Tmax > 5 s 临界值所概括的高灌注实质体积是认知障碍的独立因素（Tmax > 4 s 的 OR = 1.06 [CI 95% 1.008-1.123]），注意力/处理速度（Tmax > 4 s 的 OR = 1.07 [CI 95% 1.003-1.133]）和执行领域（Tmax > 5 s 的 OR = 1.08 [CI 95% 1.004-1.158]）也是独立因素。在认知功能方面，与其他ROI和测试评分正常的患者相比，处理速度和灵活性受损的患者额叶Tmax更高：讨论：脑灌注不足是MMA认知功能障碍的一个独立因素，尤其是在注意力/处理速度和执行力方面，额叶区域的贡献很大：结论：考虑到这一关联，血管再通手术可改善认知障碍。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Stroke Journal Multiple-

CiteScore

7.50

自引率

6.60%

发文量

102

期刊介绍： Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.