Periventricular anastomosis in moyamoya disease: detecting fragile collateral vessels with MR angiography.
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 (kw 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.
Journal of neurosurgery