T1w/T2w ratio is associated with the brush sign and perfusion delay in watershed regions in patients with moyamoya angiopathy

E Filimonova; K Ovsiannikov; B Zaitsev; J Rzaev

doi:10.1016/j.clineuro.2023.107821

T1w/T2w ratio is associated with the brush sign and perfusion delay in watershed regions in patients with moyamoya angiopathy

Clin Neurol Neurosurg. 2023 Aug:231:107821. doi: 10.1016/j.clineuro.2023.107821. Epub 2023 Jun 8.

Authors

E Filimonova¹, K Ovsiannikov², B Zaitsev³, J Rzaev⁴

Affiliations

¹ Federal Center of Neurosurgery Novosibirsk, Nemirovich-Danchenko Str. 132/1, Novosibirsk 630087, Russia; Novosibirsk State Medical University, Krasny Prospect St. 52, Novosibirsk 630091, Russia. Electronic address: e.filimonova@alumni.nsu.ru.
² Federal Center of Neurosurgery Novosibirsk, Nemirovich-Danchenko Str. 132/1, Novosibirsk 630087, Russia; Department of Neuroscience, Institute of Medicine and Psychology, Novosibirsk State University, Pirogov Str. 1, Novosibirsk 630090, Russia.
³ Federal Center of Neurosurgery Novosibirsk, Nemirovich-Danchenko Str. 132/1, Novosibirsk 630087, Russia.
⁴ Federal Center of Neurosurgery Novosibirsk, Nemirovich-Danchenko Str. 132/1, Novosibirsk 630087, Russia; Novosibirsk State Medical University, Krasny Prospect St. 52, Novosibirsk 630091, Russia; Department of Neuroscience, Institute of Medicine and Psychology, Novosibirsk State University, Pirogov Str. 1, Novosibirsk 630090, Russia.

PMID: 37302378
DOI: 10.1016/j.clineuro.2023.107821

Abstract

Background: It has been shown recently using the T1w/T2w mapping technique that white matter microstructural integrity impairments exist in watershed regions patients with moyamoya angiopathy (MMA). We hypothesized that these changes could be associated with the prominence of other neuroimaging markers of chronic brain ischemia, such as perfusion delay and the brush sign.

Methods: Thirteen adult patients with MMA (24 affected hemispheres) were evaluated using brain MRI and CT perfusion. The T1w/T2w signal intensity ratio, which reflects white matter integrity, was calculated in watershed regions (centrum semiovale and middle frontal gyrus). Brush sign prominence was evaluated with susceptibility-weighted MRI. Additionally, brain perfusion parameters such as cerebral blood flow (CBF), cerebral blood volume (CBF), and mean transit time (MTT) were assessed. Correlations between white matter integrity and perfusion changes in watershed regions, as well as the prominence of the brush sign, were evaluated.

Results: Statistically significant negative correlations between the prominence of the brush sign and the T1w/T2w ratio values from the centrum semiovale and middle frontal white matter were found (R = -0.62 to 0.71, adjusted p < 0.05). Furthermore, there was a positive correlation between the T1w/T2w ratio values and the MTT values from the centrum semiovale (R = 0.65, adjusted p < 0.05).

Conclusions: We revealed that T1w/T2w ratio changes are associated with the prominence of the brush sign as well as white matter hypoperfusion in watershed regions in patients with MMA. This could be explained by chronic ischemia due to venous congestion in the deep medullary vein territory.

Keywords: CT perfusion; Magnetic Resonance Imaging (MRI); Moyamoya Angiopathy (MMA); Susceptibility Weighted Imaging (SWI); T1w/T2w ratio.

MeSH terms

Adult
Brain
Brain Ischemia* / diagnostic imaging
Humans
Magnetic Resonance Imaging / methods
Moyamoya Disease* / diagnostic imaging
Perfusion
White Matter* / diagnostic imaging