Burden of dilated perivascular spaces in patients with moyamoya disease and moyamoya syndrome is related to middle cerebral artery stenosis

Guangsong Han; Xiaoyuan Fan; Yuehui Hong; Lixin Zhou; Yicheng Zhu; Feng Feng; Ming Yao; Jun Ni

doi:10.3389/fneur.2023.1192646

Burden of dilated perivascular spaces in patients with moyamoya disease and moyamoya syndrome is related to middle cerebral artery stenosis

Front Neurol. 2023 Jun 5:14:1192646. doi: 10.3389/fneur.2023.1192646. eCollection 2023.

Authors

Guangsong Han^#¹, Xiaoyuan Fan^#², Yuehui Hong¹, Lixin Zhou¹, Yicheng Zhu¹, Feng Feng², Ming Yao¹, Jun Ni¹

Affiliations

¹ Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
² Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.

^# Contributed equally.

Abstract

Background and objective: The correlation between intracranial large artery disease and cerebral small vessel disease (CSVD) has become a noteworthy issue. Dilated perivascular spaces (dPVS) are an important marker of CSVD, of which cerebral atrophy has been regarded as one of the pathological mechanisms. DPVS has been found to be associated with vascular stenosis in patients with moyamoya disease (MMD), but the underlying mechanism remains unclear. The purpose of our study was to explore the correlation between the middle cerebral artery (MCA) stenosis and dPVS in the centrum semiovale (CSO-dPVS) in patients with MMD/moyamoya syndrome (MMS) and to determine whether brain atrophy plays a mediating role in this relationship.

Methods: A total of 177 patients were enrolled in a single-center MMD/MMS cohort. Images of their 354 cerebral hemispheres were divided into three groups according to dPVS burden: mild (dPVS 0-10), moderate (dPVS 11-20), and severe (dPVS > 20). The correlations among cerebral hemisphere volume, MCA stenosis, and CSO-dPVS were analyzed, adjusting for the confounding factors of age, gender, and hypertension.

Results: After adjustment for age, gender, and hypertension, the degree of MCA stenosis was independently and positively associated with ipsilateral CSO-dPVS burden (standardized coefficient: β = 0.247, P < 0.001). A stratified analysis found that the subgroup with a severe CSO-dPVS burden exhibited a significantly higher risk of severe stenosis of the MCA [p < 0.001, OR = 6.258, 95% CI (2.347, 16.685)]. No significant correlation between CSO-dPVS and ipsilateral hemisphere volume was found (p = 0.055).

Conclusion: In our MMD/MMS cohort, there was a clear correlation between MCA stenosis and CSO-dPVS burden, which may be a direct effect of large vessel stenosis, without a mediating role of brain atrophy.

Keywords: cerebral atrophy; large artery stenosis; moyamoya disease; moyamoya syndrome; perivascular space.

Grants and funding

This study was supported by grants from the STI2030-Major Project #2021ZD0201100 Task 5 #2021ZD0201105 and the National High-Level Hospital Clinical Research Funding (2022-PUMCH-D-007). Sponsors were not involved in the design of the study, the data analyses, or the writing of the article.