Imaging-related factors for preoperative brain infarction in adult patients with moyamoya disease and their intercorrelations

Jiang Guishen; Du Xinyue; Dong Wei; Chai Huafeng; Yin Xiaoqin; Deng Yali; Deng Guolan

doi:10.13406/j.cnki.cyxb.004100

您当前的位置：

首页 >

文章列表页 >

Imaging-related factors for preoperative brain infarction in adult patients with moyamoya disease and their intercorrelations

Clinical research | 更新时间：2026-06-11

- Imaging-related factors for preoperative brain infarction in adult patients with moyamoya disease and their intercorrelations
- Journal of Chongqing Medical University Vol. 51, Issue 6, Pages: 859-866(2026)
- 作者机构：
  
  重庆医科大学附属第一医院心血管内科，重庆 400016
- 作者简介：
- 基金信息：
- DOI：10.13406/j.cnki.cyxb.004100
  CLC： R445.2
- Received：11 February 2026，
  
  Revised：2026-03-30，
  
  Accepted：08 April 2026，
  
  Published：28 June 2026
- 稿件说明：
移动端阅览
蒋桂伸，杜新月，董蔚，等.成人烟雾病患者术前脑梗死的影像学相关因素及其相互关联[J].重庆医科大学学报，2026，51（6）：859-866.

Jiang Guishen,Du Xinyue,Dong Wei,et al.Imaging-related factors for preoperative brain infarction in adult patients with moyamoya disease and their intercorrelations[J].Journal of Chongqing Medical University,2026,51(6):859-866.
蒋桂伸，杜新月，董蔚，等.成人烟雾病患者术前脑梗死的影像学相关因素及其相互关联[J].重庆医科大学学报，2026，51（6）：859-866. DOI： 10.13406/j.cnki.cyxb.004100.

Jiang Guishen,Du Xinyue,Dong Wei,et al.Imaging-related factors for preoperative brain infarction in adult patients with moyamoya disease and their intercorrelations[J].Journal of Chongqing Medical University,2026,51(6):859-866. DOI： 10.13406/j.cnki.cyxb.004100.

摘要

目的

探讨成人烟雾病（moyamoya disease，MMD）患者术前脑梗死（brain infarction，BI）的影像学相关因素，并分析大脑后动脉（posterior cerebral artery，PCA）受累与白质高信号（white matter hyperintensity，WMH）和常春藤征之间的关联，及其对术前BI的影响。

方法

回顾性纳入41例成人MMD患者（35例双侧和6例单侧，共76个烟雾半球），收集其临床资料、头颅计算机断层扫描血管造影（computed tomography angiography，CTA）及磁共振成像（magnetic resonance imaging，MRI）资料。根据头颅MRI表现将烟雾半球分为BI组（38个半球）与non-BI组（38个半球）。单变量分析比较2组临床资料及影像学特征差异，并通过多因素logistic回归分析确定术前BI的独立相关因素。同时，利用路径分析探讨PCA受累与WMH和常春藤征的关联，及其对术前BI的间接效应。

结果

共纳入41例患者（29例合并BI），平均年龄（48.20±12.90）岁，其中男性18例。与non-BI组相比，BI组中PCA受累（狭窄≥50%）、重度WMH及重度常春藤征的比例均更高（57.89% vs. 21.05%、42.11% vs. 5.26%、52.63% vs. 15.79%；

²=10.794、14.268、11.458；均

0.05）。多因素分析显示，男性［比值比（odds ratio，

）=5.364，95%置信区间（95% confidence interval，95%CI）=1.563~18.411］、重度WMH（

=9.950，95%CI=1.732~57.165）和重度常春藤征（

=6.256，95%CI=1.588~24.639）与术前BI独立相关（均

0.05）。此外，PCA受累与重度WMH和重度常春藤征有关（均

0.05），路径分析结果显示，PCA受累分别通过重度WMH和重度常春藤征与术前BI存在间接关联，间接效应量分别为40.41%（95%CI=4.09%~69.14%）和44.25%（95%CI=6.95%~81.70%），均

0.05。

结论

在成人MMD患者中，男性、重度WMH和重度常春藤征是术前BI的独立相关因素。PCA受累与WMH和常春藤征的严重程度密切相关，并可能通过这种关联影响术前BI的发生。

Abstract

Objective

To investigate imaging-related factors for preoperative brain infarction（BI） in adult patients with moyamoya disease（MMD），and to analyze the association between posterior cerebral artery（PCA） involvement，white matter hyperintensity （WMH），and the Ivy sign，as well as their effects on preoperative BI.

Methods

A retrospective investigation was conducted on 41 adult patients diagnosed with MMD （35 with bilateral MMD and 6 with unilateral MMD，totaling 76 moyamoya hemispheres），from whom clinical data，as well as head computed tomography angiography（CTA） and magnetic resonance imaging（MRI） data were collected. The moyamoya hemispheres were categorized into BI group（38 hemispheres） and non-BI group（38 hemispheres） based on head MRI findings. Univariate analysis was used to compare differences in clinical data and imaging characteristics between the two groups，and multivariate logistic regression analysis was performed to identify independent-related factors for preoperative BI. Meanwhile，path analysis was employed to explore the association between PCA involvement，WMH，and the Ivy sign，as well as their indirect effects on preoperative BI.

Results

A total of 41 patients were included （29 of whom had BI），with a mean age of 48.20±12.90 years，of whom 18 were male. Compared with the non-BI group，the BI group had higher percentages of PCA involvement（stenosis ≥50%），severe WMH，and severe Ivy sign（57.89% vs. 21.05%，42.11% vs. 5.26%，and 52.63% vs. 15.79%；

χ²

=10.794，14.268，11.458；all

0.05）. Multivariate analysis revealed that male（odds ratio［

］=5.364，95%CI=1.563-18.411），severe WMH（

=9.950，95%CI=1.732-57.165），and severe Ivy sign（

=6.256，95%CI=1.588-24.639） were independently associated with preoperative BI （all

0.05）. Moreover，PCA involvement was associated with severe WMH and severe Ivy sign（both

0.05）. Path analysis showed that PCA involvement had indirect associations with preoperative BI via severe WMH and severe Ivy sign，with the indirect effect size of 40.41%（95%CI=4.09%-69.14%） and 44.25% （95%CI=6.95%-81.70%），respectively（both

0.05）.

Conclusion

In adult patients with MMD，male，severe WMH，and severe Ivy sign are independent-related factors for preoperative BI. PCA involvement is closely correlated with the severity of WMH and the Ivy sign，and may influence the occurrence of preoperative BI through this association.

关键词

Keywords

references

Ihara M ， Yamamoto Y ， Hattori Y ， et al . Moyamoya disease：diagnosis and interventions [J ] . Lancet Neurol ， 2022 ， 21 （ 8 ）： 747 - 758 ．

Bao XY ， Wang QN ， Zhang Y ， et al . Epidemiology of moyamoya disease in China：single-center，population-based study [J ] . World Neurosurg ， 2019 ， 122 ： 917 - 923 ．

闫灵娟，梁　媛，金京兰，等 . 超声在STA-MCA搭桥术治疗烟雾病中的评估价值 [J ] . 重庆医科大学学报， 2023 ， 48 （ 2 ）： 148 - 154 ．

Yan LJ ， Liang Y ， Jin JL ， et al . Evaluation value of ultrasound in superficial temporal artery-middle cerebral artery anastomosis in treating moyamoya disease [J ] . J Chongqing Med Univ ， 2023 ， 48 （ 2 ）： 148 - 154 ．

Cho WS ， Kim JE ， Kim CH ， et al . Long-term outcomes after combined revascularization surgery in adult moyamoya disease [J ] . Stroke ， 2014 ， 45 （ 10 ）： 3025 - 3031 ．

Zhang XC ， Yang YP ， Gan C ， et al . Risk factors of transient neurological deficits and perioperative stroke after revascularization in patients with moyamoya disease [J ] . Brain Sci ， 2022 ， 12 （ 10 ）： 1285 ．

Antonucci MU ， Burns TC ， Pulling TM ， et al . Acute preoperative infarcts and poor cerebrovascular reserve are independent risk factors for severe ischemic complications following direct extracranial-intracranial bypass for moyamoya disease [J ] . AJNR Am J Neuroradiol ， 2016 ， 37 （ 2 ）： 228 - 235 ．

中华医学会神经外科学分会 . 烟雾病和烟雾综合征诊断与治疗中国专家共识（2024版） [J ] . 中华神经外科杂志， 2024 ， 40 （ 3 ）： 220 - 229 ．

Chinese Society of Neurosurgery . China expert consensus on diagnosis and treatment of moyamoya disease and moyamoya syndrome（2024 edition） [J ] . Chin J Neurosurg ， 2024 ， 40 （ 3 ）： 220 - 229 ．

Filimonova E ， Ovsiannikov K ， Rzaev J . Neuroimaging in moyamoya angiopathy：updated review [J ] . Clin Neurol Neurosurg ， 2022 ， 222 ： 107471 ．

Lehman VT ， Cogswell PM ， Rinaldo L ， et al . Contemporary and emerging magnetic resonance imaging methods for evaluation of moyamoya disease [J ] . Neurosurg Focus ， 2019 ， 47 （ 6 ）： E6 ．

Yuan XX ， Yu H ， Sun ZG ， et al . Evaluation of surgical revascularization procedure outcomes for adult Moyamoya disease：a computed tomography perfusion-based study [J ] . Insights Imaging ， 2023 ， 14 （ 1 ）： 184 .

Noh HJ ， Kim SJ ， Kim JS ， et al . Long term outcome and predictors of ischemic stroke recurrence in adult moyamoya disease [J ] . J Neurol Sci ， 2015 ， 359 （ 1/2 ）： 381 - 388 ．

Pettersson SD ， Olofsson HKL ， Shan AL ， et al . Risk factors for ischemic stroke after revascularization surgery in patients with moyamoya disease：an age-stratified comparative meta-analysis [J ] . World Neurosurg ， 2023 ， 173 ： 146 - 157 ．

Pang CH ， Lee SU ， Lee Y ， et al . Prediction of hemorrhagic cerebral hyperperfusion syndrome after direct bypass surgery in adult nonhemorrhagic moyamoya disease：combining quantitative parameters on RAPID perfusion CT with clinically related factors [J ] . J Neurosurg ， 2022 ， 138 （ 3 ）： 683 - 692 ．

Luo S ， Zhan WJ ， Zhang LJ ， et al . Ischemic patterns and their angiographic risk factors in adult patients with moyamoya disease [J ] . Ann Clin Transl Neurol ， 2023 ， 10 （ 12 ）： 2386 - 2393 ．

Kuroda S ， Fujimura M ， Takahashi J ， et al . Diagnostic criteria for moyamoya disease - 2021 revised version [J ] . Neurol Med Chir（Tokyo）， 2022 ， 62 （ 7 ）： 307 - 312 ．

Tigchelaar SS ， Wang AR ， Vaca SD ， et al . Incidence and outcomes of posterior circulation involvement in moyamoya disease [J ] . Stroke ， 2024 ， 55 （ 5 ）： 1254 - 1260 ．

Guo X ， Gao LY ， Yu H ， et al . Computed tomographic angiography may be used for assessing the dilatation of the anterior choroidal and posterior communicating arteries in patients with moyamoya syndrome [J ] . Eur Radiol ， 2021 ， 31 （ 8 ）： 5544 - 5551 ．

Fazekas F ， Chawluk JB ， Alavi A ， et al . MR signal abnormalities at 1.5 T in Alzheimer’s dementia and normal aging [J ] . Am J Roentgenol ， 1987 ， 149 （ 2 ）： 351 - 356 ．

Charidimou A ， Martinez-Ramirez S ， Reijmer YD ， et al . Total magnetic resonance imaging burden of small vessel disease in cerebral amyloid angiopathy：an imaging-pathologic study of concept validation [J ] . JAMA Neurol ， 2016 ， 73 （ 8 ）： 994 - 1001 ．

Yoon HK ， Shin HJ ， Chang YW . “Ivy sign” in childhood moyamoya disease：depiction on FLAIR and contrast-enhanced T1-weighted MR images [J ] . Radiology ， 2002 ， 223 （ 2 ）： 384 - 389 ．

Li Y ， Li WJ ， Xia CC ， et al . Ivy sign：usefulness in diagnosis and prognosis prediction of moyamoya disease [J ] . World Neurosurg ， 2024 ， 181 ： 1012 - 1018 ．

Birkeland P ， Hansen V ， Tharmabalan V ， et al . Long-term stroke risk in Moyamoya disease [J ] . Int J Stroke ， 2024 ， 19 （ 4 ）： 452 - 459 ．

Lu MM ， Zhang HT ， Liu DQ ， et al . Vessel wall enhancement as a predictor of arterial stenosis progression and poor outcomes in moyamoya disease [J ] . Eur Radiol ， 2023 ， 33 （ 4 ）： 2489 - 2499 ．

Hao FB ， Han C ， Lu MM ， et al . High-resolution MRI vessel wall enhancement in moyamoya disease：risk factors and clinical outcomes [J ] . Eur Radiol ， 2024 ， 34 （ 8 ）： 5179 - 5189 ．

Chen P ， Wang Y ， Li SF ， et al . Development and external validation of nomogram for cerebral infarction in moyamoya diseases [J ] . Transl Stroke Res ， 2023 ， 14 （ 6 ）： 890 - 898 ．

Sun HG ， Li WJ ， Xia C ， et al . Magnetic resonance imaging markers of cerebral small vessel disease in adults with moyamoya disease [J ] . Transl Stroke Res ， 2022 ， 13 （ 4 ）： 533 - 542 ．

Wang LX ， Lyu JH ， Han DS ， et al . Imaging assessments and clinical significance of brain frailty in moyamoya disease [J ] . AJNR Am JNeuroradiol ， 2024 ， 45 （ 7 ）： 855 - 862 ．

Yu J ， Du Q ， Xie H ， et al . What and why：the current situation and future prospects of “ivy sign” in moyamoya disease [J ] . Ther Adv Chronic Dis ， 2020 ， 11 ： 2040622320960004 ．

Wang LX ， Wang H ， Hao FB ， et al . Ivy sign in moyamoya disease：a comparative study of the FLAIR vascular hyperintensity sign against contrast-enhanced MRI [J ] . AJNR Am JNeuroradiol ， 2021 ， 42 （ 4 ）： 694 - 700 ．

Seo KD ， Suh SH ， Kim YB ， et al . Ivy sign on fluid-attenuated inversion recovery images in moyamoya disease：correlation with clinical severity and old brain lesions [J ] . Yonsei Med J ， 2015 ， 56 （ 5 ）： 1322 ．

Shen J ， Xu ZW ， Liu ZX ， et al . Association between white matter hyperintensities burden and cognitive function in adult asymptomatic moyamoya disease [J ] . J Clin Med ， 2023 ， 12 （ 3 ）： 1143 ．

Kazumata K ， Tokairin K ， Ito M ， et al . Combined structural and diffusion tensor imaging detection of ischemic injury in moyamoya disease：relation to disease advancement and cerebral hypoperfusion [J ] . J Neurosurg ， 2021 ， 134 （ 4 ）： 1155 - 1164 ．

Kaku Y ， Iihara K ， Nakajima N ， et al . The leptomeningeal ivy sign on fluid-attenuated inversion recovery images in moyamoya disease：positron emission tomography study [J ] . Cerebrovasc Dis ， 2013 ， 36 （ 1 ）： 19 - 25 ．

Hamada Y ， Shigehisa A ， Kanda Y ， et al . Enhancement of the ivy sign during an ischemic event in moyamoya disease [J ] . Intern Med ， 2023 ， 62 （ 4 ）： 617 - 621 ．

Kawashima M ， Noguchi T ， Takase Y ， et al . Unilateral hemispheric proliferation of ivy sign on fluid-attenuated inversion recovery images in moyamoya disease correlates highly with ipsilateral hemispheric decrease of cerebrovascular reserve [J ] . AJNR Am J Neuroradiol ， 2009 ， 30 （ 9 ）： 1709 - 1716 ．

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Evaluation value of ultrasound in superficial temporal artery-middle cerebral artery anastomosis in treating moyamoya disease

Epidemiological characteristics of clinically isolated bacteria from patients with urinary tract infection admitted to the intensive care unit

Research advances in traditional Chinese medicine treatment of myocardial ischemia-reperfusion injury by regulating pyroptosis based on the NLRP3/Caspase-1 signaling pathway

Application of artificial intelligence in the diagnosis and treatment of sepsis: innovations，challenges，and clinical practice

Interpretation of expert consensus on the diagnosis and therapy of endo-periodontal lesions

Related Author

Yan Lingjuan

Liang Yuan

Jin Jinglan

Gao Hongkui

Fang Wei

Wang Jia

Related Institution

Department of Ultrasound

Department of Neurosurgery，The Second Affiliated Hospital of;Air Force Medical University

⁰