Abstract：
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: Considering this association, revascularization surgery could improve cognitive impairment.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: Considering this association, revascularization surgery could improve cognitive impairment.
摘要：
■在烟雾病（MMA）中，认知障碍的潜在机制仍存在争议。我们旨在评估MMA中认知障碍与脑灌注不足程度和地形图的关系。
■对患有MMA的成年人的神经心理学和灌注MRI数据进行了回顾性分析。在脑灌注分析中，创建了缺血性和出血性病变面罩以说明脑部病变。使用4至12s的不同Tmax阈值在灌注图上概述了灌注不足的薄壁组织的全脑体积。区域分析产生了不同感兴趣区域的平均Tmax值。分析比较有和没有认知障碍的患者的灌注比，采用多变量Logistic回归分析确定预测因素。
■在20/48（41.7%）患者中发现了认知障碍。注意力/处理速度和记忆力同样受损（24％），其次是执行领域（23％）。调整后,尤其是病变体积，通过Tmax>4s或Tmax>5s阈值概述的灌注不足的实质体积是认知障碍的独立因素（对于Tmax>4s=1.06[CI95％1.008-1.123]的OR）以及注意力/处理速度（对于Tmax>4s=1.07[CI95％1.003-1.133]）和执行域（对于Tmax>5s=1.08[95％1.00158）关于认知功能，与其他ROI和测试评分正常的患者相比,处理速度和灵活性障碍患者的额叶Tmax更高.
■脑灌注不足是MMA认知障碍的独立因素，特别是在注意力/处理速度和执行领域，额叶区域有很强的贡献。
■考虑到这种关联，血运重建手术可以改善认知障碍。
■对患有MMA的成年人的神经心理学和灌注MRI数据进行了回顾性分析。在脑灌注分析中，创建了缺血性和出血性病变面罩以说明脑部病变。使用4至12s的不同Tmax阈值在灌注图上概述了灌注不足的薄壁组织的全脑体积。区域分析产生了不同感兴趣区域的平均Tmax值。分析比较有和没有认知障碍的患者的灌注比，采用多变量Logistic回归分析确定预测因素。
■在20/48（41.7%）患者中发现了认知障碍。注意力/处理速度和记忆力同样受损（24％），其次是执行领域（23％）。调整后,尤其是病变体积，通过Tmax>4s或Tmax>5s阈值概述的灌注不足的实质体积是认知障碍的独立因素（对于Tmax>4s=1.06[CI95％1.008-1.123]的OR）以及注意力/处理速度（对于Tmax>4s=1.07[CI95％1.003-1.133]）和执行域（对于Tmax>5s=1.08[95％1.00158）关于认知功能，与其他ROI和测试评分正常的患者相比,处理速度和灵活性障碍患者的额叶Tmax更高.
■脑灌注不足是MMA认知障碍的独立因素，特别是在注意力/处理速度和执行领域，额叶区域有很强的贡献。
■考虑到这种关联，血运重建手术可以改善认知障碍。
