The Relationship Between The Patterns Of Acute Cerebral Infarction And The Features Of Vascular Stenosis In Moyamoya Syndrome Based On Cerebral MRI/MRA Imaging

Objective: To explore the relationship between the features of large vessel stenosis and the patterns of cerebral infarction in moyamoya syndrome(MMS).Methods: The clinical and imaging data of 116 MMS patients diagnosed in the Affiliated Hospital of Jining Medical University from October 2016 to December 2022 were retrospectively analyzed.All patients underwent MRI and magnetic resonance angiography(MRA),and were divided into infarction group and non-infarction group according to whether the patients had cerebral infarction.The cerebral infarction patterns were divided into perforating artery infarct,pial artery infarct,border-zone infarct and multiple infarcts;The evaluation is performed in units of one cerebral hemisphere,the degree of stenosis of the internal carotid artery(ICA),anterior cerebral artery(ACA),middle cerebral artery(MCA),and posterior cerebral artery(PCA)was evaluated according to Houkin’s MRA scores,Chi-square test was used to evaluate the prevalence of large vessel involvement and the correlation between the patterns of cerebral infarction and the degree of large vessel stenosis in different groups,and Spearman correlation analysis was used to investigated the relationships between MRA scores and cerebral infarction patterns.Results: Among the 116 MMS patients,51 were in the infarction group(60 hemispheres),and 65 were in the non-infarction group(112hemispheres),the infarct patterns were pial artery infarct(28.4%),perforating artery infarct(18.3%),border-zone infarct(18.3%),and multiple infarcts(35.0%).There were no significant difference in the prevalence of ACA,MCA and ICA involvement in the cerebral hemisphere of MMS between the infarct side and the non-infarct side(all P>0.05),the prevalence of PCA involvement on the infarct side was significantly higher than that on the non-infarct side(63.3% vs.30.4%,P<0.05).The proportions of pial artery infarct and multiple infarcts in PCA severe stenosis or occlusion group(33.4%,41.7%)were significantly higher than that in normal group and mild to moderate stenosis group(all P<0.05).Correlation analysis showed that there was a positive correlation between MRA scores and multiple infarcts(r=0.429,P<0.05).Conclusions: PCA involvement leads to a higher incidence of cerebral infarction in MMS patients,which is presumed to be a related factor causing cerebral infarction.Pial artery infarct and multiple infarcts are the most common infarct patterns in severe stenosis or occlusion of PCA,and there is a certain correlation between MRA scores and multiple infarcts.