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. 2025 Aug;43(8):1286-1294.
doi: 10.1007/s11604-025-01784-8. Epub 2025 Apr 16.

Correlation between collateral compensation of the posterior cerebral artery on 5 T magnetic resonance imaging and clinical classifications in patients with Moyamoya angiopathy

Guangsong Han #  1 , Xiaoyuan Fan #  2 , Yuehui Hong #  1 , Ming Yao  1 , Lixin Zhou  1 , Yicheng Zhu  1 , Feng Feng  2 , Jun Ni  3
Affiliations

Correlation between collateral compensation of the posterior cerebral artery on 5 T magnetic resonance imaging and clinical classifications in patients with Moyamoya angiopathy

Guangsong Han et al. Jpn J Radiol. 2025 Aug.

Abstract

Purpose: Various clinical classifications of Moyamoya angiopathy (MMA) have different characteristics of collateral compensation. Advancements in 5 T MRI have made it possible to non-invasively assess vascular collateralization using 4-dimensional MR angiography (4DMRA). The objective of this study is to analyze collateral compensation in MMA patients using 4DMRA and determine variations among different clinical classifications.

Materials and methods: Collateral compensation of posterior cerebral artery (PCA) to anterior circulation was evaluated using 4DMRA at 5 T MRI. After adjusting for confounding factors, multivariate analyses were conducted to compare the distribution of PCA collateral compensation among patients with different clinical classifications of MMA.

Results: 85 MMA patients were enrolled in the study. Among the 158 hemispheres evaluated, 100 were asymptomatic, 7 were hemorrhagic, 50 were ischemic, and 1 had a combination of hemorrhagic and ischemic stroke. Multivariate logistic regression analysis revealed a statistically significant difference in total PCA collateral compensation scores between asymptomatic and ischemic hemispheres (P < 0.001, 95% CI [0.614, 0.839]). Subgroup analysis revealed a clear distinction between asymptomatic hemispheres and ischemic hemispheres (P = 0.001, 95% CI [0.193, 0.677]) in terms of PCA compensation to middle cerebral artery through the parieto-occipital branch. However, no notable differences were observed in other compensation pathways.

Conclusion: The collateral compensation of PCA to the anterior circulation in MMA patients, assessed by 4DMRA at 5 T MRI, is significantly associated with ischemic MMA. The parieto-occipital branch may be the most important compensatory pathway. 4DMRA can potentially serve as a valuable tool for evaluating the risk of ischemic stroke in patients with MMA.

Keywords: Collateral compensation; Ischemic stroke; Moyamoya angiopathy; Posterior cerebral artery.

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Conflict of interest statement

Declarations. Competing interest: The authors have no potential conflicts of interests to declare that are relevant to the content of this article. The authors have no relevant financial or non-financial interests to disclose. Ethics approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The patients were consecutively enrolled from our prospective registration study entitled clinical cohort research of Moyamoya disease and Moyamoya syndrome, which was approved by the Ethics Committee of Peking Union Medical College Hospital (ethics number: ZS- 2926). Informed consent: Written informed consents were obtained from all individual participants included in the study.

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