| Background:Moyamoya disease(MMD)was a cerebrovascular disease characterized by progressive narrowing and occlusion of the vessels at the end of the internal carotid artery and the formation of abnormal vascular proliferation and vascular networks.In recent years,neurological function and affective impairment in patients with MMD have received increasing attention from academics in China and abroad.As an important clinical feature of MMD,cognitive impairment can seriously affect the quality of patients’ survival.Therefore,it is crucial to investigate the neurological function changes and pathophysiological mechanisms in patients with MMD.Previously,structural imaging techniques such as DSA and magnetic resonance angiography were commonly used to determine the severity of the MMD and the success rate of revascularization.But they could not provide entirely accurate disease imaging information because they only showed vascular patency and collateral circulation,but not functional information about the brain.In recent years,the development of resting-state functional magnetic resonance imaging(Rs-fMRI)has advanced rapidly,providing an important method for cognitive neuroscience research.Rs-fMRI can be used to analyze neurological changes in subjects by detecting blood oxygen level-dependent signal changes.Among them,Regional homogeneity(ReHo)enables the detection of brain neurological functions,pinpointing cortical functions and providing a scientific means to understand the physiological mechanisms behind neurological dysfunction.Objectives:In this study,we aimed to investigate the effects of MMD on changes in brain activity patterns and neurological function by using ReHo analysis and neurological function assessment scales and to investigate the effects of combined hemodynamic reconstruction on abnormal brain activity patterns and neurological dysfunction in adult Patients with MMD.(1)Study 1:Using ReHo analysis to explore the altered brain activity and functional imaging localization adult patients with MMD.(2)Study 2:Using ReHo analysis to explore the effects of combined reconstruction surgery on spontaneous brain activity and neurological function in adult patients with MMD.Methods:(1)Study 1:Fifteen adult patients with the first diagnosis of MMD were included as study subjects,and fifteen age-and gender-matched healthy adults were also included in healthy controls(HC).The Hospital Anxiety and Depression Scale(HADS)was used to assess subjects’ anxiety and depression status,and the Minimum Mental State Examination(MMSE)and the Montreal Cognitive Assessment(MoCA)were used to assess overall cognitive functioning.All subjects underwent Rs-fMRI scans to obtain blood oxygen level-dependent signals for ReHo analysis of changes in neural activity in brain regions and to investigate the correlation between brain regions with differential ReHo values and neurological function assessment results.(2)Study 2:Sixteen patients with MMD who were diagnosed with MMD and had undergone combined hemodynamic surgery at the Department of Neurosurgery of the First Affiliated Hospital of Nanchang University for one year were included as study subjects,and 16 gender-and age-matched patients with MMD without surgical treatment were included as the non-operated group.HADS was used to assess subjects’ anxiety and depression,and MMSE and MoCA were used to assess subjects’cognitive function.All subjects underwent Rs-fMRI scanning to obtain blood oxygen level-dependent signals for ReHo analysis of neural activity changes in brain regions and to investigate the correlation between brain regions with differential ReHo values and neurological function assessment results.Results:(1)Study 1:Compared with the HC group,the left middle frontal gyrus,left inferior frontal gyrus,right thalamus,and right caudate nucleus ReHo values were decreased in the MMD group.In the MMD group,the left middle frontal and left inferior frontal gyrus ReHo values were positively correlated with MMSE and MoCA scores and negatively correlated with Suzuki stages;MoCA scores were positively correlated with Suzuki stages.ROC curve analysis showed that ReHo values in these brain regions could perfectly distinguish MMD patients from HC.(2)Study 2:Compared with the no-surgery MMD group,the right caudate nucleus,right middle frontal gyrus,right superior frontal gyrus,and right bilateral supplementary motor areas had higher ReHo values,and the left cerebellar and left middle temporal gyrus had lower ReHo values in the MMD group with combined revascularization surgery.No correlation was found between the ReHo values in statistically different brain regions and clinical characteristics in the MMD group 1 year after combined revascularization surgery.Conclusions:(1)Study 1:Hemodynamic impairment can lead to cognitive impairment in adult MMD patients,and some MMD patients have anxiety or depressive affective disorders.MMD can cause abnormal ReHo in several brain regions,and there is a significant correlation between ReHo values in some frontal regions and cognitive function assessment and disease severity.(2)Study 2:Combined revascularization surgery improved cognitive function in adult patients with MMD,but no significant improvement in anxiety or depressive affective disorders.Compared to MMD patients without surgery,MMD patients with combined revascularization surgery had significantly improved ReHo abnormalities in specific brain regions.These changes may be related to improved neurological function after combined revascularization surgery. |
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