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This study investigates the functional role of LMAs and their vessel-level interactions with the cerebral vasculature, using patient-specific flow data and accounting for uncertainty in peripheral vessel anatomy. Synthetic vascular trees were generated via a stochastic, anatomically informed sampling process. Assuming that discrepancies between 4D Flow MRI and Single-Photon Emission Computed Tomography (SPECT) are attributable to LMA-mediated redistribution, LMA configurations were optimized using an island genetic algorithm (IGA) to minimize residuals between simulated distal flows and SPECT-derived perfusion data. The resulting configurations successfully recreated physiologically plausible collateral patterns across four clinical scenarios, encompassing mild to severe, asymmetric, and symptomatic unilateral stenosis.<\/jats:p>","DOI":"10.1007\/s10439-026-04003-1","type":"journal-article","created":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T15:32:33Z","timestamp":1771601553000},"page":"2159-2175","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Investigating Leptomeningeal Anastomoses\u2019 Role in Collateral Blood Flow using SPECT and 4D Flow MRI"],"prefix":"10.1007","volume":"54","author":[{"given":"Chi Hang","family":"To","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6227-9818","authenticated-orcid":false,"given":"Marie","family":"Oshima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shigeki","family":"Yamada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,2,20]]},"reference":[{"key":"4003_CR1","doi-asserted-by":"publisher","first-page":"1167","DOI":"10.1161\/01.STR.24.8.1167","volume":"24","author":"I Odano","year":"1993","unstructured":"Odano, I., T. 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Stroke. 14(1):50\u201358, 1983. https:\/\/doi.org\/10.1161\/01.STR.14.1.50.","journal-title":"Stroke"}],"container-title":["Annals of Biomedical Engineering"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10439-026-04003-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10439-026-04003-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10439-026-04003-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T17:13:45Z","timestamp":1782234825000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10439-026-04003-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,20]]},"references-count":44,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["4003"],"URL":"https:\/\/doi.org\/10.1007\/s10439-026-04003-1","relation":{},"ISSN":["0090-6964","1573-9686"],"issn-type":[{"value":"0090-6964","type":"print"},{"value":"1573-9686","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,20]]},"assertion":[{"value":"25 September 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 January 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 February 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This research was conducted under the framework of the JSPS KAKENHI project (22H00190) and was approved by the ethics committees of the participating institutions, including the University of Tokyo. Informed consent was obtained from all patients at each hospital. The medical data used in this study were reviewed and approved separately by the ethics committees of the University of Tokyo. Personal information was protected through anonymization of medical images and management with coded identifiers. All procedures were performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing financial or non-financial interests related to this work.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}