{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:43:05Z","timestamp":1786124585679,"version":"build-2736575974"},"reference-count":44,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2019,6,27]],"date-time":"2019-06-27T00:00:00Z","timestamp":1561593600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neurosurg.","NEUROS"],"published-print":{"date-parts":[[2020,4]]},"abstract":"Abstract<\/jats:title>\n \n BACKGROUND<\/jats:title>\n Moyamoya disease often leads to ischemic strokes visible on diffusion-weighted imaging (DWI) and T2-weighted magnetic resonance imaging (MRI) with subsequent cognitive impairment. In adults with moyamoya, apparent diffusion coefficient (ADC) is correlated with regions of steal phenomenon and executive dysfunction prior to white matter changes.<\/jats:p>\n <\/jats:sec>\n \n OBJECTIVE<\/jats:title>\n To investigate quantitative global diffusion changes in pediatric moyamoya patients prior to explicit structural ischemic damage.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n We retrospectively reviewed children (<20 yr old) with moyamoya disease and syndrome who underwent bypass surgery at our institution. We identified 29 children with normal structural preoperative MRI and without findings of cortical infarction or chronic white matter ischemic changes. DWI datasets were used to calculate ADC maps for each subject as well as for 60 age-matched healthy controls. Using an atlas-based approach, the cerebral white matter, cerebral cortex, thalamus, caudate, putamen, pallidum, hippocampus, amygdala, nucleus accumbens, and brainstem were segmented in each DWI dataset and used to calculate regional volumes and ADC values.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n \n Multivariate analysis of covariance using the regional ADC and volume values as dependent variables and age and gender as covariates revealed a significant difference between the groups (\n P<\/jats:italic>\n \u00a0<\u00a0.001). Post hoc analysis demonstrated significantly elevated ADC values for children with moyamoya in the cerebral cortex, white matter, caudate, putamen, and nucleus accumbens. No significant volume differences were found.\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSION<\/jats:title>\n Prior to having bypass surgery, and in the absence of imaging evidence of ischemic stroke, children with moyamoya exhibit cerebral diffusion changes. These findings could reflect microstructural changes stemming from exhaustion of cerebrovascular reserve.<\/jats:p>\n <\/jats:sec>","DOI":"10.1093\/neuros\/nyz230","type":"journal-article","created":{"date-parts":[[2019,5,26]],"date-time":"2019-05-26T07:07:22Z","timestamp":1558854442000},"page":"530-537","source":"Crossref","is-referenced-by-count":11,"title":["Early Diffusion Magnetic Resonance Imaging Changes in Normal-Appearing Brain in Pediatric Moyamoya Disease"],"prefix":"10.1227","volume":"86","author":[{"given":"Jennifer L","family":"Quon","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Stanford University School of Medicine, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lily H","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University School of Medicine, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah J","family":"MacEachern","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryam","family":"Maleki","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neuroradiology, Department of Radiology, Lucile Packard Children's Hospital, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary K","family":"Steinberg","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University School of Medicine, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Venkatesh","family":"Madhugiri","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University School of Medicine, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael S B","family":"Edwards","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University School of Medicine, Stanford, California"},{"name":"Division of Pediatric Neurosurgery, Lucile Packard Children's Hospital, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald A","family":"Grant","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University School of Medicine, Stanford, California"},{"name":"Division of Pediatric Neurosurgery, Lucile Packard Children's Hospital, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristen W","family":"Yeom","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neuroradiology, Department of Radiology, Lucile Packard Children's Hospital, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nils D","family":"Forkert","sequence":"additional","affiliation":[{"name":"Division of Image Science, Department of Radiology, University of Calgary, Calgary, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020,4]]},"reference":[{"issue":"3","key":"bib1-20231011","first-page":"347","article-title":"Transient ischemic attack requiring hospitalization of children in the United States: kids\u2019 inpatient database 2003 to 2009","volume":"45","author":"Adil","year":"2014","journal-title":"Cerebrovasc Dis"},{"issue":"1","key":"bib2-20231011","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1007\/s00234-016-1766-y","article-title":"Cerebral blood flow, transit time, and apparent diffusion coefficient in moyamoya disease before and after acetazolamide","volume":"59","author":"Federau","year":"2017","journal-title":"Neuroradiology"},{"issue":"1","key":"bib3-20231011","first-page":"50","article-title":"Direct and combined revascularization in pediatric moyamoya disease","volume":"45","author":"Golby","year":"1999","journal-title":"Neurosurgery"},{"key":"bib4-20231011","first-page":"49","article-title":"Moyamoya disease and syndromes: from genetics to clinical management","volume":"8","author":"Guey","year":"2015","journal-title":"Appl Clin Genet"},{"issue":"7","key":"bib5-20231011","doi-asserted-by":"crossref","first-page":"566","DOI":"10.7150\/ijms.11719","article-title":"Research progress of moyamoya disease in children","volume":"12","author":"Piao","year":"2015","journal-title":"Int J Med Sci"},{"issue":"4","key":"bib6-20231011","doi-asserted-by":"crossref","first-page":"753","DOI":"10.3171\/2010.4.JNS091808","article-title":"Correlation between cognitive impairment and cerebral hemodynamic disturbances on perfusion magnetic resonance imaging in European adults with moyamoya disease. Clinical article","volume":"113","author":"Calviere","year":"2010","journal-title":"J Neurosurg"},{"issue":"3","key":"bib7-20231011","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1227\/NEU.0b013e3182320d1a","article-title":"Neurocognitive impairment in adults with moyamoya disease without stroke","volume":"70","author":"Karzmark","year":"2012","journal-title":"Neurosurgery"},{"issue":"3","key":"bib8-20231011","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1016\/j.braindev.2014.06.008","article-title":"Characteristics of brain magnetic resonance images at symptom onset in children with moyamoya disease","volume":"37","author":"Jung","year":"2015","journal-title":"Brain Dev"},{"issue":"9","key":"bib9-20231011","doi-asserted-by":"crossref","first-page":"2054","DOI":"10.1016\/j.jstrokecerebrovasdis.2015.04.026","article-title":"Apparent diffusion coefficient and transient neurological deficit after revascularization surgery in moyamoya disease","volume":"24","author":"Araki","year":"2015","journal-title":"J Stroke Cereb Dis"},{"issue":"5","key":"bib10-20231011","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1111\/jon.12347","article-title":"White matter diffusion abnormalities in carotid artery disease: a systematic review and meta-analysis","volume":"26","author":"Baradaran","year":"2016","journal-title":"J Neuroimag"},{"issue":"8","key":"bib11-20231011","doi-asserted-by":"crossref","first-page":"1610","DOI":"10.1161\/STROKEAHA.110.579540","article-title":"Impaired cerebrovascular reactivity with steal phenomenon is associated with increased diffusion in white matter of patients with Moyamoya disease","volume":"41","author":"Conklin","year":"2010","journal-title":"Stroke"},{"issue":"5","key":"bib12-20231011","doi-asserted-by":"crossref","first-page":"935","DOI":"10.3174\/ajnr.A5582","article-title":"Brain diffusion abnormalities in children with tension-type and migraine-type headaches","volume":"39","author":"Santoro","year":"2018","journal-title":"AJNR Am J Neuroradiol"},{"issue":"9","key":"bib13-20231011","doi-asserted-by":"crossref","first-page":"1738","DOI":"10.3174\/ajnr.A4772","article-title":"Gray matter growth is accompanied by increasing blood flow and decreasing apparent diffusion coefficient during childhood","volume":"37","author":"Forkert","year":"2016","journal-title":"AJNR Am J Neuroradiol"},{"issue":"4","key":"bib14-20231011","doi-asserted-by":"crossref","first-page":"1213","DOI":"10.1177\/0271678X16651088","article-title":"Imaging of cerebrovascular reserve and oxygenation in Moyamoya disease","volume":"37","author":"Ni","year":"2017","journal-title":"J Cereb Blood Flow Metab"},{"issue":"5","key":"bib15-20231011","first-page":"1437","article-title":"Changes in cerebrovascular reactivity in healthy adults after acute exposure to high altitude","volume":"22","author":"Liu","year":"2018","journal-title":"Eur Rev Med Pharmacol Sci"},{"issue":"2","key":"bib16-20231011","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1016\/j.jstrokecerebrovasdis.2017.08.035","article-title":"Measurement of cerebrovascular reactivity as blood oxygen level-dependent magnetic resonance imaging signal response to a hypercapnic stimulus in mechanically ventilated patients","volume":"27","author":"Venkatraghavan","year":"2018","journal-title":"J Stroke Cereb Dis"},{"issue":"4","key":"bib17-20231011","doi-asserted-by":"crossref","first-page":"483","DOI":"10.3171\/jns.1993.79.4.0483","article-title":"Increased stroke risk predicted by compromised cerebral blood flow reactivity","volume":"79","author":"Yonas","year":"1993","journal-title":"J Neurosurg"},{"issue":"4","key":"bib18-20231011","doi-asserted-by":"crossref","first-page":"721","DOI":"10.3174\/ajnr.A2365","article-title":"Quantitative measurement of cerebrovascular reactivity by blood oxygen level-dependent MR imaging in patients with intracranial stenosis: preoperative cerebrovascular reactivity predicts the effect of extracranial-intracranial bypass surgery","volume":"32","author":"Mandell","year":"2011","journal-title":"AJNR Am J Neuroradiol"},{"issue":"4","key":"bib19-20231011","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1007\/s13244-018-0624-3","article-title":"Clinical applications of diffusion weighted imaging in neuroradiology","volume":"9","author":"Drake-Perez","year":"2018","journal-title":"Insights Imaging"},{"issue":"11","key":"bib20-20231011","doi-asserted-by":"crossref","first-page":"1666","DOI":"10.1038\/jcbfm.2013.140","article-title":"Mouse models to study the effect of cardiovascular risk factors on brain structure and cognition","volume":"33","author":"Bink","year":"2013","journal-title":"J Cereb Blood Flow Metab"},{"key":"bib21-20231011","doi-asserted-by":"crossref","first-page":"978761","DOI":"10.4061\/2011\/978761","article-title":"Lessons from a mouse model characterizing features of vascular cognitive impairment with white matter changes","volume":"2011","author":"Ihara","year":"2011","journal-title":"J Aging Res"},{"issue":"11","key":"bib22-20231011","doi-asserted-by":"crossref","first-page":"2598","DOI":"10.1161\/01.STR.0000143725.19053.60","article-title":"White matter lesions and glial activation in a novel mouse model of chronic cerebral hypoperfusion","volume":"35","author":"Shibata","year":"2004","journal-title":"Stroke"},{"issue":"10","key":"bib23-20231011","doi-asserted-by":"crossref","first-page":"1893","DOI":"10.3174\/ajnr.A2683","article-title":"Changes in integrity of normal-appearing white matter in patients with moyamoya disease: a diffusion tensor imaging study","volume":"32","author":"Jeong","year":"2011","journal-title":"AJNR Am J Neuroradiol"},{"key":"bib24-20231011","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1016\/j.neuroimage.2014.04.072","article-title":"Heritability of brain volume","volume":"c","author":"Brouwer","year":"2014","journal-title":"Neuroimage"},{"issue":"4","key":"bib25-20231011","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1002\/jmri.1880080403","article-title":"MRI and MR angiography in moyamoya disease","volume":"8","author":"Hasuo","year":"1998","journal-title":"J Magn Reson Imaging"},{"issue":"1","key":"bib26-20231011","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1186\/s12883-017-0935-x","article-title":"Prevalence of and risk factors for enlarged perivascular spaces in adult patients with moyamoya disease","volume":"17","author":"Kuribara","year":"2017","journal-title":"BMC Neurol"},{"issue":"3","key":"bib27-20231011","doi-asserted-by":"crossref","first-page":"188","DOI":"10.3340\/jkns.2014.56.3.188","article-title":"Preliminary study of neurocognitive dysfunction in adult moyamoya disease and improvement after superficial temporal artery-middle cerebral artery bypass","volume":"56","author":"Baek","year":"2014","journal-title":"J Korean Neurosurg Soc"},{"issue":"8","key":"bib28-20231011","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1007\/BF00302089","article-title":"Mental outcome following encephaloduroarteriosynangiosis in children with moyamoya disease with the onset earlier than 5 years of age","volume":"6","author":"Matsushima","year":"1990","journal-title":"Child's Nerv Syst"},{"issue":"6","key":"bib29-20231011","doi-asserted-by":"crossref","first-page":"440","DOI":"10.3340\/jkns.2015.57.6.440","article-title":"Cognitive outcome of pediatric moyamoya disease","volume":"57","author":"Shim","year":"2015","journal-title":"J Korean Neurosurg Soc"},{"issue":"6","key":"bib30-20231011","doi-asserted-by":"crossref","first-page":"E21","DOI":"10.3171\/2011.3.FOCUS1150","article-title":"Moyamoya disease: functional and neurocognitive outcomes in the pediatric and adult populations","volume":"30","author":"Weinberg","year":"2011","journal-title":"Neurosurg Focus"},{"issue":"6","key":"bib31-20231011","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1136\/jnnp-2011-301388","article-title":"Executive dysfunction in adults with moyamoya disease is associated with increased diffusion in frontal white matter","volume":"83","author":"Calviere","year":"2012","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"5","key":"bib32-20231011","doi-asserted-by":"crossref","first-page":"927","DOI":"10.3171\/2009.4.JNS081649","article-title":"Clinical outcome after 450 revascularization procedures for moyamoya disease. Clinical article","volume":"111","author":"Guzman","year":"2009","journal-title":"J Neurosurg"},{"issue":"6","key":"bib33-20231011","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.1161\/01.STR.28.6.1170","article-title":"Effects of surgical revascularization on outcome of patients with pediatric moyamoya disease","volume":"28","author":"Ishikawa","year":"1997","journal-title":"Stroke"},{"issue":"5","key":"bib34-20231011","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1227\/01.NEU.0000312712.55567.E6","article-title":"Effect of moyamoya disease on neuropsychological functioning in adults","volume":"62","author":"Karzmark","year":"2008","journal-title":"Neurosurgery"},{"issue":"2","key":"bib35-20231011","doi-asserted-by":"crossref","first-page":"E16","DOI":"10.3171\/FOC\/2008\/24\/2\/E16","article-title":"Moyamoya disease in pediatric patients: outcomes of neurosurgical interventions","volume":"24","author":"Veeravagu","year":"2008","journal-title":"Neurosurg Focus"},{"issue":"6","key":"bib36-20231011","doi-asserted-by":"crossref","first-page":"1514","DOI":"10.1161\/STROKEAHA.116.016028","article-title":"Neurocognitive performance after cerebral revascularization in adult moyamoya disease","volume":"48","author":"Zeifert","year":"2017","journal-title":"Stroke"},{"issue":"2","key":"bib37-20231011","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1159\/000369524","article-title":"Clinical features, surgical treatment, and long-term outcome in pediatric patients with moyamoya disease in China","volume":"39","author":"Bao","year":"2015","journal-title":"Cerebrovasc Dis"},{"issue":"1-2","key":"bib38-20231011","doi-asserted-by":"crossref","first-page":"39","DOI":"10.3109\/00207458508985601","article-title":"Neuropsychological performance in moya moya disease: a case study","volume":"26","author":"Bornstein","year":"1985","journal-title":"Int J Neurosci"},{"issue":"5","key":"bib39-20231011","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1017\/S1355617703950132","article-title":"Moyamoya disease in a patient with schizophrenia","volume":"9","author":"Lubman","year":"2003","journal-title":"J Int Neuropsychol Soc"},{"issue":"6","key":"bib40-20231011","doi-asserted-by":"crossref","first-page":"E1380","DOI":"10.1227\/01.NEU.0000159719.47528.2E","article-title":"Neural damage caused by cerebral hyperperfusion after arterial bypass surgery in a patient with moyamoya disease: case report","volume":"56","author":"Ogasawara","year":"2005","journal-title":"Neurosurgery"},{"issue":"2","key":"bib41-20231011","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1148\/radiol.13130982","article-title":"Cerebral hemodynamic impairment: assessment with resting-state functional MR imaging","volume":"270","author":"Amemiya","year":"2014","journal-title":"Radiology"},{"issue":"8","key":"bib42-20231011","doi-asserted-by":"crossref","first-page":"e0182759","DOI":"10.1371\/journal.pone.0182759","article-title":"Mapping altered brain connectivity and its clinical associations in adult moyamoya disease: a resting-state functional MRI study","volume":"12","author":"Kazumata","year":"2017","journal-title":"PLoS One"},{"issue":"5","key":"bib43-20231011","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1159\/000087935","article-title":"Novel magnetic resonance angiography stage grading for moyamoya disease","volume":"20","author":"Houkin","year":"2005","journal-title":"Cerebrovasc Dis"},{"issue":"4","key":"bib44-20231011","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1016\/j.braindev.2008.05.008","article-title":"Combination of olfactory course anterior cerebral artery and accessory middle cerebral artery (MCA) with occluded in situ MCA and related moyamoya phenomenon","volume":"31","author":"Lin","year":"2009","journal-title":"Brain Dev"}],"container-title":["Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/neurosurgery\/advance-article-pdf\/doi\/10.1093\/neuros\/nyz230\/28873739\/nyz230.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ovid.com\/10.1093\/neuros\/nyz230","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:42:59Z","timestamp":1786120979000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1093\/neuros\/nyz230"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,6,27]]},"references-count":44,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2020]]}},"URL":"https:\/\/doi.org\/10.1093\/neuros\/nyz230","relation":{},"ISSN":["0148-396X","1524-4040"],"issn-type":[{"value":"0148-396X","type":"print"},{"value":"1524-4040","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,6,27]]}}}