{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T14:59:56Z","timestamp":1781189996691,"version":"3.54.1"},"reference-count":70,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,5,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n The authors\u2019 objective was to retrospectively compare two methods for defining the hypoperfusion intensity ratio (HIR) in moyamoya disease (MMD) by using hypoperfused volumes calculated from time to maximum of the residue function (Tmax) thresholds of 10 seconds\/4 seconds and 10 seconds\/6 seconds.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n \n All hemispheres were categorized into normal, ischemic, and hemorrhagic groups. Hypoperfused volumes were calculated using Tmax thresholds of 10 seconds, 6 seconds, and 4 seconds. HIR was computed as Tmax > 10 seconds\/Tmax > 4 seconds (HIR\n 10\/4<\/jats:sub>\n ) and Tmax > 10 seconds\/Tmax > 6 seconds (HIR\n 10\/6<\/jats:sub>\n ). Angiographic collaterals were assessed using CT perfusion (CTP)\u2013sourced images (CTP-sis). The 3-month clinical follow-up included primary outcomes (survival or death) and secondary outcomes (modified Rankin Scale [mRS] and Katz activities of daily living [ADL] scale scores). Multivariate logistic regression and correlation analyses were conducted.\n <\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n \n Thirty patients (54 hemispheres) were included. Patients with poor primary outcomes exhibited higher rates of hypertension (p = 0.015), larger hypoperfused volumes, and elevated HIR\n 10\/4<\/jats:sub>\n and HIR\n 10\/6<\/jats:sub>\n (p < 0.001). The regression model with HIR\n 10\/4<\/jats:sub>\n outperformed that with HIR\n 10\/6<\/jats:sub>\n for predicting primary outcomes (Z = 2.02, p = 0.044). Both HIR\n 10\/4<\/jats:sub>\n and HIR\n 10\/6<\/jats:sub>\n correlated with mRS and ADL scores (p < 0.05). Although there was no correlation between HIR and CTP-sis when all hemispheres were included, a significant association was found between HIR\n 10\/4<\/jats:sub>\n and CTP-sis when hemispheres with hemorrhagic lesions were excluded (p = 0.013).\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n \n HIR\n 10\/4<\/jats:sub>\n exhibited a superior predictive value for primary outcomes in MMD compared to HIR\n 10\/6<\/jats:sub>\n . Additionally, HIR\n 10\/4<\/jats:sub>\n showed a significant association with angiographic collaterals, particularly in ischemic MMD cases. This study suggested that HIR defined as Tmax > 10 seconds\/Tmax > 4 seconds may be more suitable than Tmax > 10 seconds\/Tmax > 6 seconds in MMD.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2024.9.jns241300","type":"journal-article","created":{"date-parts":[[2024,12,6]],"date-time":"2024-12-06T20:45:31Z","timestamp":1733517931000},"page":"1419-1427","source":"Crossref","is-referenced-by-count":1,"title":["Identification of the optimal thresholds for the hypoperfusion intensity ratio in moyamoya disease"],"prefix":"10.3171","volume":"142","author":[{"given":"Liuxian","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Radiology, No 908th Hospital of Chinese PLA Joint Logistic Support Force\/Changcheng Hospital affiliated to Nanchang University, Nanchang, Jiangxi, China; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongshan","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Radiology, Qingdao Special Servicemen Recuperation Center of PLA Navy, Qingdao, Shandong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming","family":"Liao","sequence":"additional","affiliation":[{"name":"Department of Radiology, No 908th Hospital of Chinese PLA Joint Logistic Support Force\/Changcheng Hospital affiliated to Nanchang University, Nanchang, Jiangxi, China; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Zha","sequence":"additional","affiliation":[{"name":"Department of Radiology, No 908th Hospital of Chinese PLA Joint Logistic Support Force\/Changcheng Hospital affiliated to Nanchang University, Nanchang, Jiangxi, China; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Radiology, No 908th Hospital of Chinese PLA Joint Logistic Support Force\/Changcheng Hospital affiliated to Nanchang University, Nanchang, Jiangxi, China; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huagang","family":"Fan","sequence":"additional","affiliation":[{"name":"Department of Radiology, No 908th Hospital of Chinese PLA Joint Logistic Support Force\/Changcheng Hospital affiliated to Nanchang University, Nanchang, Jiangxi, China; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenfeng","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Radiology, No 908th Hospital of Chinese PLA Joint Logistic Support Force\/Changcheng Hospital affiliated to Nanchang University, Nanchang, Jiangxi, China; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoqian","family":"Ji","sequence":"additional","affiliation":[{"name":"Department of Radiology, No 908th Hospital of Chinese PLA Joint Logistic Support Force\/Changcheng Hospital affiliated to Nanchang University, Nanchang, Jiangxi, China; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anming","family":"Xie","sequence":"additional","affiliation":[{"name":"Department of Radiology, No 908th Hospital of Chinese PLA Joint Logistic Support Force\/Changcheng Hospital affiliated to Nanchang University, Nanchang, Jiangxi, China; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"5","key":"b1","series-title":"Neurol Med Chir (Tokyo)","first-page":"245","article-title":"Guidelines for diagnosis and treatment of moyamoya disease (spontaneous occlusion of the circle of Willis)","volume":"52","year":"2012","unstructured":"Guidelines for diagnosis and treatment of moyamoya disease (spontaneous occlusion of the circle of Willis). Neurol Med Chir (Tokyo). 2012;52(5):245\u2013266."},{"issue":"9","key":"b2","series-title":"Korean J Radiol","first-page":"1537","article-title":"Monitoring cerebral perfusion changes using arterial spin-labeling perfusion MRI after indirect revascularization in children with moyamoya disease","volume":"22","author":"Lee SB","year":"2021","unstructured":"Lee SB, Lee S, Cho YJ, Choi YH, Cheon JE, Kim WS. Monitoring cerebral perfusion changes using arterial spin-labeling perfusion MRI after indirect revascularization in children with moyamoya disease. Korean J Radiol. 2021;22(9):1537\u20131546."},{"issue":"4","key":"b3","series-title":"Neurology","first-page":"e388","article-title":"Predictors of clinical or cerebral lesion progression in adult moyamoya angiopathy","volume":"93","author":"Herv\u00e9 D","year":"2019","unstructured":"Herv\u00e9 D, Ibos-Aug\u00e9 N, Calvi\u00e8re L, Predictors of clinical or cerebral lesion progression in adult moyamoya angiopathy. Neurology. 2019;93(4):e388\u2013e397."},{"key":"b4","series-title":"World Neurosurg","first-page":"e180","article-title":"Improving indirect revascularization for effective treatment of adult moyamoya disease: a prospective clinical, cerebral angiographic, and perfusion study","volume":"119","author":"Chou SC","year":"2018","unstructured":"Chou SC, Chen YF, Lee CW, Improving indirect revascularization for effective treatment of adult moyamoya disease: a prospective clinical, cerebral angiographic, and perfusion study. World Neurosurg. 2018;119:e180\u2013e191."},{"issue":"11","key":"b5","series-title":"J Neurol Neurosurg Psychiatry","first-page":"1152","article-title":"Novel selection paradigms for endovascular stroke treatment in the extended time window","volume":"92","author":"Bouslama M","year":"2021","unstructured":"Bouslama M, Haussen DC, Rodrigues G, Barreira C, Frankel M, Nogueira RG. Novel selection paradigms for endovascular stroke treatment in the extended time window. J Neurol Neurosurg Psychiatry. 2021;92(11):1152\u20131157."},{"issue":"21","key":"b6","series-title":"Neurology","first-page":"e2126","article-title":"Factors associated with fast early infarct growth in patients with acute ischemic stroke with a large vessel occlusion","volume":"101","author":"Seners P","year":"2023","unstructured":"Seners P, Yuen N, Olivot JM, Factors associated with fast early infarct growth in patients with acute ischemic stroke with a large vessel occlusion. Neurology. 2023;101(21):e2126\u2013e2137."},{"issue":"13","key":"b7","series-title":"Neurology","first-page":"1140","article-title":"Perfusion MRI (Tmax and MTT) correlation with xenon CT cerebral blood flow in stroke patients","volume":"72","author":"Olivot JM","year":"2009","unstructured":"Olivot JM, Mlynash M, Zaharchuk G, Perfusion MRI (Tmax and MTT) correlation with xenon CT cerebral blood flow in stroke patients. 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Ann Neurol. 2023;94(5):848\u2013855."},{"issue":"3","key":"b11","series-title":"Neurology","first-page":"e336","article-title":"Thrombectomy outcomes with general vs nongeneral anesthesia: a pooled patient-level analysis from the EXTEND-IA trials and SELECT study","volume":"100","author":"Sarraj A","year":"2023","unstructured":"Sarraj A, Albers GW, Mitchell PJ, Thrombectomy outcomes with general vs nongeneral anesthesia: a pooled patient-level analysis from the EXTEND-IA trials and SELECT study. Neurology. 2023;100(3):e336\u2013e347."},{"issue":"4","key":"b12","series-title":"Stroke","first-page":"917","article-title":"Hypoperfusion intensity ratio is correlated with patient eligibility for thrombectomy","volume":"50","author":"Guenego A","year":"2019","unstructured":"Guenego A, Marcellus DG, Martin BW, Hypoperfusion intensity ratio is correlated with patient eligibility for thrombectomy. Stroke. 2019;50(4):917\u2013922."},{"issue":"3","key":"b13","series-title":"Stroke","first-page":"1006","article-title":"Perfusion computed tomography accurately quantifies collateral flow after acute ischemic stroke","volume":"51","author":"Lin L","year":"2020","unstructured":"Lin L, Chen C, Tian H, Perfusion computed tomography accurately quantifies collateral flow after acute ischemic stroke. Stroke. 2020;51(3):1006\u20131009."},{"key":"b14","series-title":"World Neurosurg","first-page":"e112","article-title":"Assessment of transient cerebral hemodynamic disturbance via whole-brain computed tomography perfusion after extracranial-intracranial bypass in ischemic moyamoya disease","volume":"146","author":"Yao F","year":"2021","unstructured":"Yao F, Han Q, Zhang Z, Huang Y. Assessment of transient cerebral hemodynamic disturbance via whole-brain computed tomography perfusion after extracranial-intracranial bypass in ischemic moyamoya disease. 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Stroke. 2005;36(9):e83\u2013e99."},{"issue":"10","key":"b24","series-title":"Cureus","first-page":"e10994","article-title":"Moyamoya: an update and review","volume":"12","author":"Berry JA","year":"2020","unstructured":"Berry JA, Cortez V, Toor H, Saini H, Siddiqi J. Moyamoya: an update and review. Cureus. 2020;12(10):e10994."},{"issue":"10","key":"b25","series-title":"Stroke","first-page":"3308","article-title":"Distal medium vessel occlusions can be accurately and rapidly detected using Tmax maps","volume":"52","author":"Amukotuwa SA","year":"2021","unstructured":"Amukotuwa SA, Wu A, Zhou K, Page I, Brotchie P, Bammer R. Distal medium vessel occlusions can be accurately and rapidly detected using Tmax maps. 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