Whole-brain volumetric analysis in adult Moyamoya patients reveals significant atrophy compared to healthy controls.

Moyamoya disease (MMD) may lead to perfusion deficits, stroke and brain atrophy in the long-term. Our aim was to analyse whole-brain volumetry of a large cohort of Moyamoya disease patients compared to healthy controls. 3D T1w MRI sequences of adult Moyamoya disease patients treated at our centre between 2016 and 2022 without prior revascularization were analysed for whole-brain volumetry (AssemblyNet) and compared age-controlled to healthy controls. A total of 133 different regions of interest were examined retrospectively for each patient separately by localization, structure and tissue type. All segmentations were subjected to automated and manual quality control. After quality control, 149 hemispheres from 80 Moyamoya disease patients were compared to 258 hemispheres from 129 healthy controls. A significant brain volume loss was observed in Moyamoya disease patients with increasing age, with the greatest reduction seen in bilaterally affected patients with Suzuki grade >3. As direct signs of brain atrophy, significant differences were seen across all regions of interests, emphasized in cortical grey matter with a reduction of 4.4% (95% CI 2.7-6.1%;