Introduction:Brain arteriovenous malformations (bAVMs) are the leading cause of intracerebral hemorrhage (ICH) in children. Prior studies have implicated inflammation as a major contributor to bAVM pathogenesis and rupture, with increased inflammatory cell infiltration and interleukin protein levels reported in bAVM tissue. However, few studies have evaluated circulating inflammatory proteins as potential biomarkers for ICH in children with bAVMs. Hypothesis:Plasma levels of inflammatory markers differ in pediatric patients with ruptured bAVMs compared to unruptured bAVMs. Methods:This cross-sectional study included children with bAVMs (< 19 years old at presentation) evaluated at our institution between 2005 and 2022, who were enrolled in a prospective cohort study. Plasma samples (n = 52) were collected after diagnosis but before treatment and analyzed using a commercially available, comprehensive multiplex panel of 384 inflammatory markers. To control for confounders, such as the acute response to ICH, we performed segmented multivariable linear regression analysis, which allows initial protein levels to vary but assumes slopes to be constant within groups after a specified time point (e.g., 32 days). The model adjusted for age, sex, time to blood collection, and interaction of time with ICH status to identify plasma proteins associated with ICH. Exponentiated coefficients are presented and interpreted as proportional increases (PIs). We report nominally associated (p ≤ 0.05) and significantly associated proteins based on Bonferroni adjustment (p = 0.05/368 proteins = 0.00014). Results:We analyzed blood samples collected prior to treatment in 27 unruptured bAVMs (non-ICH cases) and 25 ruptured bAVMs. The median time from study enrollment to sample collection was 126 days (IQR = 64-247) for non-ICH cases and 11 days (IQR = 4-37) for ICH cases. We observed four different patterns of association of biomarker levels with ICH status:1) no differences between ICH and non-ICH groups over time (n=306 markers); 2) no long-term differences between ICH and non-ICH groups but initial trajectories differ after presentation (n=29); 3) long-term differences between ICH and non-ICH groups and initial trajectories differ after presentation (n=5); and 4) consistent differences between ICH and non-ICH groups over time (n=28). Thus, 33 inflammatory proteins were nominally associated (p < 0.05) with ICH either with or without initial trajectory differences (patterns 3 or 4, PI ranging from 0.71 to 4.23). Five of these 33 proteins have been associated with bAVM development and rupture in previous studies (VEGFA, MMP-10, TNF, ANGPTL2, and CSF1). No proteins were statistically significant after adjustment for multiple testing. Conclusion:We measured a large set of inflammatory proteins in blood samples from pediatric bAVM patients and identified 33 proteins with levels nominally associated with ICH with or without initial trajectory differences, including elevated levels of VEGFA and MMP-10. Further studies are needed in larger bAVM cohorts and should include serial measurements of angiogenic or inflammatory proteins to validate the association of these potential biomarkers of ICH risk in children with bAVM.

In recent years, the interaction of intracellular organelles such as mitochondria and lysosomal functions has attracted increasing attention. Recent evidence suggests that mitochondrion-lysosomal contact plays a key role in regulating lysosomal biogenesis and maintaining cellular homeostasis. Myocardial ischemia and reperfusion will lead to corresponding changes in the autophagy flux in cardiomyocytes, and lysosomes are a key link in the process of autophagy, and the fusion of lysosomes and autophagosomes is an essential link in the occurrence of autophagy. Therefore, the function and homeostasis of lysosomes also undergo different changes during myocardial ischemia and reperfusion. Lysosomal-related biological factors and membrane proteins also play different roles. This article will review the mechanism of lysosomes in myocardial ischemia-reperfusion injury and the research progress of lysosomal-related proteins.

Cardiomyocytes undergo a variety of cell death events during myocardial ischemia‒reperfusion injury (MIRI). Understanding the causes of cardiomyocyte mortality is critical for the prevention and treatment of MIRI. Among the various types of cell death, autosis is a recently identified type of autophagic cell death with distinct morphological and chemical characteristics. Autosis can be attenuated by autophagy inhibitors but not reversed by apoptosis or necrosis inhibitors. In recent years, it has been shown that during the late phase of reperfusion, autosis is activated, which exacerbates myocardial injury. This article describes the characteristics of autosis, autophagic cell death, and the relationship between autophagic cell death and autosis; reviews the mechanism of autosis in MIRI; and discusses its clinical significance.

Cardiovascular disease remains the leading cause of death worldwide, with acute myocardial infarction and anticancer drug-induced cardiotoxicity being the significant factors. The most effective treatment for acute myocardial infarction is rapid restoration of coronary blood flow by thrombolytic therapy or percutaneous coronary intervention. However, myocardial ischemia-reperfusion injury (MI/RI) after reperfusion therapy is common in acute myocardial infarction, thus affecting the prognosis of patients with acute myocardial infarction. There is no effective treatment for MI/RI. Anthracyclines such as Doxorubicin (DOX) have limited clinical use due to their cardiotoxicity, and the mechanism of DOX-induced cardiac injury is complex and not yet fully understood. N6-methyladenosine (m6A) plays a crucial role in many biological processes. Emerging evidence suggests that m6A methylation plays a critical regulatory role in MI/RI and DOX-induced cardiotoxicity (DIC), suggesting that m6A may serve as a novel biomarker and therapeutic target for MI/RI and DIC. M6A methylation may mediate the pathophysiological processes of MI/RI and DIC by regulating cellular autophagy, apoptosis, oxidative stress, and inflammatory response. In this paper, we first focus on the relationship between m6A methylation and MI/RI, then further elucidate that m6A methylation may mediate the pathophysiological process of MI/RI through the regulation of cellular autophagy, apoptosis, oxidative stress, and inflammatory response. Finally, briefly outline the roles played by m6A in DIC, which will provide a new methodology and direction for the research and treatment of MI/RI and DIC.

AbstractBackgroundCarotid vulnerable plaque is an important risk factor for stroke occurrence and recurrence. However, the relationship between risk parameters related to carotid vulnerable plaque (plaque size, echogenicity, intraplaque neovascularization, and plaque stiffness) and neurological outcome after ischemic stroke or TIA is unclear. This study investigates the value of multimodal ultrasound-based carotid plaque risk biomarkers to predict poor short-term functional outcome after ischemic stroke or TIA.MethodsThis study was a single-center, prospective, continuous, cohort study to observe the occurrence of adverse functional outcomes (mRS 2–6/3–6) 90 days after ischemic stroke or TIA in patients, where the exposure factors in this study were carotid plaque ultrasound risk biomarkers and the risk factors were sex, age, disease history, and medication history. Patients with ischemic stroke or TIA (mRS ≤3) whose ipsilateral internal carotid artery stenosis was ≥50% within 30 days were included. All patients underwent multimodal ultrasound at baseline, including conventional ultrasound, superb microvascular imaging (SMI), and shear wave elastography (SWE). Continuous variables were divided into four groups at interquartile spacing for inclusion in univariate and multifactorial analyses. After completion of a baseline ultrasound, all patients were followed up at 90 days after ultrasound, and patient modified neurological function scores (mRSs) were recorded. Multivariate Cox regression and ROC curves were used to assess the risk factors and predictive power for predicting poor neurological function.ResultsSMI revealed that 20 (30.8%) patients showed extensive neovascularization in the carotid plaque, and 45 (69.2%) patients showed limited neovascularization in the carotid plaque. SWE imaging showed that the mean carotid plaque stiffness was 51.49 ± 18.34 kPa (23.19–111.39 kPa). After a mean follow-up of 90 ± 14 days, a total of 21 (32.3%) patients had a mRS of 2–6, and a total of 10 (15.4%) patients had a mRS of 3–6. Cox regression analysis showed that the level of intraplaque neovascularization and plaque stiffness were independent risk factors for a mRS of 2–6, and the level of intraplaque neovascularization was an independent risk factor for a mRS of 3–6. After correcting for confounders, the HR of intraplaque neovascularization level and plaque stiffness predicting a mRS 2–6 was 3.06 (95% CI 1.05–12.59,P = 0.041) and 0.51 (95% CI 0.31–0.83,P = 0.007), respectively; the HR of intraplaque neovascularization level predicting a mRS 3–6 was 6.11 (95% CI 1.19–31.45,P = 0.031). For ROC curve analysis, the mRSs for intraplaque neovascularization level, plaque stiffness, and combined application to predict 90-day neurological outcome ranged from 2 to 6, with AUCs of 0.73 (95% CI 0.59–0.87), 0.76 (95% CI 0.64–0.89) and 0.85 (95% CI 0.76–0.95), respectively. The mRSs for the intraplaque neovascularization level to predict 90-day neurological outcome ranged from 3 to 6, with AUCs of 0.79 (95% CI 0.63–0.95).ConclusionIntraplaque neovascularization level and plaque stiffness may be associated with an increased risk of poor short-term functional outcome after stroke in patients with recent anterior circulation ischemic stroke due to carotid atherosclerosis. The combined application of multiple parameters has efficacy in predicting poor short-term functional outcome after stroke.

Recently, Arenja et al. [ [1] Arenja N. Mueller C. Tomilovskaya E. et al. Real-world experience of feasibility and efficacy of electrical muscle stimulation in elderly patients with acute heart failure: a randomized controlled study[J]. Int. J. Cardiol. 2021; 344: 113-119 Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar ]. research shows that electrical muscle stimulation (EMS) improves 6-min walk test distance (6-MWTD) results in elderly acute heart failure (AHF) patients, indicating that EMS may played a critical role in improve the quality of life of elderly AHF patients. After reading this article, we have some suggestions.

Background: Focused ultrasound (FUS) combined with microbubbles (MBs) has emerged as a potential approach for opening the blood-brain barrier (BBB) for delivering drugs into the brain. However, MBs range in size of microns and thus can hardly extravasate into the brain parenchyma. Recently, growing attention has been paid to gas vesicles (GVs), which are genetically encoded gas-filled nanostructures with protein shells, due to their potential for extravascular targeting in ultrasound imaging and therapy. However, the use of GVs as agents for BBB opening has not yet been investigated. Methods: In this study, GVs were extracted and purified from Halobacterium NRC-1. Ultrasound imaging performance of GVs was assessed in vitro and in vivo. Then, FUS/GVs-mediated BBB opening for small molecular Evans blue or large molecular liposome delivery across the BBB was examined. Results: The results showed a good contrast performance of GVs for brain perfusion ultrasound imaging in vivo. At the acoustic negative pressure of 1.5 MPa, FUS/GVs opened the BBB safely, and effectively enhanced Evans blue and 200-nm liposome delivery into the brain parenchyma. Conclusion: Our study suggests that biosynthetic GVs hold great potential to serve as local BBB-opening agents in the development of new targeted drug delivery strategies for central nervous system disorders.

目的 观察常规超声及超声造影(CEUS)评估颈动脉斑块、预测颈动脉狭窄患者缺血性脑卒中的价值.方法 回顾性分析115例经超声证实的颈动脉斑块致狭窄(狭窄率≥50％)患者,根据近6个月内有无缺血性脑卒中将其分为症状组(n=53)及无症状组(n=62).以单因素分析及多因素logistic回归分析筛选颈动脉狭窄患者发生缺血性脑卒中的颈动脉斑块超声特征,建立回归模型,绘制受试者工作特征(ROC)曲线,评估其预测患缺血性脑卒中的效能.结果 单因素分析显示,组间颈动脉狭窄率、斑块表面形态及斑块内新生血管分级差异均有统计学意义(P均＜0.05).多因素logistic回归分析显示,斑块表面形态及斑块内新生血管分级为颈动脉狭窄患者发生缺血性脑卒中的独立预测因素,建立回归模型Y=-4.914+2.272X1+2.354X2(X1为斑块表面形态,X2为斑块内新生血管分级),其预测缺血性脑卒中的曲线下面积为0.886.结论 常规超声联合CEUS评估颈动脉狭窄患者颈动脉斑块有助于预测缺血性脑卒中.

Background Coronary slow flow phenomenon (CSFP) is not uncommon in conventional coronary angiography. A disorder of serum homocysteine (tHcy) metabolism may play a role in the pathogenesis of slow coronary flow. Moreover, elevated tHcy concentration is closely associated with atherosclerosis. We aimed to evaluate the relationship between carotid artery stiffness and serum tHcy levels in patients with CSFP. Methods This was a case-control study. The study population comprised 146 patients with newly diagnosed stable angina, including 73 patients with CSFP and 73 patients with normal coronary flow. All participants underwent conventional coronary angiography, carotid ultrasonography, and biochemical examination. Results The carotid artery stiffness parameters of β index (β), pressure-strain elastic modulus (Ep), and local pulse wave velocity (PWV) in the CSFP group were significantly higher than those in the control group (β: 10.75±2.16 vs. 9.02±2.11, P=0.007; Ep: 147.41±41.22 vs. 116.21±39.21, P=0.004; PWV: 7.45±1.23 vs. 6.16±1.20, P=0.003), However, arterial compliance (AC) was lower in the CSFP group than the control group (0.52±0.11 vs. 0.69±0.24, P=0.008). The mean thrombolysis in myocardial infarction (TIMI) frame count and the tHcy concentration in the CSFP group were significantly higher than those in the control group (48.60±1.30 vs. 24.50±3.80, P=0.001; 19.95±4.00 vs. 9.12±2.72, P=0.009). The tHcy concentration was positively correlated with β (R value =0.494, P<0.0001), Ep (R value =0.469, P<0.0001), and PWV (R value =0.436, P<0.0001), but negatively correlated with AC (R value =-0.230, P=0.022). The predictors of CSFP were tHcy concentration, left PWV, right PWV, left β index, and right β index. Among them, the left β index and right β index were the best indictors for predicting CSFP. The cutoff values of left β index, right β index, left PWV, and right PWV were 9.3, 9.3, 6.7, and 6.6, respectively. Conclusions Our data showed that serum tHcy levels were elevated in patients with CSFP compared with the control group. Carotid artery stiffness parameters were correlated with tHcy. The best predictors of CSFP were left β index and right β index. These findings may contribute to a better understanding of systemic vascular disorders in patients with coronary slow flow, rather than simply attributing such disorders to a single and isolated lesion of the epicardial coronary artery.

Objective: To explore the association between ultrasound parameters and previous ischemic or hemorrhagic stroke in patients with moyamoya disease (MMD), and develop an ultrasound-based nomogram to identify stroke in patients with MMD.Methods: We prospectively enrolled 52 consecutive patients (92 hemispheres) with MMD at the Beijing Tiantan Hospital. Thirty-six patients (65 hemispheres) were assigned to the training dataset from September 2019 to February 2020, and 16 patients (27 hemispheres) were assigned to the validation dataset from March 2020 to July 2020. Multivariate logistic regression analysis was applied to identify ultrasound parameters associated with previous history of ipsilateral stroke in patients with MMD, and a nomogram was subsequently constructed to identify stroke in patients with MMD. The performance of the nomogram was evaluated with respect to discrimination, calibration, and clinical usefulness.Results: Multivariate analysis indicated that the flow volume (FV) of the extracranial internal carotid artery (EICA) and the peak systolic velocity (PSV) of the posterior cerebral artery (PCA) were independently associated with ipsilateral stroke in patients with MMD, a nomogram incorporating these two parameters was constructed to identify stroke patients. The area under the receiver operating characteristic (AUROC) curves was 0.776 (95% CI, 0.656–0.870) in the training dataset and 0.753 (95% CI, 0.550–0.897) in the validation dataset suggested that the model had good discrimination ability. The calibration plot showed good agreement in both the two datasets. The decision curve analysis (DCA) revealed that the nomogram was clinically useful.Conclusions: Ultrasound parameters of EICA and PCA are independently associated with history of previous ipsilateral ischemic or hemorrhagic stroke in patients with MMD. The present ultrasound-based nomogram might provide information to identify MMD patients with high risk of stroke. Future long-term follow-up studies are needed to prove the predictive value in other independent cohorts.Clinical Trial Registration:http://www.chictr.org.cn/index.aspx. Unique Identifier: ChiCTR1900026075.

BACKGROUND:To develop an ultrasound-derived stroke risk (USR) score combining plaque stiffness, surface morphology and lumen narrowing to evaluate the risk of stroke in patients with asymptotic carotid stenosis. METHODS:We developed the USR score in a prospective study of symptomatic and asymptomatic patients with ipsilateral carotid lumen narrowing. Multivariable analysis was performed to identify parameters associated with ischemic events, and a USR score was constructed based on the observed β coefficient. The discrimination performance of the USR score was assessed using receiver operating characteristic (ROC) curves. Twenty iterations of 5-fold cross-validation were used for internal validation. RESULTS:We derived the USR score (range, 0-7) by incorporating plaque stiffness (≥80 kPa, 0 points; 60-79 kPa, 1 point; 40-59 kPa, 2 points; <40 kPa, 3 points), plaque surface (smooth, 0 points; irregular, 1 point; ulcer, 2 points) and carotid stenosis (<50%, 0 points; 50-69%, 1 point; ≥70%, 2 points). After adjusting for age and sex, the odds ratio (OR) for every 1-point increase in the USR score increase was 3.3 (P<0.001). The risk of ischemic events increased with increasing USR score (P for trend <0.001). The C statistic of the USR score was 0.84 in the derivation sample and 0.82 in the validation sample. CONCLUSIONS:The USR score to assess the risk of ischemic events in patients with carotid stenosis showed preferable discrimination ability and robustness. While external validation is warranted to prove the predictive value, this risk score could help accelerate triage decisions in similar patient populations.

Abstract. Background. The current deep learning diagnosis of breast masses is mainly reflected by the diagnosis of benign and malignant lesions. In China, breast masses are divided into four categories according to the treatment method: inflammatory masses, adenosis, benign tumors, and malignant tumors. These categorizations are important for guiding clinical treatment. In this study, we aimed to develop a convolutional neural network (CNN) for classification of these four breast mass types using ultrasound (US) images. Methods. Taking breast biopsy or pathological examinations as the reference standard, CNNs were used to establish models for the four-way classification of 3623 breast cancer patients from 13 centers. The patients were randomly divided into training and test groups (n = 1810 vs. n = 1813). Separate models were created for two-dimensional (2D) images only, 2D and color Doppler flow imaging (2D-CDFI), and 2D-CDFI and pulsed wave Doppler (2D-CDFI-PW) images. The performance of these three models was compared using sensitivity, specificity, area under receiver operating characteristic curve (AUC), positive (PPV) and negative predictive values (NPV), positive (LR+) and negative likelihood ratios (LR−), and the performance of the 2D model was further compared between masses of different sizes with above statistical indicators, between images from different hospitals with AUC, and with the performance of 37 radiologists. Results. The accuracies of the 2D, 2D-CDFI, and 2D-CDFI-PW models on the test set were 87.9%, 89.2%, and 88.7%, respectively. The AUCs for classification of benign tumors, malignant tumors, inflammatory masses, and adenosis were 0.90, 0.91, 0.90, and 0.89, respectively (95% confidence intervals [CIs], 0.87–0.91, 0.89–0.92, 0.87–0.91, and 0.86–0.90). The 2D-CDFI model showed better accuracy (89.2%) on the test set than the 2D (87.9%) and 2D-CDFI-PW (88.7%) models. The 2D model showed accuracy of 81.7% on breast masses ≤1 cm and 82.3% on breast masses >1 cm; there was a significant difference between the two groups (P < 0.001). The accuracy of the CNN classifications for the test set (89.2%) was significantly higher than that of all the radiologists (30%). Conclusions. The CNN may have high accuracy for classification of US images of breast masses and perform significantly better than human radiologists. Trial registration. Chictr.org, ChiCTR1900021375; http://www.chictr.org.cn/showproj.aspx?proj=33139.

Background Risk stratification of asymptomatic carotid plaque remains an issue in stroke prevention in clinical practice. Purpose To investigate whether a multimodal ultrasound (MMU) model would help plaque risk stratification in patients with asymptomatic carotid stenosis. Material and Methods A prospective study was conducted of symptomatic and asymptomatic patients with > 50% proximal internal carotid artery (ICA) stenosis. All patients underwent MMU examination. Multivariable regression analyses were performed to identify parameters associated with ischemic vascular events (IVE). These parameters were used to develop a scoring nomogram to assess the probability of IVE. We elaborated the diagnostic performance of the MMU nomogram using receiver operating characteristic (ROC) curves. Results From December 2018 to December 2019, 98 patients (75 men, mean age 67 ± 8 years) were included; 50 were symptomatic and 48 were asymptomatic. Multivariable regression analyses revealed that plaque surface morphology (PSM) (odds ratio [OR] 2.99, 95% confidence interval [CI] 1.26–7.12, P = 0.013), intraplaque neovascularization (IPN) grades (OR 3.23, 95% CI 1.77–5.89, P<0.001), and carotid stenosis degree (CSD) (OR 4.12, 95% CI 1.47–11.55, P = 0.007) were independently associated with IVE. For the nomogram, the area under the ROC curve was 0.85 (95% CI 0.77–0.92) and the Hosmer-Lemeshow test P value was 0.822. Conclusions In patients with proximal ICA > 50%, PSM, IPN grades, and CSD were independent variables associated with IVE. The MMU nomogram provided favorable value to risk stratification of IVE. Future large-scale studies with long-term follow-up are needed to validate these findings.

颈动脉粥样硬化易损斑块与缺血性脑血管事件的发生密切相关.颈动脉超声不仅可以量化颈动脉狭窄程度,还可以评估颈动脉粥样硬化斑块的易损性.三维超声可定量评估颈动脉粥样硬化斑块的体积,超声造影可显示斑块内新生血管的密度及分布区域,剪切波弹性成像可测定斑块组织的硬度,反映斑块不同部位的组织成分.颈动脉超声技术的发展使其在缺血性卒中诊疗领域中的应用更加广泛,对颈动脉血流动力学和管壁的评价更加精确,有助于临床判断脑血管事件的风险并进行相应的干预.

Background Advanced carotid ultrasound techniques may be useful in characterizing plaque vulnerability, but comprehensive studies are still lacking. The aim of this study was to identify factors associated with vulnerable plaques using advanced ultrasound techniques. Methods This is a prospective observational study of patients with >50% internal carotid stenosis (ICA). All patients underwent conventional ultrasound, superb microvascular imaging (SMI) and shear wave elastography (SWE) examinations. Plaque size, echogenicity, stiffness and intraplaque neovascularization (IPN) were assessed and compared between symptomatic and asymptomatic groups. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic performance of SWE and SMI of the vulnerable plaques. Results The final analysis included 123 patients (78.9% male; mean age, 66±8 years), 65 were enrolled in the symptomatic group, and 58 were enrolled in the asymptomatic group. The mean elasticity was 78.1±25.4 kPa for asymptomatic and 51.5±18.3 kPa for symptomatic plaques. Symptomatic plaques showed higher visual IPN grades on SMI than asymptomatic plaques (P<0.001). Multivariate regression analysis showed that plaque stiffness (PS) (OR 0.95, 95% CI, 0.919-0.974) and IPN level (OR 4.17, 95% CI, 2.008-8.664) were independently associated with symptomatic plaques. The combination of the two factors had a preferable accuracy to discriminate symptomatic plaques (AUC 0.89, 95% CI, 0.827-0.944). Conclusions Advanced carotid ultrasound techniques can identify plaque characteristics that are associated with ischemic events and may be potentially indicative of plaque vulnerability. These factors may ultimately be used in the clinical management of carotid stenosis.

OBJECTIVE:Moyamoya is a progressive arteriopathy that predisposes patients to stroke due to stenosis of the intracranial internal carotid arteries and their proximal branches. Despite the morbidity caused by this condition, the ability to accurately predict prognosis for individual patients remains challenging. The goal of this study was to develop a systematic scoring method based on parenchymal findings on preoperative brain MRI to predict long-term outcomes for surgically treated pediatric patients with moyamoya.METHODS:A retrospective surgical cohort of pediatric patients (≤ 18 years of age at the time of the initial surgery) with moyamoya from a single center were studied. Radiological variables with existing correlations between outcomes in moyamoya or other vascular diseases were chosen to score preoperative MRI based on easily defined parenchymal findings that could be rapidly assessed and used to make a numeric score. Calculated scores were correlated with clinical outcome measures using the Pearson correlation coefficient and area under the receiver operating characteristic curve (AUROC).RESULTS:A total of 35 children with moyamoya disease or moyamoya syndrome were included in the study, with a median follow-up time of 2.6 years from the time of surgery. The pediatric moyamoya MRI score (PMMS) consists of ischemic changes (0-2; 0 = none, 1 = focal, 2 = diffuse), encephalomalacia (0-2; 0 = none, 1 = focal, 2 = diffuse), and hemorrhage (0-1; 0 = not present, 1 = present). PMMSs were highly correlated with pediatric modified Rankin Scale scores at the last follow-up (r = 0.7, 95% CI 0.44-0.84; p < 0.001) as a six-point scale, and when dichotomized (AUROC = 0.85).CONCLUSIONS:The PMMS was found to be a simple tool based on preoperative MRI data that could be quickly and easily calculated and correlated with disability. This scoring method may aid future development of predictive models of outcomes for children with moyamoya disease and moyamoya syndrome.

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