Altered neurovascular coupling and structure-function coupling in Moyamoya disease affect postoperative collateral formation

Chronic ischemia in moyamoya disease (MMD) impaired white matter microstructure and neural functional network. However, the coupling between cerebral blood flow (CBF) and functional connectivity and the association between structural and functional network are largely unknown. 38 MMD patients and 20 sex/age-matched healthy controls (HC) were included for T1-weighted imaging, arterial spin labeling imaging, resting-state functional MRI and diffusion tensor imaging. All patients had preoperative and postoperative digital subtraction angiography. Upon constructing the structural connectivity (SC) and functional connectivity (FC) networks, the SC-FC coupling was calculated. After obtaining the graph theoretical parameters, neurovascular coupling represented the spatial correlation between node degree centrality (DC) of functional networks and CBF. The CBF-DC coupling and SC-FC coupling were compared between MMD and HC groups. We further analyzed the correlation between coupling indexes and cognitive scores, as well as postoperative collateral formation. Compared with HC, CBF-DC coupling was decreased in MMD (p = 0.021), especially in the parietal lobe (p = 0.047). SC-FC coupling in MMD decreased in frontal, occipital, and subcortical regions. Cognitive scores were correlated with the CBF-DC coupling in frontal lobes (r = 0.394, p = 0.029) and SC-FC coupling (r = 0.397, p = 0.027). The CBF-DC coupling of patients with good postoperative collateral formation was higher (p = 0.041). Overall, neurovascular decoupling and structure-functional decoupling at the cortical level may be the underlying neuropathological mechanisms of MMD.