Glymphatic System Impairment Along the Perivascular Space in Adults With Moyamoya Disease: A Systematic Review and Meta-Analysis Publisher



S Ghaderi SADEGH ; S Mohammadi SANA ; F Fatehi FARZAD
Source: Heliyon Published:2025

Abstract

Objective: To assess the existing literature on glymphatic system impairment in adult patients with moyamoya disease in comparison to healthy controls, with a specific emphasis on the utility of DTI-ALPS as a potential biomarker. Methods: A systematic review and meta-analysis were conducted according to the PRISMA 2020 guidelines. Studies from inception to January 15, 2025, were searched in PubMed, Web of Science, Scopus, and Embase. Studies that examined the ALPS index in moyamoya disease using a DTI approach were included. A random-effects meta-analysis (standardized mean difference) was conducted, complemented by sensitivity analysis, Trim-and-Fill adjustment for publication bias, and risk of bias assessment. Publication bias was evaluated using funnel plot asymmetry, Egger's regression, and Begg's rank correlation tests. Results: Four studies (172 patients with moyamoya disease and 104 healthy controls) were included. The pooled meta-analysis revealed a statistically significant reduction in the DTI-ALPS index in patients with moyamoya disease compared to healthy controls (Cohen's d = −0.38, 95 % CI: −0.68, −0.09; p = 0.01), indicating impaired glymphatic function. Low heterogeneity was observed across the studies (I2 = 26.13 %), and publication bias assessments confirmed the robustness of the findings. Conclusion: This meta-analysis suggests that impaired glymphatic function is associated with moyamoya disease, highlighting the potential of this index as a non-invasive biomarker. © 2025 Elsevier B.V., All rights reserved.