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Diffusion-weighted imaging in moyamoya disease
T B Soman1, M Takeoka, E C Dooling
1Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, USA. teestas@yahoo.com
Abstract:
Moyamoya disease is characterized by progressive intracranial vascular stenoses of the circle of Willis, resulting in successive ischemic events. We report serial diffusion-weighted imaging studies in a case of moyamoya disease. A 4-year-old right-handed patient presented with multiple infarcts in the right and left hemispheres. Each new infarct was unambiguously recognized as bright on diffusion-weighted imaging. Previous infarcts, readily detected on other magnetic resonance imaging sequences, were not bright on diffusion-weighted imaging. The patient subsequently underwent bilateral synangiosis. In this case, the diffusion-weighted images were helpful in assessing the extent of infarcts, determining the age of the lesion, and correlation with new clinical findings. We emphasize the usefulness of diffusion-weighted imaging for following the clinical course of children with moyamoya disease, in whom new focal deficits are highly suspicious of new infarcts.
Insights
Diffusion-weighted imaging (DWI) helps track new brain infarcts in children with moyamoya disease. DWI distinguishes acute lesions, aiding in monitoring disease progression and treatment effectiveness.
Area of Science:
- Neurology
- Radiology
- Pediatric Neurology
Background:
- Moyamoya disease involves progressive stenosis of intracranial arteries, leading to recurrent ischemic strokes.
- Pediatric moyamoya disease presents with significant neurological deficits due to these ischemic events.
Observation:
- Serial diffusion-weighted imaging (DWI) studies were performed on a 4-year-old patient with moyamoya disease and multiple hemispheric infarcts.
- New infarcts appeared as hyperintense (bright) lesions on DWI, while older infarcts were not hyperintense on DWI.
Findings:
- DWI effectively identified acute ischemic lesions, differentiating them from pre-existing infarcts.
- The imaging modality aided in assessing the extent and age of brain infarcts.
- Correlation between new DWI findings and clinical presentation was established.
Implications:
- Diffusion-weighted imaging is a valuable tool for monitoring the clinical course of pediatric moyamoya disease.
- DWI assists in the early detection of new infarcts, prompting timely clinical correlation and management adjustments.
- This technique enhances the understanding and management of cerebrovascular disease in children.