High-resolution magnetic resonance wall imaging findings of Moyamoya disease
Sookyung Ryoo1, Jihoon Cha1, Suk Jae Kim1
1From the Departments of Neurology (S.R., S.J.K., O.Y.B.) and Radiology (J.C., J.W.C., K.H.K., P.J.), Laboratory Medicine and Genetics (C.-S.K.), and Neurosurgery (J.-S.K., S.-C.H.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Background And Purpose:
Diagnosis of Moyamoya disease (MMD) is based on the characteristic angiographic findings. However, differentiating MMD from intracranial atherosclerotic disease (ICAD) is difficult. We compared vessel wall imaging findings on high-resolution magnetic resonance imaging between MMD and ICAD.
Methods:
High-resolution magnetic resonance imaging was performed on 32 patients with angiographically proven MMD and 16 patients with acute infarcts because of ICAD. Bilateral internal carotid arteries and steno-occlusive middle cerebral artery were analyzed for wall enhancement and remodeling.
Results:
Enhancement patterns and distribution were different. Most patients with MMD (90.6%) showed concentric enhancement on distal internal carotid arteries and middle cerebral arteries, whereas focal eccentric enhancement was observed on the symptomatic segment in ICAD. MMD was characterized by middle cerebral artery shrinkage; the remodeling index and wall area were lower in MMD than in ICAD (remodeling index, 0.19±0.11 versus 1.00±0.43; wall area, 0.32±0.22 versus 6.00±2.72; P<0.001).
Conclusions:
MMD was characterized by concentric enhancement on bilateral distal internal carotid arteries and shrinkage of middle cerebral artery, regardless of symptoms.
Insights
Moyamoya disease (MMD) shows concentric vessel wall enhancement and middle cerebral artery shrinkage. Intracranial atherosclerotic disease (ICAD) presents with focal eccentric enhancement, aiding differentiation using high-resolution MRI.
Area of Science:
- Neurology
- Radiology
- Vascular Imaging
Background:
- Moyamoya disease (MMD) diagnosis relies on angiographic findings.
- Distinguishing MMD from intracranial atherosclerotic disease (ICAD) poses diagnostic challenges.
- High-resolution magnetic resonance imaging (HR-MRI) offers advanced vessel wall visualization.
Purpose of the Study:
- To compare HR-MRI vessel wall imaging findings between MMD and ICAD.
- To identify differentiating imaging biomarkers for MMD and ICAD.
- To improve diagnostic accuracy in cerebrovascular diseases.
Main Methods:
- HR-MRI was performed on 32 MMD patients and 16 ICAD patients.
- Analysis focused on bilateral internal carotid arteries and middle cerebral arteries.
- Key metrics included vessel wall enhancement patterns and remodeling indices.
Main Results:
- MMD exhibited concentric enhancement in distal internal carotid and middle cerebral arteries (90.6%).
- ICAD showed focal eccentric enhancement in symptomatic segments.
- MMD demonstrated significant middle cerebral artery shrinkage (lower remodeling index and wall area; P<0.001).
Conclusions:
- MMD is characterized by concentric enhancement and middle cerebral artery shrinkage.
- These HR-MRI findings are consistent regardless of patient symptoms.
- HR-MRI can effectively differentiate MMD from ICAD based on vessel wall characteristics.
Related Concept Videos
01:21Imaging Studies for Cardiovascular System IV: CMRI
01:24Magnetic Resonance Imaging