Neuroimaging diagnosis and the collateral circulation in moyamoya disease

Area of Science:

• Neurology
• Radiology
• Vascular Medicine

Background:

• Moyamoya disease (MMD) is a rare cerebrovascular disorder.
• It is defined by progressive stenosis of the internal carotid artery's terminal portion and its branches.
• This condition leads to the formation of fragile collateral vessels at the brain's base.

Purpose of the Study:

• To review neuroimaging modalities for diagnosing MMD.
• To highlight the significance of hyperintense vessels on fluid-attenuated inversion recovery (FLAIR) MRI in evaluating MMD collateral patterns.
• To summarize common angiographic collateral patterns in MMD and their association with cerebrovascular lesions.

Main Methods:

• Review of neuroimaging techniques for MMD diagnosis.
• Analysis of fluid-attenuated inversion recovery (FLAIR) MRI findings, specifically hyperintense vessels.
• Summary of conventional cerebral angiography findings and collateral patterns.
• Correlation of angiographic patterns with ischemic and hemorrhagic lesions.

Main Results:

• Neuroimaging plays a crucial role in MMD diagnosis.
• Hyperintense vessels on FLAIR MRI are valuable indicators for assessing collateral circulation in MMD.
• Specific angiographic collateral patterns are associated with increased risk of ischemia and hemorrhage in MMD patients.

Conclusions:

• Comprehensive neuroimaging, including advanced MRI techniques, is essential for MMD diagnosis and management.
• Understanding collateral patterns is key to predicting MMD-related cerebrovascular events.
• This review provides a framework for evaluating MMD using various imaging modalities.