Isolated MCA disease in patients without significant atherosclerotic risk factors: a high-resolution magnetic
Sung-Ho Ahn1, Jookyung Lee1, Yeon-Jung Kim1
1From the Department of Neurology (S.-H.A., J.L., Y.-J.K., S.U.K., D.-W.K., J.S.K.) and Neuroradiology (D.L., S.-C.J.), University of Ulsan, Asan Medical Center, Seoul, South Korea.
Background And Purpose:
Diagnosis of intracranial artery atherosclerosis remains often uncertain. The high-resolution magnetic resonance imaging (HR-MRI) enables vessel wall assessment for more precise diagnoses. The aim of the present study was to investigate the etiologies of middle cerebral artery steno-occlusive disease in young adult patients with few atherosclerotic risk factors using HR-MRI.
Methods:
We prospectively studied patients who visited a tertiary hospital in Seoul, Korea, and had (1) unilateral middle cerebral artery disease (≥50% stenosis or occlusion), (2) were ≤55 years old and had no or minimal (≤1) atherosclerotic risk factors. We excluded patients with a confirmed diagnosis of Moyamoya disease, vasculitis, or dissection and those having emboligenic sources. A presumptive diagnosis was made based on HR-MRI findings, and patients were categorized as HR-athero (atherosclerotic disease), HR-MMD (Moyamoya disease), HR-dissection, or HR-vasculitis.
Results:
Among 95 patients analyzed, 26 (27.4%) had HR-athero who were more often male (P=0.004), smokers (P=0.018), and had focal stenosis (P=0.003) than others.As compared with the HR-athero patients, 29 HR-MMD patients were more often female (P<0.001) and more often had occlusive lesions (P=0.001) and nonfocal stenosis (P<0.001). The 22 HR-dissection patients tended to have hypertension less often, and the 13 HR-vasculitis patients were younger (P=0.004) and tended to have nonfocal stenosis. [corrected].
Conclusions:
In our cohort of young patients with minimal risk factors, atherosclerosis seems to be an uncommon pathology of middle cerebral artery stenosis. HR-MRI aids us to make a more reliable diagnosis.
Insights
In young adults with few risk factors, atherosclerosis is an uncommon cause of middle cerebral artery stenosis. High-resolution magnetic resonance imaging (HR-MRI) improves diagnostic accuracy for cerebrovascular diseases.
Area of Science:
- Neurology
- Radiology
- Vascular Medicine
Background:
- Diagnosis of intracranial artery atherosclerosis can be challenging.
- High-resolution magnetic resonance imaging (HR-MRI) offers enhanced vessel wall assessment for improved diagnostic precision.
Purpose of the Study:
- To investigate the causes of middle cerebral artery steno-occlusive disease in young adults with minimal atherosclerotic risk factors.
- To evaluate the utility of HR-MRI in differentiating etiologies of middle cerebral artery disease.
Main Methods:
- Prospective study of patients (≤55 years) with unilateral middle cerebral artery disease (≥50% stenosis or occlusion) and ≤1 atherosclerotic risk factor.
- Exclusion of Moyamoya disease, vasculitis, dissection, and emboligenic sources.
- Diagnosis categorization based on HR-MRI findings: HR-athero, HR-MMD, HR-dissection, HR-vasculitis.
Main Results:
- Atherosclerosis (HR-athero) was diagnosed in 27.4% of patients, more common in males and smokers with focal stenosis.
- Moyamoya disease (HR-MMD) was more frequent in females with occlusive, nonfocal lesions.
- Dissection and vasculitis were less common, with distinct demographic and imaging features.
Conclusions:
- Atherosclerosis is an uncommon cause of middle cerebral artery stenosis in young adults with minimal risk factors.
- HR-MRI is a valuable tool for accurate diagnosis of cerebrovascular diseases in this population.
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