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Updated: Jun 26, 2025
Assessing Cortical Cerebral Microinfarcts on High Resolution MR Images
Published on: November 20, 2015
Acute Magnetic Resonance Imaging Findings in Young Children With Moyamoya Disease
Shingo Numoto1, Syuntaro Takasu2, Tomomi Nakamura3
1Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, Japan; Department of Child Neurology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan.
Insights
Diffusion-weighted imaging (DWI) in young children with moyamoya disease (MMD) shows characteristic cortical lesions, often gyral or atypical territorial, differing from typical strokes. These findings are crucial for diagnosing MMD in this age group.
Area of Science:
- Pediatric Neurology
- Neuroradiology
- Neuroimaging
Background:
- Moyamoya disease (MMD) is a rare cerebrovascular disorder.
- Understanding acute diffusion-weighted imaging (DWI) findings in young children with MMD is essential for early diagnosis and management.
- Previous studies have not fully characterized DWI findings in the acute phase of MMD in pre-school aged children.
Purpose of the Study:
- To describe the diffusion-weighted imaging (DWI) findings in young children (under six years) with moyamoya disease (MMD) during the acute symptomatic period.
- To correlate DWI findings with the severity of arterial stenosis in this pediatric population.
Main Methods:
- Retrospective analysis of clinical data from 12 children under six years old with MMD.
- DWI scans obtained within one week of MMD symptom onset were reviewed.
- DWI abnormalities were classified into patterns: gyral, atypical territorial, honeycomb, classical territorial, multiple-dot, border zone, and deep lacunar.
- Arterial stenosis severity was graded using established angiographic stages.
Main Results:
- DWI abnormalities were predominantly located in the cerebral cortex in 11 out of 12 children.
- Gyral lesions were observed in seven children, and atypical territorial lesions in five, distinct from typical arterial stroke patterns.
- All 12 children had internal carotid artery stenosis, mostly mild (11 children).
- The severity of arterial stenosis did not consistently correlate with the location or pattern of ischemic lesions.
Conclusions:
- Acute DWI findings in young children with MMD are typically confined to the cerebral cortex.
- Lesions are often gyral or atypical territorial, differentiating them from classic arterial territory infarcts.
- These characteristic cortical lesions on DWI are a key feature of MMD in very young children.
Background:
To describe the diffusion-weighted imaging (DWI) findings in young children with moyamoya disease (MMD) during the acute period of the condition.
Methods:
Clinical data were collected from 12 children with MMD aged less than six years, in whom abnormalities were observed on DWI scans obtained within one week after the appearance of symptoms related to MMD. The DWI abnormalities were classified into gyral, atypical territorial, honeycomb, classical territorial, multiple-dot, border zone, and deep lacunar patterns. The severity of arterial stenosis was graded by angiographic stages that have been previously described.
Results:
In all but one child, the DWI abnormalities were restricted to the cerebral cortex. The lesions were gyral in nature in seven children and atypical territorial in five; all differed from those of typical arterial strokes. Internal carotid artery stenosis was observed in all 12 children, although the stenosis was mild in 11. The severity of arterial stenosis did not match the regions of ischemic lesions in some children. There was no statistically significant difference in the severity of arterial stenosis according to the presence or absence of ischemic lesions or the pattern of the lesions.
Conclusions:
Lesions located mainly in the cerebral cortex, i.e., not in arterial territories, are characteristic of young children with MMD.
