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Contrast enhancement patterns associated with acute stroke in moyamoya disease using MR vessel wall imaging
Jae-Chan Ryu1, Chul-Rae Jang1, Sang-Hun Lee1
1Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea.
Background And Purpose:
High-resolution magnetic resonance imaging (HR-MRI) can provide valuable insights into the histopathological characteristics of moyamoya disease (MMD). However, the patterns of vessel wall contrast enhancement have not been well established. We aimed to identify the contrast enhancement patterns of the vessel walls associated with acute cerebral infarction using HR-MRI in MMD.
Methods:
In this retrospective study, we conducted genetic tests for Ring Finger Protein 213 (RNF 213) and performed HR-MRI on patients suspected of having MMD. We analyzed wall enhancement patterns including concentric, eccentric, or mixed enhancement types, and the occurrence of acute cerebral infarction in patients who simultaneously tested positive for RNF 213 and exhibited definite features of MMD on HR-MRI.
Results:
Among 306 patients who underwent RNF 213 tests for the evaluation of MMD, 56 showed positive RNF 213, and HR-MRI was performed on 32 of them. Among the patients with acute cerebral infarction, the incidence rate was significantly higher in the group with concentric wall enhancement compared to patients without acute cerebral infarction (73.3% vs. 17.0%, p < .002). Furthermore, the incidence was notably elevated, even in patients with pure concentric wall enhancement (40.0% vs. 5.9%, p = .033). The area under the curve (AUC) for the group with any concentric wall enhancement showed a significant result of .78 (95% confidence interval [CI]: .61-.95, p = .007), whereas the predictive ability for pure concentric wall enhancement did not reach significance (AUC = .67, 95% CI: .48-.86, p = .100).
Conclusions:
Concentric wall enhancement was a significant predictor of acute cerebral infarction in patients with MMD.
Insights
Concentric vessel wall enhancement on high-resolution MRI is a significant predictor of acute cerebral infarction in moyamoya disease (MMD) patients. This finding aids in understanding MMD progression and stroke risk.
Area of Science:
- Neurology
- Radiology
- Genetics
Background:
- Moyamoya disease (MMD) is a rare cerebrovascular disorder characterized by progressive stenosis of the internal carotid arteries and their branches.
- High-resolution magnetic resonance imaging (HR-MRI) offers detailed visualization of vessel wall characteristics.
- The relationship between specific HR-MRI vessel wall enhancement patterns and acute cerebral infarction in MMD remains incompletely understood.
Purpose of the Study:
- To identify contrast enhancement patterns of vessel walls using HR-MRI in MMD patients.
- To determine the association between these enhancement patterns and the occurrence of acute cerebral infarction.
- To evaluate the predictive value of vessel wall enhancement patterns for acute cerebral infarction in MMD.
Main Methods:
- Retrospective analysis of 32 MMD patients who tested positive for Ring Finger Protein 213 (RNF213) and underwent HR-MRI.
- Classification of vessel wall enhancement patterns as concentric, eccentric, or mixed.
- Correlation of enhancement patterns with the incidence of acute cerebral infarction.
Main Results:
- Concentric wall enhancement was significantly more frequent in MMD patients with acute cerebral infarction (73.3%) compared to those without (17.0%).
- Pure concentric wall enhancement also showed a higher incidence in patients with infarction (40.0%) versus those without (5.9%).
- Any concentric wall enhancement demonstrated significant predictive ability for acute cerebral infarction (AUC = 0.78, p = 0.007).
Conclusions:
- Concentric vessel wall enhancement is a significant predictor of acute cerebral infarction in MMD patients.
- HR-MRI can identify specific vessel wall characteristics associated with stroke risk in MMD.
- These findings contribute to a better understanding of MMD pathophysiology and stroke prevention strategies.
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