Correlation Between Contrast-Enhanced Magnetic Resonance Vessel Wall Imaging and Cerebral Hemodynamic Reserve in
Akihiro Hirayama1, Takatoshi Sorimachi1, Jun Hashimoto2
1Department of Neurosurgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
Background:
In Moyamoya disease (MMD), enhanced sulci on contrast-enhanced (CE) magnetic resonance (MR) vessel wall imaging (VWI) are more sensitive to blood flow changes than the fluid-attenuated inversion recovery (FLAIR) ivy sign. FLAIR ivy sign is associated with cerebral blood flow and cerebrovascular reserve (CVR) but this remains controversial. We aimed to clarify the correlation between the number of enhanced sulci on CE-MR VWI or FLAIR ivy signs and CVR, which is essential for treatment planning.
Methods:
We retrospectively analyzed patients with MMD who underwent CE-MR VWI and acetazolamide single-photon emission computed tomography in 2020-2025. Enhanced sulci on CE-MR VWI and FLAIR ivy signs were quantified in basal ganglia slices, divided into 4 regions per hemisphere. Correlations with CVR in corresponding regions were assessed.
Results:
Among 58 patients, both enhanced sulci on CE-MR VWI and FLAIR ivy signs were most common in the middle cerebral artery territory and least in the posterior cerebral artery territory. The correlation coefficient between the number of enhanced sulci and mean CVR across all regions was -0.718 (P < 0.05) (strong correlation), while that between the number of FLAIR ivy signs and mean CVR was -0.473 (P < 0.05) (weak correlation). Enhanced sulci on CE-MR VWI correlated strongly with CVR in bilateral anterior middle cerebral artery regions (|r| > 0.7), while the correlation between FLAIR ivy signs and CVR was weaker in these regions (|r| ≤ 0.4).
Conclusions:
The number of enhanced sulci on CE-MR VWI correlates more with reduced CVR than FLAIR ivy sign. CE-MR VWI may aid CVR estimation and guide MMD treatment.
Insights
Enhanced sulci on contrast-enhanced MR vessel wall imaging (CE-MR VWI) in moyamoya disease (MMD) correlate more strongly with cerebrovascular reserve (CVR) than FLAIR ivy signs. CE-MR VWI may improve CVR assessment for MMD treatment planning.
Area of Science:
- Neurology
- Radiology
- Vascular Imaging
Background:
- Moyamoya disease (MMD) involves progressive cerebrovascular stenosis.
- Enhanced sulci on CE-MR VWI are more sensitive to hemodynamic changes than FLAIR ivy signs in MMD.
- The association between FLAIR ivy signs and cerebrovascular reserve (CVR) in MMD is debated.
Purpose of the Study:
- To evaluate the correlation between enhanced sulci on CE-MR VWI and FLAIR ivy signs with CVR in MMD patients.
- To determine the utility of CE-MR VWI for assessing CVR in MMD for treatment guidance.
Main Methods:
- Retrospective analysis of 58 MMD patients who underwent CE-MR VWI and acetazolamide SPECT.
- Quantification of enhanced sulci and FLAIR ivy signs in basal ganglia regions.
- Assessment of correlations between imaging findings and regional CVR.
Main Results:
- Both enhanced sulci and FLAIR ivy signs were most prevalent in the middle cerebral artery (MCA) territory.
- A strong negative correlation (r=-0.718) was found between enhanced sulci count and mean CVR.
- A weak negative correlation (r=-0.473) was observed between FLAIR ivy sign count and mean CVR.
Conclusions:
- Enhanced sulci on CE-MR VWI show a stronger correlation with reduced CVR compared to FLAIR ivy signs in MMD.
- CE-MR VWI offers a potentially valuable tool for estimating CVR and guiding MMD treatment strategies.
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