High-Resolution MRI Revealed Different Etiology-Specific Associations With Cerebral Infarction in Adult Moyamoya...

Area of Science:

• Neurology
• Radiology
• Vascular Medicine

Background:

• Moyamoya vasculopathy encompasses moyamoya disease and atherosclerosis-associated moyamoya vasculopathy.
• High-resolution MRI (HR-MRI) offers detailed intracranial vessel wall imaging.
• Understanding subtype-specific HR-MRI features is crucial for assessing ischemic infarction risk.

Purpose of the Study:

• Classify adult moyamoya vasculopathy etiologies using HR-MRI.
• Examine subtype-specific associations between HR-MRI features and ischemic infarction.

Main Methods:

• 398 adult moyamoya vasculopathy patients were analyzed.
• 340 patients were classified into moyamoya disease (n=279) or atherosclerosis-associated moyamoya vasculopathy (n=61) based on HR-MRI.
• Generalized estimating equations logistic models assessed associations between HR-MRI measures and ischemic hemispheres.

Main Results:

• Moyamoya disease patients were more often female, with a family history of stroke and posterior cerebral artery involvement.
• In moyamoya disease, MCA stenosis, Suzuki stage, and ICA/MCA/PCA involvement correlated with ischemia; MCA remodeling index was inversely associated.
• In atherosclerosis-associated moyamoya vasculopathy, MCA remodeling index and ACA involvement correlated with ischemia.

Conclusions:

• HR-MRI quantitative metrics reveal distinct ischemia-related patterns in moyamoya disease and atherosclerosis-associated moyamoya vasculopathy.
• Ischemic hemispheres in moyamoya disease are characterized by global steno-occlusive burden and impaired MCA remodeling.
• Adverse MCA remodeling and ACA involvement are key correlates of ischemia in atherosclerosis-associated moyamoya vasculopathy.