High-resolution MR imaging of the arterial wall in moyamoya disease

Yuan, Min; Liu, Zhiqiang; Wang, Zhiqiang; Li, Bin; Xu, Lijun; Xiao, Xinlan

doi:10.1016/j.neulet.2014.10.021

Cited by 67 publications

(44 citation statements)

References 28 publications

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“…Kim et al 8 compared 12 MMD and 20 atherosclerosis patients using vessel-wall MRI, and found that MMD typically showed non-eccentric, non-enhancing lesions with wall shrinkage, while atherosclerosis showed eccentric, enhancing and outward remodeling lesions. Yuan et al 10 compared 21 MMD and 44 atherosclerosis subjects, and found that on vessel-wall MRI, MMD typically shows concentric wall thickening with homogeneous signal as compared to eccentric, heterogeneous atherosclerotic lesions. These studies agree with our findings that atherosclerotic lesions show outward remodeling and heterogeneous wall signal, but in addition, we showed atherosclerosis differs from MMD by having a T2 hyperintense juxtaluminal band and either homogeneous or heterogeneous lesion enhancement, while MMD typically does not show appreciable wall thickening and rarely enhances.…”

Section: Discussionmentioning

confidence: 99%

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Added Value of Vessel Wall Magnetic Resonance Imaging in the Differentiation of Moyamoya Vasculopathies in a Non-Asian Cohort

Mossa‐Basha

Havenon

Becker

et al. 2016

Stroke

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Background and Purpose Although studies have evaluated the differential imaging of moyamoya disease and atherosclerosis, none have investigated the added value of vessel-wall MRI. The current study evaluates the added diagnostic value of vessel-wall MRI in differentiating moyamoya disease (MMD), atherosclerotic-moyamoya syndrome (A-MMS) and vasculitic-moyamoya syndrome (V-MMS) with a multi-contrast protocol. Methods We retrospectively reviewed the carotid artery territories of patients with clinically defined vasculopathies (MMD, atherosclerosis, vasculitis) and steno-occlusive intracranial carotid disease. Two neuroradiologists, blinded to clinical data reviewed the luminal imaging of each carotid, evaluating collateral extent and making a presumed diagnosis with diagnostic confidence. After three weeks, the two readers reviewed the luminal imaging+vessel-wall MRI for presence, pattern and intensity of post-contrast enhancement, T2 signal characteristics, pattern of involvement, presumed diagnosis and confidence. Results Ten A-MMS, three V-MMS and eight MMD cases with 38 affected carotid segments were included. There was significant improvement in diagnostic accuracy with luminal imaging+vessel-wall MRI as compared to luminal imaging (87% vs. 32%, p<.001). The most common vessel-wall MRI findings for MMD were non-enhancing, non-remodeling lesions without T2 heterogeneity; for A-MMS eccentric, remodeling, and T2 heterogeneous lesions with mild/moderate and homogeneous/heterogeneous enhancement; and for V-MMS concentric lesions with homogeneous, moderate enhancement. Inter-reader agreement was moderate to substantial for all vessel-wall MRI characteristics (κ=0.46-0.86) and fair for collateral grading (κ=0.35). There was 11% inter-reader agreement for diagnosis on luminal imaging as compared to 82% for luminal imaging+vessel-wall MRI (p<.001). Conclusion Vessel-wall MRI can significantly improve the differentiation of moyamoya vasculopathies when combined with traditional imaging techniques.

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Section: Discussionmentioning

confidence: 99%

“…There have only been a few studies that evaluated differences in vessel-wall MRI appearances between atherosclerosis and MMD 8-10 . The current study is the first to assess the added value of a multi-contrast vessel-wall MRI protocol in addition to luminal imaging for differentiation of MMD, A-MMS and V-MMS.…”

Section: Introductionmentioning

confidence: 99%

Added Value of Vessel Wall Magnetic Resonance Imaging in the Differentiation of Moyamoya Vasculopathies in a Non-Asian Cohort

Mossa‐Basha

Havenon

Becker

et al. 2016

Stroke

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“…Kaku and colleagues (2012) recently proposed the constrictive remodeling theory that outer diameter narrowing of the affected intracranial vessels was the early characteristic change of moyamoya disease as demonstrated by three-dimensional (3D) constructive interference in steady-state (CIISS) MR image. Yuan et al (2015) also reported that the vascular wall thinning and the arterial outer diameter narrowing shown by high resolution MR imaging could be the early morphological changes characteristic to moyamoya disease. Taken together, the high resolution MR imaging including 3D-CISS could provide the supportive information for the accurate diagnosis of moyamoya disease especially in the early angiographic stage.…”

Section: Modern Supportive Diagnostic Toolsmentioning

confidence: 91%

Current Status of Revascularization Surgery for Moyamoya Disease: Special Consideration for Its ‘Internal Carotid-External Carotid (IC-EC) Conversion’ as the Physiological Reorganization System

Fujimura

Tominaga

2015

Tohoku J. Exp. Med.

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Moyamoya disease is a chronic cerebrovascular disease with unknown etiology, which is characterized by bilateral steno-occlusive changes at the terminal portion of the internal carotid artery and an abnormal vascular network formation at the base of the brain. Moyamoya disease is known to have unique and dynamic nature to convert the vascular supply for the brain from internal carotid (IC) system to the external carotid (EC) system, as indicated by Suzuki's angiographic staging established in 1969. Insufficiency of this 'IC-EC conversion system' may result in cerebral ischemia, as well as in intracranial hemorrhage from inadequate collateral vascular network, both of which represent the clinical presentation of moyamoya disease. Therefore, surgical revascularization by extracranial-intracranial bypass is the preferred procedure for moyamoya disease to complement 'IC-EC conversion' and thus to avoid cerebral infarction and/or intracranial hemorrhage. Long-term outcome of revascularization surgery for moyamoya disease is favorable, but rapid increase in cerebral blood flow on the affected hemisphere could temporarily cause unfavorable phenomenon such as cerebral hyperperfusion syndrome. We would review the current status of revascularization surgery for moyamoya disease based on its basic pathology, and sought to discuss the significance of measuring cerebral blood flow in the acute stage and intensive perioperative management.

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“…Moyamoya disease can have similar IVWM findings to vasculitis such as mild concentric enhancement, but confined to the locations favored by the disease -distal ICA and the M1/A1 segments; or moyamoya can display stenosis alone without enhancement [7,109]. Additional findings include absence of wall thickening, collateralization and homogenous signal intensity of the arterial wall [110]. Other imaging features more common in moymoya disease include lack of eccentric lesions and focal enhancement, which help enable differentiation of moyamoya disease from intracranial atherosclerosis and other inflammatory etiologies [46,109].…”

Section: Comparisons To Histopathologymentioning

confidence: 99%

Intracranial vessel wall MRI: a review of current indications and future applications

et al. 2016

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Background: Intracranial vessel wall MRI (IVWM) is a new diagnostic imaging approach with the goal of evaluating intracranial vascular pathology by directly visualizing arterial vessel wall abnormalities with MR sequences, preferably at 3 Tesla field strength, that suppress blood and have excellent spatial resolution. Body: The differentiation of intracranial vascular pathology has historically relied on luminal imaging techniques that depict the alteration of flow created by atherosclerotic stenosis or vasospasm. With IVWM, it is possible to identify distinct radiologic findings of the pathology within the intracranial vessel wall itself, ranging from arterial dissection to vasculitis. Futhermore, IVWM imaging characteristics, such as post-contrast enhancement, can elucidate the temporal relationship between imaging findings and clinical pathology; and may predict future behavior of unruptured aneurysms or atherosclerotic plaques. Conclusion: We present a review of the basic IVWM imaging techniques and the relevant published literature on IVWM, with a focus on evidence-based diagnostic indications for IVWM and discussion of the strengths and weaknesses of each indication. Finally, we discuss how IVWM can be used to differentiate between intracranial pathology and future directions for IVWM research.

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High-resolution MR imaging of the arterial wall in moyamoya disease

Cited by 67 publications

References 28 publications

Added Value of Vessel Wall Magnetic Resonance Imaging in the Differentiation of Moyamoya Vasculopathies in a Non-Asian Cohort

Added Value of Vessel Wall Magnetic Resonance Imaging in the Differentiation of Moyamoya Vasculopathies in a Non-Asian Cohort

Current Status of Revascularization Surgery for Moyamoya Disease: Special Consideration for Its ‘Internal Carotid-External Carotid (IC-EC) Conversion’ as the Physiological Reorganization System

Intracranial vessel wall MRI: a review of current indications and future applications

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