Predictors of Stroke Outcomes in Conservatively Treated Patients With Moyamoya Disease: A Follow‐up MRI Study

Abstract

BackgroundLittle is known about the association between stroke and imaging and clinical features in conservatively treated patients with moyamoya disease (MMD).PurposeTo investigate independent risk factors for stroke in conservatively treated patients with MMD during a long‐term follow‐up.Study TypeProspective study.SubjectsOne hundred sixty conservatively managed patients with MMD (median age 46 years, 89 male).Field Strength/SequenceTime of flight, turbo inversion recovery magnitude T1WI, turbo spin echo (TSE) T2WI, echo‐planar imaging DWI, T2‐fluid attenuated inversion recovery, dynamic susceptibility contrast‐magnetic resonance imaging, and pre‐ and post‐contrast 3D TSE T1WI sequences at 3.0 Tesla.AssessmentPatients were assessed at baseline and followed yearly. Ischemic and hemorrhagic stroke incidence rates were determined. Multiple demographic, clinical (modified Rankin score [mRS]), and cerebral imaging (cerebral blood volume [CBV] and concentric enhancement of arterial wall) factors at baseline were considered as potential predictors of stroke during the follow‐up period.Statistical TestsUnivariable and multivariable Cox proportional hazards models to calculate the hazard ratios (HRs) and corresponding 95% confidence interval (CI) for stroke. Cumulative risk of stroke was estimated by the Kaplan–Meier product‐limit method. A P value <0.05 was considered statistically significant.ResultsThe median follow‐up duration was 47 months. During the follow‐up period, 18 (11.25%) patients experienced stroke events (13 [8.13%] ischemic, 5 [3.12%] hemorrhagic). Univariable analysis showed that 11 factors were significantly associated with stroke. After adjustment for clinical characteristics, multivariable analysis showed that mRS score ≥3 (HR, 1.99; 95% CI, 1.26–3.14), decreased CBV (HR, 5.31; 95% CI, 2.32–12.13), and concentric enhancement of the arterial wall (HR, 4.16; 95% CI, 1.55–11.15) were significantly associated with stroke.Data ConclusionDecreased CBV, mRS score ≥ 3, and concentric enhancement of the arterial wall were significantly associated with increased incidence of stroke in conservatively treated MMD.Evidence Level2Technical EfficacyStage 4

High-resolution magnetic resonance vessel wall imaging provides new insights into Moyamoya disease

“…It can be seen that PCES can help detect major blood vessels that cause bleeding in MMD patients ( Ryu et al, 2022 ). Using HR-VWI to predict stroke incidence in conservatively treated MMD patients, one prospective study concluded that VWE was significantly associated with an increased incidence of stroke (HR, 4.16; 95% CI, 1.55–11.15) ( Zhang H. et al, 2023 ). However, the small number of subjects in most studies may have biased the final results.…”