High-Resolution Magnetic Resonance Wall Imaging Findings of Moyamoya Disease

Abstract

Background and Purpose-Diagnosis of Moyamoya disease (MMD) is based on the characteristic angiographic findings.However, differentiating MMD from intracranial atherosclerotic disease (ICAD) is difficult. We compared vessel wall imaging findings on high-resolution magnetic resonance imaging between MMD and ICAD. Methods-High-resolution magnetic resonance imaging was performed on 32 patients with angiographically proven MMD and 16 patients with acute infarcts because of ICAD. Bilateral internal carotid arteries and steno-occlusive middle cerebral artery were analyzed for wall enhancement and remodeling. Results-Enhancement patterns and distribution were different. Most patients with MMD (90.6%) showed concentric enhancement on distal internal carotid arteries and middle cerebral arteries, whereas focal eccentric enhancement was observed on the symptomatic segment in ICAD. MMD was characterized by middle cerebral artery shrinkage; the remodeling index and wall area were lower in MMD than in ICAD (remodeling index, 0.19±0.11 versus 1.00±0.43; wall area, 0.32±0.22 versus 6.00±2.72; P<0.001). Conclusions-MMD

Clinical Significance of the Champagne Bottle Neck Sign in the Extracranial Carotid Arteries of Patients with Moyamoya Disease

“…Because of the increasing number of elderly patients with MMD, 19 differential diagnosis between MMD and atherosclerotic occlusive cerebrovascular disease is becoming more important. Although advantages of high-resolution MR wall imaging for the differential diagnosis between MMD and atherosclerosis have been reported, 20 ultrasonography would be helpful to differentiate these 2 diseases with respect to the morphologically different features of their vessel walls. Especially in young children, sedation is sometimes necessary to perform MR imaging, but not carotid ultrasonography.…”

Reversible Cerebral Vasoconstriction Syndrome, Part 2: Diagnostic Work-Up, Imaging Evaluation, and Differential Diagnosis

“…20,[30][31][32][33][34] This method can use highresolution 2D or 3D imaging, frequently with pre-and postcontrast T1 or proton-attenuation sequences. 20,32,[35][36][37][38] In addition, high-resolution T2-weighted imaging can be used for multicontrast imaging.…”

“…20,32,[35][36][37][38] In addition, high-resolution T2-weighted imaging can be used for multicontrast imaging. 33,[39][40][41] In contradistinction to conventional angiographic imaging techniques that primarily evaluate the blood vessel lumen, such as conventional angiography, this approach provides information regarding the blood vessel wall itself, which is typically only 1-2 mm thick in proximal intracranial vessels. 42 VWI has been described as black-blood imaging because it results in low signal in the vessel lumen, thereby aiding in the visualization of the blood vessel wall.…”

Intracranial Vessel Wall MRI: Principles and Expert Consensus Recommendations of the American Society of Neuroradiology

“…39 These VW-MR imaging findings are consistent with histopathologic studies showing thinning of the arterial media and a paucity of inflammatory cells in the vessel wall of patients with Moyamoya disease. 40 However, a subsequent study 41 found a considerably higher frequency of concentric internal carotid and middle cerebral artery wall enhancement in patients diagnosed with Moyamoya disease and, perhaps surprisingly, no difference in vessel wall enhancement between early and late angiographic stages of the disease. Further research is needed to resolve the discordance among studies.…”