The Contrast Enhancement of Intracranial Arterial Wall on High-resolution MRI and Its Clinical Relevance in Patients with Moyamoya Vasculopathy

Wang, Maoxue; Yang, Yongbo; Zhou, Fei; Li, Ming; Liu, Renyuan; Guan, Maobin; Li, Rui; He, Le; Xu, Yun; Zhang, Bing; Zhu, Bin; Zhao, Xihai

doi:10.1038/srep44264

Cited by 41 publications

(27 citation statements)

References 30 publications

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“…Among the 166 steno-occlusive lesions detected by HRVWI, 6.02% of lesions only showed contrast enhancement, which is lower in comparison with the previously published data, which accounted for 70%-93%. 1,3,15,16 This may be related to the characteristics of the population under study or might be related to the small sample size. There is evidence that MMD is primarily a proliferative disease of the intima and smooth muscles that leads to vascular stenosis and that concentric enhancement may represent hyperproliferation of vessel components.…”

Section: Discussionmentioning

confidence: 99%

“…However, in 1 study, 19.6% of ACAs showed contrast enhancement. 3 We also studied the role of HRVWI to possibly predict a future event based on its characteristic findings. It was observed that grade II enhancing lesions were significantly associated with ischemic events within 4 weeks of imaging.…”

Section: Discussionmentioning

confidence: 99%

“…The degree of enhancement of vessels was qualitatively graded, depending on its signal intensity on postcontrast T1 images compared with corresponding precontrast images: grade 0, no enhancement; grade I, mild enhancement, the signal intensity of vessel wall is less than that of the pituitary infundibulum; and grade II, strong enhancement, the signal intensity of contrast-enhanced vessel wall is similar to or greater than that of the infundibulum. 3,13 Enhancement was considered concentric if it was circumferential and uniform (defined specifically as the width of the thinnest wall segment of $50% of the thickest segment). Eccentric enhancement was defined as either limited to 1 side of the vessel wall (eg, not 360°circumferential enhancement) or, where circumferential enhancement was noted, the thinnest part of the wall enhancement was estimated to be , 50% of the thickest point.…”

Section: Image Reviewmentioning

confidence: 99%

“…M oyamoya disease (MMD) is a rare cerebrovascular disease characterized by progressive steno-occlusive changes at the terminal portion of the ICA associated with the development of a fine basal collateral network. [1][2][3] In the routine clinical practice, particularly in the Asian population where both intracranial atherosclerotic disease and MMD are common and may present with similar angiographic features, clinicians face difficulties in differentiating them, which may delay the appropriate management. High-resolution intracranial vessel wall imaging (HRVWI) has recently been developed as a reliable tool to distinguish MMD from other intracranial vessel pathologies.…”

mentioning

confidence: 99%

“…1 In addition, one recent study also observed a significant association of vessel wall enhancement with cerebral ischemic events in patients with MMD, which suggests the role of inflammation and neovascularization. 3,6,7 Little is known about the characteristic HRVWI findings and the clinical significance of those findings in MMD. This study sought to investigate the high-resolution imaging characteristics of MMD and their correlation with recent ischemic events in an Indian population.…”

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confidence: 99%

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Vessel Wall Thickening and Enhancement in High-Resolution Intracranial Vessel Wall Imaging: A Predictor of Future Ischemic Events in Moyamoya Disease

Kathuveetil¹,

Sylaja²,

Senthilvelan

et al. 2020

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Very few data are available with regard to high-resolution intracranial vessel wall imaging characteristics of Moyamoya disease and their relation to ischemic stroke risk. We investigated the high resolution imaging characteristics of MMD and its correlation with recent ischemic events. MATERIALS AND METHODS:Patients with Moyamoya disease confirmed by DSA, including patients after revascularization, were enrolled. All the patients underwent high-resolution intracranial vessel wall imaging. Vessel wall thickening, enhancement, and the remodeling index of the bilateral distal ICA and proximal MCA were noted. The patients were followed up at 3 months and 6 months after high-resolution intracranial vessel wall imaging and the association of ischemic events with imaging characteristics was assessed. RESULTS:Twenty-nine patients with Moyamoya disease were enrolled. The median age at symptom onset was 12 years (range, 1-51 years). A total of 166 steno-occlusive lesions were detected by high-resolution intracranial vessel wall imaging. Eleven lesions with concentric wall thickening (6.6%) were noted in 9 patients. Ten concentric contrast-enhancing lesions were observed in 8 patients, of which 3 patients (4 lesions) showed grade II enhancement. The presence of contrast enhancement (P 4 .01) and wall thickening (P # .001) showed a statistically significant association with ischemic events within 3 months before and after the vessel wall imaging. Grade II enhancement showed a statistically significant (P 4 .02) association with ischemic events within 4 weeks of high-resolution intracranial vessel wall imaging. The mean 6 standard deviation outer diameter of the distal ICA (right, À3.3 6 0.68 mm; left, 3.4 6 0.60 mm) and the remodeling index (right, 0.71 6 0.13; left, 0.69 6 0.13) were lower in Moyamoya disease. CONCLUSIONS:High-resolution intracranial vessel wall imaging characteristics of concentric wall thickening and enhancement are relatively rare in our cohort of patients with Moyamoya disease. The presence of wall thickening and enhancement may predict future ischemic events in patients with Moyamoya disease. ABBREVIATIONS: ACA 4 anterior cerebral artery; HRVWI 4 high-resolution intracranial vessel wall imaging; MMD 4 Moyamoya disease; PCA 4 posterior cerebral artery; SD 4 standard deviation Indicates open access to non-subscribers at www.ajnr.org http://dx.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Image Reviewmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Vessel Wall Thickening and Enhancement in High-Resolution Intracranial Vessel Wall Imaging: A Predictor of Future Ischemic Events in Moyamoya Disease

Kathuveetil¹,

Sylaja²,

Senthilvelan

et al. 2020

AJNR Am J Neuroradiol

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Risk Factors for Cerebrovascular Events in Moyamoya Angiopathy Using 4D Flow MRI: A Pilot Study

Wang

Yang

Zhang

et al. 2022

Magnetic Resonance Imaging

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BackgroundLittle is known about internal carotid artery (ICA) hemodynamics in patients with moyamoya angiopathy (MMA) and its role in cerebrovascular events.PurposeTo characterize ICA hemodynamics in MMA patients by 4D flow MRI and investigate its relationship with cerebrovascular events.Study TypeProspective.SubjectsSeventy MMA patients (50 years old ± 9, 30 males).Field Strength/SequenceTime‐resolved three‐directional velocity encoded fast field echo sequence (4D flow) MRI, T1‐weighted fast field echo sequence, T2 weighted turbo spin echo sequence, diffusion weighted echo planar imaging; T2‐weighted fluid‐attenuated inversion recovery turbo spin echo sequence, susceptibility weighted fast field echo sequence, and time‐of‐flight MR angiography fast field echo sequence at 3.0T.AssessmentICA hemodynamics (maximum and average velocity [Vmax, Vavg], average blood flow [Flowavg], and wall shear stress) were analyzed based on 4D flow data. Cerebral infarction, defined as the occurrence of events, in 124 brain hemispheres was determined according to clinical symptoms and conventional brain MR imaging.Statistical TestsThe independent‐samples T test was used to evaluate differences in ICA hemodynamics between infarcted and non‐infarcted hemispheres. Binary logistic regression was performed to investigate the relationship between ICA hemodynamics and events. A P value < 0.05 was considered statistically significant.ResultsSixty‐one infarcted hemispheres (eight hemispheres with acute ischemic damage, 30 with chronic ischemic damage, and 23 with chronic hemorrhagic damage) had cerebrovascular events and 63 non‐infarcted hemispheres did not. The hemodynamic parameters in the infarcted hemispheres (Vmax: P < 0.001; Vavg: P = 0.003; and Flowavg: P = 0.004) were significantly lower than those in the non‐infarcted hemispheres. However, Vmax (P = 0.052), Vavg (P = 0.107), and Flowavg (P = 0.074) were not significantly different among hemispheres with acute ischemic lesions, chronic ischemic lesions and chronic hemorrhagic lesions. Vmax (odds ratio 3.033, 95% CI: 1.075–8.562) was independently associated with cerebrovascular events.Data ConclusionVmax maybe a higher risk factor of cerebrovascular events in MMA patients.Evidence Level2Technical Efficacy Stage3

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The Characteristics of Extracranial Internal Carotid Artery and Their Relationship With Surgical Outcomes in Patients With Moyamoya Disease: A Combined Head‐and‐Neck Vessel Wall MR Imaging Study

Lu,

Liu,

Peng

et al. 2023

Magnetic Resonance Imaging

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BackgroundThe features of intracranial arteries in patients with Moyamoya disease (MMD) have been widely investigated. However, the MR characteristics of extracranial internal carotid artery (EICA) and their effect on outcomes of revascularization treatment are not fully understood.PurposeTo investigate the characteristics of EICA and their relationship with outcomes of revascularization treatment in adult patients with MMD based on higher‐resolution MRI (HRMRI).Study TypeProspective interventional outcomes.SubjectsTwo hundred eighty‐eight consecutive patients with MMD (mean age: 43.7 ± 11.2 years; 140 male).Field Strength/SequenceTurbo inversion recovery magnitude T1‐weighted imaging and turbo spin echo (TSE) T2‐weighted imaging, three‐dimensional time‐of‐flight MR angiography, T2‐fluid attenuated inversion recovery, and 3D T1‐SPACE vessel wall imaging at 3.0 T.AssessmentThe HRMRI characteristics of EICA were determined. The relationship between the characteristics of EICA (proximal stenosis, diffuse wall thickening, carotid plaques, and luminal thrombosis) and stroke outcomes of revascularization treatment in patients with MMD was analyzed. The discriminative ability of EICA characteristics in combination with intracranial carotid artery features (involvement of vessel segments, bilateral involvement, and Suzuki stage) to determine stroke outcomes was compared with that of intracranial artery features alone during a mean 8.0 months follow‐up period.Statistical TestsCox proportional hazards models and Kaplan–Meier curves to calculate the hazard ratios (HRs) for stroke with 95% confidence intervals (CIs). Area under the receiver operating characteristic curve (AUC) for assessing discriminative performance. A P value <0.05 was considered statistically significant.ResultsDuring a mean 8.0 ± 2.2 months follow‐up, of the 288 participants, 137 had proximal stenosis (47.6%), 106 had diffuse wall thickening (36.8%), 60 had carotid plaques (20.8%), and 27 had luminal thrombosis (9.4%) of EICA. Of these features, proximal stenosis (HR = 2.86; 95% CI = 1.13–7.29) and diffuse wall thickening (HR = 2.62; 95% CI = 1.16–5.94) of EICA were significantly associated with stroke after surgery, before and after adjusting for confounding factors. In discriminating the stroke outcomes after surgery, combining characteristics of EICA with features of intracranial arteries resulted in a significant incremental improvement (DeLong test, P < 0.05) in the AUC over that obtained with features of intracranial arteries alone (AUC: 0.73 vs. 0.60–0.64).ConclusionProximal stenosis and diffuse wall thickening of EICA were significantly associated with stroke outcomes after surgery in patients with MMD. Our findings suggest that understanding the characteristics of EICA has added value for intracranial vessels in predicting future events after surgery in patients with MMD.Evidence Level2Technical EfficacyStage 4

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The Contrast Enhancement of Intracranial Arterial Wall on High-resolution MRI and Its Clinical Relevance in Patients with Moyamoya Vasculopathy

Cited by 41 publications

References 30 publications

Vessel Wall Thickening and Enhancement in High-Resolution Intracranial Vessel Wall Imaging: A Predictor of Future Ischemic Events in Moyamoya Disease

Vessel Wall Thickening and Enhancement in High-Resolution Intracranial Vessel Wall Imaging: A Predictor of Future Ischemic Events in Moyamoya Disease

Risk Factors for Cerebrovascular Events in Moyamoya Angiopathy Using 4D Flow MRI: A Pilot Study

The Characteristics of Extracranial Internal Carotid Artery and Their Relationship With Surgical Outcomes in Patients With Moyamoya Disease: A Combined Head‐and‐Neck Vessel Wall MR Imaging Study

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