Vessel wall enhancement as a predictor of arterial stenosis progression and poor outcomes in moyamoya disease

Lu, Mingming; Zhang, Hongtao; Liu, Dongqing; Hao, Fangbin; Zhang, Lichen; Peng, Peng; Yuan, Fang; Liu, Shitong; Sheng, Fugeng; Liu, Yuan; Zhao, Xihai; He, Yao; Han, Cong; Cai, Jianming

doi:10.1007/s00330-022-09223-2

Cited by 8 publications

(4 citation statements)

References 26 publications

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“…However, in the present study, most wall enhancements were identified and evaluated at intracranial large arteries such as distal ICA, the proximal segments of MCA and ACA, and it was difficult to detect the wall characteristics of their small branches and collateral vessels with current imaging technology because of their small size. Nonetheless, because of the integrity of cerebral vessels, the enhancement characteristics of large arteries in one hemisphere can still reflect the status of the ipsilateral cerebral vessels, including their small branches and collateral vessels, 33 potentially providing a way to understand status of cerebral vessel wall and to clarify possible mechanisms of stroke induced by MMD.…”

Section: Discussionmentioning

confidence: 99%

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

Zhang

Liu

et al. 2023

Magnetic Resonance Imaging

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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

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Section: Discussionmentioning

confidence: 99%

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

Zhang

Liu

et al. 2023

Magnetic Resonance Imaging

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“…Diffuse wall thickness was defined when smooth and concentric thickened wall with mean wall thickness >1.5 mm was identified at the extracranial portion of the ICA on HRMR images 10 . Carotid atherosclerotic plaques were defined as markedly eccentric or focal wall thickening of EICA on HRMR images, with the thickest part of the wall being estimated to be twice that of the thinnest part of the lesion 14 . Luminal thrombosis was identified when hyperintense embolism in EICA on HRMRI was observed and caused severe luminal stenosis or obstruction of the artery 15 (Fig.…”

Section: Methodsmentioning

confidence: 99%

“…10 Carotid atherosclerotic plaques were defined as markedly eccentric or focal wall thickening of EICA on HRMR images, with the thickest part of the wall being estimated to be twice that of the thinnest part of the lesion. 14 Luminal thrombosis was identified when hyperintense embolism in EICA on HRMRI was observed and caused severe luminal stenosis or obstruction of the artery 15 (Fig. 2).…”

Section: Analysis Of Mr Imagesmentioning

confidence: 99%

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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“…One study studied 29 patients with MMD using 3.0 T HR-VWI intracranial vessel wall imaging and found that VWE was positively correlated with ischemic events ( Kathuveetil et al, 2020 ). Another study showed that VWE could be used as a predictor of arterial stenosis and poor prognosis in MMD ( Lu et al, 2023a ). However, some studies claim that lumen and vessel outer wall diameters decrease with disease severity, but there is no significant difference in wall thickness ( Cogswell et al, 2020 ).…”

Section: Application Of Hr-vwi In MMDmentioning

confidence: 99%

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

Yang,

Huang,

et al. 2024

Front. Neurosci.

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Moyamoya disease (MMD) is a rare condition that affects the blood vessels of the central nervous system. This cerebrovascular disease is characterized by progressive narrowing and blockage of the internal carotid, middle cerebral, and anterior cerebral arteries, which results in the formation of a compensatory fragile vascular network. Currently, digital subtraction angiography (DSA) is considered the gold standard in diagnosing MMD. However, this diagnostic technique is invasive and may not be suitable for all patients. Hence, non-invasive imaging methods such as computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are often used. However, these methods may have less reliable diagnostic results. Therefore, High-Resolution Magnetic Resonance Vessel Wall Imaging (HR-VWI) has emerged as the most accurate method for observing and analyzing arterial wall structure. It enhances the resolution of arterial walls and enables quantitative and qualitative analysis of plaque, facilitating the identification of atherosclerotic lesions, vascular entrapment, myofibrillar dysplasia, moyamoya vasculopathy, and other related conditions. Consequently, HR-VWI provides a new and more reliable evaluation criterion for diagnosing vascular lesions in patients with Moyamoya disease.

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Vessel wall enhancement as a predictor of arterial stenosis progression and poor outcomes in moyamoya disease

Cited by 8 publications

References 26 publications

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

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

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

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