Evaluation of vessel-wall contrast-enhancement on high-resolution MRI in European patients with Moyamoya disease

Dr Med Maximilian Patzig; Pd Dr Med Robert Forbrig; Dr Med Clemens Küpper; Dr Med Ozan Emre Eren; Dr Med Ilias Masouris; Prof Dr Med Tobias Saam; Prof Dr Med Lars Kellert; Prof Dr Med Thomas Liebig; Pd Dr Med Florian Schöberl

doi:10.1016/j.jstrokecerebrovasdis.2023.107135

Evaluation of vessel-wall contrast-enhancement on high-resolution MRI in European patients with Moyamoya disease

J Stroke Cerebrovasc Dis. 2023 Jun;32(6):107135. doi: 10.1016/j.jstrokecerebrovasdis.2023.107135. Epub 2023 Apr 18.

Authors

Dr Med Maximilian Patzig¹, Pd Dr Med Robert Forbrig², Dr Med Clemens Küpper³, Dr Med Ozan Emre Eren⁴, Dr Med Ilias Masouris⁵, Prof Dr Med Tobias Saam⁶, Prof Dr Med Lars Kellert⁷, Prof Dr Med Thomas Liebig⁸, Pd Dr Med Florian Schöberl⁹

Affiliations

¹ Institute of Diagnostic and Interventional Neuroradiology, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377 Munich, Germany; Radiologie Augsburg Friedberg, Augsburg, Germany, Phone: +49 89 440072501. Electronic address: maximilian.patzig@med.uni-muenchen.de.
² Institute of Diagnostic and Interventional Neuroradiology, Ludwig-Maximilians-University Munich, Germany, Phone: +49 89 440072501. Electronic address: robert.forbrig@med.uni-muenchen.de.
³ Department of Neurology, Ludwig-Maximilians-University Munich, Germany, Phone: +49 89 440073690. Electronic address: clemens.kuepper@med.uni-muenchen.de.
⁴ Department of Neurology, Ludwig-Maximilians-University Munich, Germany, Phone: +49 89 440073690. Electronic address: ozan.eren@med.uni-muenchen.de.
⁵ Department of Neurology, Ludwig-Maximilians-University Munich, Germany, Phone: +49 89 440073690. Electronic address: ilias.masouris@med.uni-muenchen.de.
⁶ Institute of Clinical Radiology, Ludwig-Maximilians-University Munich, Germany; Die Radiologie, Rosenheim, Germany, Phone: +89 8031 230970. Electronic address: tobias.saam@die-radiologie.de.
⁷ Department of Neurology, Ludwig-Maximilians-University Munich, Germany, Phone: +49 89 440073690. Electronic address: lars.kellert@med.uni-muenchen.de.
⁸ Institute of Diagnostic and Interventional Neuroradiology, Ludwig-Maximilians-University Munich, Germany, Phone: +49 89 440072501. Electronic address: thomas.liebig@med.uni-muenchen.de.
⁹ Department of Neurology, Ludwig-Maximilians-University Munich, Germany, Phone: +49 89 440073690. Electronic address: florian.schoeberl@med.uni-muenchen.de.

PMID: 37079960
DOI: 10.1016/j.jstrokecerebrovasdis.2023.107135

Abstract

Objectives: Data regarding MR vessel-wall imaging (VWI) in patients with Moyamoya disease (MMD) is sparse, particularly in non-asian cohorts. We contribute data regarding the frequency of vessel wall contrast-enhancement (VW-CE) and its potential clinical significance in a European patient group.

Materials and methods: Patients with a diagnosis of MMD who were examined by VWI were included in the study. VW-CE of stenoocclusive lesions of the terminal internal carotid artery and/or its proximal branches was rated qualitatively. Changes of VW-CE on available follow-up were recorded. VW-CE was correlated with diffusion-restricted lesions and magnetic resonance angiography (MRA) findings.

Results: Eleven patients (eight female, three male) were included. Twenty-eight stenoocclusive lesions were analyzed, of which 16 showed VW-CE (57.1%). VW-CE was mostly concentric (n=15), rather than eccentric (n=1). In all three patients in whom follow-up VWI was available, changes of VW-CE were documented. Diffusion-restricted lesions were more frequently related to stenoocclusive lesions with VW-CE (n=9) than without VW-CE (n=2), bordering statistical significance. The affected arteries were assessed as stenotic and as occluded in 14 cases each and VW-CE was seen significantly more often in stenotic (n=12) than in occluded arteries (n=4). No correlation was found between the presence of VW-CE and moyamoya stages determined by MRA.

Conclusions: Our data suggest that concentric VW-CE is a relatively frequent finding in European MMD patients. VW-CE may change over time and occur in certain stages, possibly representing "active stenosing". Larger studies are needed to validate these findings and determine the clinical relevance of VW-CE in MMD.

Keywords: MRI; Moyamoya; Stroke; Vessel wall imaging.

MeSH terms

Arteries
Constriction, Pathologic
Female
Humans
Magnetic Resonance Angiography
Magnetic Resonance Imaging / methods
Male
Moyamoya Disease* / diagnostic imaging
Moyamoya Disease* / pathology

Supplementary concepts

Moyamoya disease 1