Added Value of Vessel Wall Magnetic Resonance Imaging in the Differentiation of Moyamoya Vasculopathies in a Non-Asian Cohort.
Although studies have evaluated the differential imaging of moyamoya disease and atherosclerosis, none have investigated the added value of vessel wall magnetic resonance imaging (MRI). This study evaluates the added diagnostic value of vessel wall MRI in differentiating moyamoya disease, atherosclerotic-moyamoya syndrome (A-MMS), and vasculitic-MMS (V-MMS) with a multicontrast protocol.



We retrospectively reviewed the carotid artery territories of patients with clinically defined vasculopathies (moyamoya disease, atherosclerosis, and vasculitis) and steno-occlusive intracranial carotid disease. Two neuroradiologists, blinded to clinical data reviewed the luminal imaging of each carotid, evaluating collateral extent and making a presumed diagnosis with diagnostic confidence. After 3 weeks, the 2 readers reviewed the luminal imaging+vessel wall MRI for the presence, pattern and intensity of postcontrast enhancement, T2 signal characteristics, pattern of involvement, and presumed diagnosis and confidence.



Ten A-MMS, 3 V-MMS, and 8 moyamoya disease cases with 38 affected carotid segments were included. There was significant improvement in diagnostic accuracy with luminal imaging+vessel wall MRI when compared with luminal imaging (87% versus 32%, P<0.001). The most common vessel wall MRI findings for moyamoya disease were nonenhancing, nonremodeling lesions without T2 heterogeneity; for A-MMS eccentric, remodeling, and T2 heterogeneous lesions with mild/moderate and homogeneous/heterogeneous enhancement; and for V-MMS concentric lesions with homogeneous, moderate enhancement. Inter-reader agreement was moderate to substantial for all vessel wall MRI characteristics (κ=0.46-0.86) and fair for collateral grading (κ=0.35). There was 11% inter-reader agreement for diagnosis on luminal imaging when compared with 82% for luminal imaging+vessel wall MRI (P<0.001).



Vessel wall MRI can significantly improve the differentiation of moyamoya vasculopathies when combined with traditional imaging techniques.
From the Departments of Radiology (M.M.-B., D.K.H., W.A.C., D.S.H., C.Y.), Neurology (K.J.B., D.L.T., C.A.-L.), Neurosurgery (M.R.L.), and Surgery (T.H.), University of Washington, Seattle, WA; Department of Neurology, University of Utah, Salt Lake City (A.d.H.); and Department of Radiology, University of California-San Francisco (M.D.A.). mmossab@uw.edu.
Mahmud
M
Mossa-Basha
From the Departments of Radiology (M.M.-B., D.K.H., W.A.C., D.S.H., C.Y.), Neurology (K.J.B., D.L.T., C.A.-L.), Neurosurgery (M.R.L.), and Surgery (T.H.), University of Washington, Seattle, WA; Department of Neurology, University of Utah, Salt Lake City (A.d.H.); and Department of Radiology, University of California-San Francisco (M.D.A.).
Adam
A
de Havenon
From the Departments of Radiology (M.M.-B., D.K.H., W.A.C., D.S.H., C.Y.), Neurology (K.J.B., D.L.T., C.A.-L.), Neurosurgery (M.R.L.), and Surgery (T.H.), University of Washington, Seattle, WA; Department of Neurology, University of Utah, Salt Lake City (A.d.H.); and Department of Radiology, University of California-San Francisco (M.D.A.).
Kyra J
KJ
Becker
From the Departments of Radiology (M.M.-B., D.K.H., W.A.C., D.S.H., C.Y.), Neurology (K.J.B., D.L.T., C.A.-L.), Neurosurgery (M.R.L.), and Surgery (T.H.), University of Washington, Seattle, WA; Department of Neurology, University of Utah, Salt Lake City (A.d.H.); and Department of Radiology, University of California-San Francisco (M.D.A.).
Danial K
DK
Hallam
From the Departments of Radiology (M.M.-B., D.K.H., W.A.C., D.S.H., C.Y.), Neurology (K.J.B., D.L.T., C.A.-L.), Neurosurgery (M.R.L.), and Surgery (T.H.), University of Washington, Seattle, WA; Department of Neurology, University of Utah, Salt Lake City (A.d.H.); and Department of Radiology, University of California-San Francisco (M.D.A.).
Michael R
MR
Levitt
From the Departments of Radiology (M.M.-B., D.K.H., W.A.C., D.S.H., C.Y.), Neurology (K.J.B., D.L.T., C.A.-L.), Neurosurgery (M.R.L.), and Surgery (T.H.), University of Washington, Seattle, WA; Department of Neurology, University of Utah, Salt Lake City (A.d.H.); and Department of Radiology, University of California-San Francisco (M.D.A.).
Wendy A
WA
Cohen
From the Departments of Radiology (M.M.-B., D.K.H., W.A.C., D.S.H., C.Y.), Neurology (K.J.B., D.L.T., C.A.-L.), Neurosurgery (M.R.L.), and Surgery (T.H.), University of Washington, Seattle, WA; Department of Neurology, University of Utah, Salt Lake City (A.d.H.); and Department of Radiology, University of California-San Francisco (M.D.A.).
Daniel S
DS
Hippe
From the Departments of Radiology (M.M.-B., D.K.H., W.A.C., D.S.H., C.Y.), Neurology (K.J.B., D.L.T., C.A.-L.), Neurosurgery (M.R.L.), and Surgery (T.H.), University of Washington, Seattle, WA; Department of Neurology, University of Utah, Salt Lake City (A.d.H.); and Department of Radiology, University of California-San Francisco (M.D.A.).
Matthew D
MD
Alexander
From the Departments of Radiology (M.M.-B., D.K.H., W.A.C., D.S.H., C.Y.), Neurology (K.J.B., D.L.T., C.A.-L.), Neurosurgery (M.R.L.), and Surgery (T.H.), University of Washington, Seattle, WA; Department of Neurology, University of Utah, Salt Lake City (A.d.H.); and Department of Radiology, University of California-San Francisco (M.D.A.).
David L
DL
Tirschwell
From the Departments of Radiology (M.M.-B., D.K.H., W.A.C., D.S.H., C.Y.), Neurology (K.J.B., D.L.T., C.A.-L.), Neurosurgery (M.R.L.), and Surgery (T.H.), University of Washington, Seattle, WA; Department of Neurology, University of Utah, Salt Lake City (A.d.H.); and Department of Radiology, University of California-San Francisco (M.D.A.).
Thomas
T
Hatsukami
From the Departments of Radiology (M.M.-B., D.K.H., W.A.C., D.S.H., C.Y.), Neurology (K.J.B., D.L.T., C.A.-L.), Neurosurgery (M.R.L.), and Surgery (T.H.), University of Washington, Seattle, WA; Department of Neurology, University of Utah, Salt Lake City (A.d.H.); and Department of Radiology, University of California-San Francisco (M.D.A.).
Catherine
C
Amlie-Lefond
From the Departments of Radiology (M.M.-B., D.K.H., W.A.C., D.S.H., C.Y.), Neurology (K.J.B., D.L.T., C.A.-L.), Neurosurgery (M.R.L.), and Surgery (T.H.), University of Washington, Seattle, WA; Department of Neurology, University of Utah, Salt Lake City (A.d.H.); and Department of Radiology, University of California-San Francisco (M.D.A.).
Chun
C
Yuan
D000328:Adult; D050197:Atherosclerosis / Q000000981:diagnostic imaging*; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging; D009072:Moyamoya Disease / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D014657:Vasculitis / Q000000981:diagnostic imaging*
atherosclerosis; carotid artery; magnetic resonance imaging; moyamoya disease; retrospective study