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65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

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Imaging of moyamoya vessel pathology using ultrahigh-field MRI at 7 Tesla

Meeting Abstract

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  • Nora Sandow - Klinik für Neurochirurgie, Charité – Universitätsmedizin Berlin, Berlin, Deutschland
  • Vince Madai - Klinik für Neurologie und Centrum für Stroke Research Berlin (CSB), Charité – Universitätsmedizin Berlin, Berlin, Deutschland
  • Jens Würfel - Neurocure Clinical Research Centre, Charité – Universitätsmedizin Berlin, Deutschland; Institut für Neuroradiologie, Universität Göttingen, Göttingen, Deutschland
  • Thoralf Niendorf - Berlin Ultra-High Field Facility (B.U.F.F.), Max Delbrück Center for Molecular Medicine (MDC), Berlin, Deutschland
  • Jan Sobesky - Klinik für Neurologie und Centrum für Stroke Research Berlin (CSB), Charité – Universitätsmedizin Berlin, Berlin, Deutschland
  • Peter Vajkoczy - Klinik für Neurochirurgie, Charité – Universitätsmedizin Berlin, Berlin, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocP 183

doi: 10.3205/14dgnc577, urn:nbn:de:0183-14dgnc5773

Published: May 13, 2014

© 2014 Sandow et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: The potential of ultrahigh-field magnetic resonance imaging (UHF-MRI) at 7 Tesla (T) in cerebrovascular disease has been shown recently. A major benefit is expected for MR-angiography (MRA) due to increased spatial resolution and novel contrast mechanisms. 7 T MRA might therefore contribute substantial impact for the diagnosis of moyamoya disease (MMD), which is characterized by slowly progressive occlusion of major cerebral arteries and prominent collateral artery formation. In MMD, to date digital subtraction angiography (DSA) is the gold standard for assessment of preoperative vessel status for extra-intracranial (EC-IC) bypass surgery. We hypothesized that UHF-MRI at 7 T can yield preoperative diagnostic information equivalent to DSA for planning of EC-IC bypass surgery.

Method: In an ongoing, WHO-registered and prospective imaging trial (7UP, WHO-register No. DRKS00003193) three patients suffering from MMD were investigated at 7 T (Magnetom 7 T, Siemens Healthcare, Erlangen, Germany) and at 3 T (Magnetom Verio) prior EC-IC BS. 7 T MRA included MPRAGE-MRA (resolution: 0.7 mm isotropic, whole brain coverage, acquisition time (TA): 6:40 min) and time-of-flight (TOF)-MRA (0.4 mm isotropic, 5.1 cm coverage, TA: 8:16 min). At 3 T, TOF-MRA was performed (0.6 mm isotropic, 8.2 cm coverage, TA: 5:54 min). MRI was compared to DSA performed during presurgical planning. All patients gave written informed consent prior to the study.

Results: In all three patients, 3 T TOF MRA and 7 T MPRAGE MRA were able to depict the complete major vascular tree and showed MMD specific stenosis or occlusion of a major cerebral artery as identified prior by DSA (middle cerebral artery (MCA): n=2 / internal carotid artery (ICA): n=1). In contrast to 3 T MRI, 7 T MRI depicted small moyamoya specific vessels (7 T TOF MRA) and identified donor vessels (7 T MPRAGE MRA) for EC-IC bypass surgery.

Conclusions: Our preliminary results indicate that a specific 7 T vascular imaging protocol might yield diagnostic information about vessel pathology in MMD that approximate conventional DSA. This finding is promising and will be validated in a larger patient sample.