Artikel
Incidence of vessel-wall contrast-enhancement in Moyamoya-Angiopathy (MMA)
Inzidenz der Kontrastmittelaufnahme der Gefäßwand im Moyamoya-Angiopathien (MMA)
Suche in Medline nach
Autoren
-
Sophie Wang
- Universitätsklinikum Tübingen, Department für Neurochirurgie und Neurotechnologie, Tübingen, Deutschland; Universitätsklinikum Tübingen, Zentrum für Moyamoya und cerebrale Revaskularisation, Tübingen, Deutschland
-
Benjamin Bender
- Universitätsklinikum Tübingen, Neuroradiologie, Tübingen, Deutschland
-
Ulrike Ernemann
- Universitätsklinikum Tübingen, Neuroradiologie, Tübingen, Deutschland
-
Nadia Kahn
- Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland; Universitätsklinikum Tübingen, Zentrum für Moyamoya und cerebrale Revaskularisation, Tübingen, Deutschland; Universitätskinderspital Zürich, Moyamoya Center, Zürich, Schweiz
-
Marcos Tatagiba
- Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland
-
Constantin Roder
- Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland; Universitätsklinikum Tübingen, Zentrum für Moyamoya und cerebrale Revaskularisation, Tübingen, Deutschland
| Veröffentlicht: | 25. Mai 2022 |
|---|
Gliederung
Text
Objective: The underlying pathophysiological cause of Moyamoya-Angiopathy (MMA) is still unclear. In neurovascular imaging, high-resolution vessel wall imaging has become a useful tool in characterization and identification of unstable unruptured brain aneurysm, identifying aneurysms with a higher risk of rupture or acute vasculitis. A diagnostic exclusion criteria for MMA is vasculitis (by CSF diagnostics). However, appearance of contrast-enhancement in the vessel has also been described in MMA. The incidence of this MR (magnetic resonance) finding has not been described yet.
Methods: This is a retrospective blinded cohort study, which analyzed all consecutive patients with MMD treated at our center, which received a MR imaging with contrast-enhanced high-resolution vessel wall Imaging. Incidence of vessel wall contrast enhancement was evaluated by two independent physicians. Clinical data was acquired retrospectively. To compare non-numeric parameters of both groups, the chi-square test was applied. Statistical analysis was performed in R Studio.
Results: Ninety-Seven MMA patients were included in this study, of which 65 suffered from Moyamoya Disease (MMD) with bilateral involvement and 32 with unilateral MMA. Overall incidence of pathological contrast-enhancement was 61/97 (63%). This was significantly higher in bilateral MMD (N=20/65; 69%) then in unilateral MMA (N= 15/32; 47%) with p = 0.007. Incidence of contrast-enhancement was independent of patients’ sex (men: N=7/36; 20% and women: N=14/60; 23%). Mean age was indifferent in both MMA with (43.08 years ±SD14.86) and without contrast-enhancement (40.92 years ±SD14.09).
Conclusion: The incidence of pathological contrast enhancement in Moyamoya patients is 63%. The majority of bilateral MMD undergo a contrast-enhancement in the course of their medical history – this is seen in Moyamoya although vessel wall contrast uptake has described as a typical vasculitis marker. This data underlines the importance of vessel wall Imaging in MMA diagnostics, but diminishes this MR finding's specificity in vasculitis itself. CSF examination is crucial to to exclude vasculitis and reliably diagnose Moyamoya. Further prospective studies are required to determine the specificity of this contrast-enhancement and the difference in signal to the known inflammatory vasculitis signal to better understand pathophysiological processss, leading to Moyamoya.
