gms | German Medical Science

67th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Korean Neurosurgical Society (KNS)

German Society of Neurosurgery (DGNC)

12 - 15 June 2016, Frankfurt am Main

Ventricular microaneurysms in Moyamoya angiopathy visualized with 7 Tesla magnetic resonance angiography

Meeting Abstract

  • Toshinori Matsushige - Klinik für Neurochirurgie, Universitätsklinik Essen, Essen, Germany; Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Erwin L. Hahn Institut für Kernspintomographie, Universität Duisburg-Essen, Essen, Germany
  • Markus Kraemer - Klinik für Neurologie, Alfried-Krupp-Krankenhaus, Essen, Germany
  • Marc Schlamann - Institut für Neuroradiologie, Universitätsklinikum Gießen und Marburg, Gießen, Germany
  • Michael Forsting - Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie , Universitätsklinik Essen, Germany
  • Ulrich Sure - Klinik für Neurochirurgie, Universitätsklinik Essen, Essen, Germany
  • Karsten H. Wrede - Klinik für Neurochirurgie, Universitätsklinik Essen, Essen, Germany; Erwin L. Hahn Institut für Kernspintomographie, Universität Duisburg-Essen, Essen, Germany

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocMO.05.06

doi: 10.3205/16dgnc027, urn:nbn:de:0183-16dgnc0272

Published: June 8, 2016

© 2016 Matsushige et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: The pathophysiological role of hemodynamic stress to peripheral vessels in Moyamoya angiopathy and formation of microaneurysms remains unclear. The purpose of this in-vivo 7 Tesla magnetic resonance angiography (MRA) study was to investigate microaneurysms in collateral Moyamoya vessels.

Method: In addition to a standard clinical workup with 3 Tesla MRA and selective digital subtraction angiography (DSA), 10 patients with Moyamoya angiopathy were prospectively recruited in a 7 Tesla time-of-flight (TOF) MRA feasibility study between October 2011 and November 2012. These data were recently re-evaluated to screen for presence of microaneurysms in collateral Moyamoya vessels. All patients underwent TOF MRA acquired with 0.22 × 0.22 × 0.41 mm3 resolution utilizing a 7 Tesla whole-body MR system equipped with a 32-channel head coil. Images were analyzed by two experienced vascular neurosurgeons in consensus reading using multiplanar three-dimensional image reconstructions as well as maximum intensity projections to investigate the vascular microanatomy.

Results: There were no signs of acute hemorrhage or bleeding remnants in any patient. Collateral vessels in the ventricles branching from posterior choroidal arteries were present in 8 of 10 patients. Neither conventional 3 Tesla MRA nor DSA detected microaneurysms in these collateral Moyamoya vessels. Out of ten patients with moyamoya angiopathy 4 microaneuryms were delineated by 7 Tesla MRA. The mean diameter of these microaneurysms arising from tiny collateral vessels were 0.80 mm (range 0.56 - 0.96 mm) and 0.87 mm (range 0.79 - 1.07 mm), respectively. In one case with follow-up scans 6 months after direct extracranial-intracranial bypass surgery the microaneurysm disappeared.

Conclusions: In the presented cases of Moyamoya angiopathy, 7 Tesla MRA could detect ventricular microaneurysms in collateral vessels, which may be a key pathophysiological finding due to hemodynamic stress.