Article
Arterial wall contrast enhancement in progressive moyamoya disease
Kontrastmittelanreicherung in der Gefäßwand bei Patienten mit progredienter Moyamoya Erkrankung
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Published: | May 8, 2019 |
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Objective: To evaluate chronological patterns of arterial wall contrast enhancement in high resolution MRI (CE-HR-MRI) of Moyamoya patients.
Methods: A blinded analysis of clinical and imaging data was performed for Moyamoya patients with CE-HR-MRI. Data were analyzed chronologically for each patient and intensity of arterial wall enhancement was correlated with the clinical and imaging-based progression status of the disease.
Results: 31 Moyamoya patients with 61 imaging timepoints were included. Of these, 56 CE-HR-MRI were available, representing 112 analyzed hemispheres. Of these, 54 (48%) had no (grade 1), 24 (21%) mild (grade 2), 15 (13%) medium (grade 3) and 19 (17%) strong (grade 4) mainly concentric arterial wall contrast enhancement. Grade 4 contrast enhancement was significantly (p<0.001) associated with clinical disease progression within 6 months (pro- and retrospectively) compared to grade 1–3 with positive (PPV) and negative (NPV) predictive values of 0.8 and 0.88 respectively. No or only mild (grade 1 and 2) contrast enhancement were highly predictive (NPV: 0.95) for a stable disease.
Conclusion: We have identified a specific chronological increasing and decreasing pattern of arterial wall contrast enhancement associated with “beginning” as well as progression of angiopathy in Moyamoya patients. In clinical routine, CE-HR-MRI of the arterial wall may help to identify patients at risk of new strokes caused by disease progression and hence impel early treatment for future stroke prevention. Understanding of this temporary enhancement of the arterial wall might also bring new insights in the etiology of Moyamoya Disease.