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72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

06.06. - 09.06.2021

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Vessel wall contrast enhancement as sign of disease progression in Moyamoya disease

Veränderungen der Kontrast-Aufnahme in der arteriellen Gefäßwand als Marker einer Krankheitsprogression bei Moyamoya-Patienten

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  • presenting/speaker Sophie Wang - Universitätsklinikum Tübingen, Neurochirurgie, Tübingen, Deutschland; Universitätsklinikum Tübingen, Zentrum für Moyamoya und cerebrale Revaskularisation, Tübingen, Deutschland
  • Helene Hurth - Universitätsklinikum Tübingen, Neurochirurgie, Tübingen, Deutschland; Universitätsklinikum Tübingen, Zentrum für Moyamoya und cerebrale Revaskularisation, Tübingen, Deutschland
  • Patrick Haas - Universitätsklinikum Tübingen, Neurochirurgie, 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
  • Marcos Tatagiba - Universitätsklinikum Tübingen, Neurochirurgie, Tübingen, Deutschland
  • Nadia Kahn - Universitätsklinikum Tübingen, Neurochirurgie, Tübingen, Deutschland; Universitätsklinikum Tübingen, Zentrum für Moyamoya und cerebrale Revaskularisation, Tübingen, Deutschland; Universitätskinderspital Zürich, Moyamoya Center, Zürich, Schweiz
  • Constantin Roder - Universitätsklinikum Tübingen, Neurochirurgie, Tübingen, Deutschland; Universitätsklinikum Tübingen, Zentrum für Moyamoya und cerebrale Revaskularisation, Tübingen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie. sine loco [digital], 06.-09.06.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocV023

doi: 10.3205/21dgnc027, urn:nbn:de:0183-21dgnc0276

Published: June 4, 2021

© 2021 Wang 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

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Objective: Vessel wall contrast enhancement has been shown to possibly predict disease progression in Moyamoya patients. Aim of this study is to investigate the natural course of vessel wall contrast enhancement in MMD and its association with local disease progression as seen in conventional angiography.

Methods: This retrospective blinded cohort study included all consecutive MMD patients at our department with availability of CE-HR-MRI (contrast-enhanced high-resolution magnetic resonance imaging). The imaging was analyzed and graded for vessel wall contrast-enhancement according to the following scale: 1.) none, 2.) mild, 3.) moderate, 4.) strong and characterized by concentric or eccentric enhancement. Patients were only included if serial CE-HR-MRI (≥2) and at least one conventional cerebral angiography were available.

Results: 79 patients received CE-HR-MRI in the course of their treatment. 35 of these have received more than one CE-HR-MRI to allow serial vessel wall contrast enhancement analysis. In total, 97 MRI (194 hemispheres) of 35 MMD patients were included in our analysis. 10 patients did not have any contrast enhancement in their vessel wall. 25 patients had 49 locations with vessel wall contrast-enhancement throughout their treatment and follow-up period. The most common location for contrast-enhancement was the terminal carotid artery (41%) and proximal MCA (M1) (39%). Vessel wall contrast enhancement was found in 8% in the ACA (A1), 6% in the periopthalmic ICA and 2% in each in the cavernous ICA, PCOM and petrous ICA. There was a dynamic change of increase and decrease in intensity of the contrast enhancement (increase/decrease of >2 grades) of 15.24 months (± SD 8.19). Contrast enhancement of the vessel wall was significantly associated with local stenosis as seen in conventional cerebral angiography (p-value < 0.05) and disease progression (p value <0.05) seen in follow-up imaging.

Conclusion: Vessel wall contrast enhancement in MMD is a sign for disease activity. This dynamic increase and decrease of contrast enhancement can be seen in a time-frame of approximately one and a half year and is significantly correlated with angiographically proven local stenosis and disease progression. High-resolution vessel wall imaging might be an important predictor of disease progression in MMD patients and should be used for follow-up examinations. The pathophysiological process causing the contrast enhancement have to be investigated in the future.