From the Comprehensive Stroke Care Program (A.K., P.N.S.), Department of Neurology.
From the Comprehensive Stroke Care Program (A.K., P.N.S.), Department of Neurology
AJNR Am J Neuroradiol. 2020 Jan;41(1):100-105. doi: 10.3174/ajnr.A6360. Epub 2020 Jan 2.
Very few data are available with regard to high-resolution intracranial vessel wall imaging characteristics of Moyamoya disease and their relation to ischemic stroke risk. We investigated the high resolution imaging characteristics of MMD and its correlation with recent ischemic events.
Patients with Moyamoya disease confirmed by DSA, including patients after revascularization, were enrolled. All the patients underwent high-resolution intracranial vessel wall imaging. Vessel wall thickening, enhancement, and the remodeling index of the bilateral distal ICA and proximal MCA were noted. The patients were followed up at 3 months and 6 months after high-resolution intracranial vessel wall imaging and the association of ischemic events with imaging characteristics was assessed.
Twenty-nine patients with Moyamoya disease were enrolled. The median age at symptom onset was 12 years (range, 1-51 years). A total of 166 steno-occlusive lesions were detected by high-resolution intracranial vessel wall imaging. Eleven lesions with concentric wall thickening (6.6%) were noted in 9 patients. Ten concentric contrast-enhancing lesions were observed in 8 patients, of which 3 patients (4 lesions) showed grade II enhancement. The presence of contrast enhancement (= .01) and wall thickening ( ≤ .001) showed a statistically significant association with ischemic events within 3 months before and after the vessel wall imaging. Grade II enhancement showed a statistically significant (= .02) association with ischemic events within 4 weeks of high-resolution intracranial vessel wall imaging. The mean ± standard deviation outer diameter of the distal ICA (right, -3.3 ± 0.68 mm; left, 3.4 ± 0.60 mm) and the remodeling index (right, 0.71 ± 0.13; left, 0.69 ± 0.13) were lower in Moyamoya disease.
High-resolution intracranial vessel wall imaging characteristics of concentric wall thickening and enhancement are relatively rare in our cohort of patients with Moyamoya disease. The presence of wall thickening and enhancement may predict future ischemic events in patients with Moyamoya disease.
关于烟雾病颅内血管壁高分辨率影像学特征及其与缺血性卒中风险的关系，目前仅有少量数据。本研究旨在探讨烟雾病的高分辨率影像学特征及其与近期缺血性事件的相关性。
纳入经 DSA 确诊的烟雾病患者，包括血管重建术后患者。所有患者均行颅内血管壁高分辨率成像检查，记录双侧颈内动脉远端和大脑中动脉近端血管壁增厚、强化及重塑指数。在高分辨率颅内血管壁成像后 3 个月和 6 个月对患者进行随访，评估缺血性事件与影像学特征的相关性。
共纳入 29 例烟雾病患者，中位发病年龄为 12 岁（1~51 岁）。高分辨率颅内血管壁成像共检出 166 处狭窄-闭塞病变。9 例患者共发现 11 处同心性管壁增厚（6.6%），8 例患者共发现 10 处同心性强化病灶，其中 3 例（4 处病灶）呈 II 级强化。血管壁成像前 3 个月内和后 3 个月内出现强化（=0.01）和管壁增厚（ ≤0.001）与缺血性事件具有统计学显著相关性。高分辨率颅内血管壁成像后 4 周内，II 级强化与缺血性事件具有统计学显著相关性（=0.02）。烟雾病患者颈内动脉远端（右侧，-3.3 ±0.68mm；左侧，3.4 ±0.60mm）和重塑指数（右侧，0.71 ±0.13；左侧，0.69 ±0.13）均值较小。
本研究队列中烟雾病患者颅内血管壁高分辨率成像特征以同心性管壁增厚和强化较为少见。管壁增厚和强化的存在可能预测烟雾病患者未来发生缺血性事件。
