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Association of intracranial vessel wall enhancement and cerebral hemorrhage in moyamoya disease: a high-resolution magnetic resonance imaging study

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Abstract

Background and purpose

This study aimed to investigate the enhancement characteristics of vessel wall in patients with moyamoya disease (MMD) using 3D high-resolution magnetic resonance (MR) imaging and their relationship with initial and recurrent intracranial hemorrhage.

Methods

Consecutive patients with MMD were retrospectively analyzed and classified as intracranial hemorrhagic and non-hemorrhagic groups according to the CT or MR images. The clinical features and vessel wall characteristics were compared between the two groups. Logistic regression was performed to relate the vessel wall characteristics to the initial hemorrhage in MMD patients. Patients in hemorrhagic group were followed up after surgery to evaluate the relationship between vessel wall characteristics and recurrent hemorrhage.

Results

A total of 507 MMD patients including 79 hemorrhagic and 428 non-hemorrhagic MMD patients were recruited in the study. We found that hemorrhagic group had more patients with vessel wall enhancements (40.5% vs. 25.7%, p = 0.009) and more eccentric enhanced lesions (17.7% vs. 6.5%, p = 0.001) compared to those in non-hemorrhage group and vessel wall enhancements were independently associated with ipsilateral initial hemorrhage after adjusted for clinical factors (OR = 1.99, CI 1.20–3.28, p = 0.007). Furthermore, three recurrent intracranial hemorrhagic episodes in the present study were all observed in MMD patients with vessel wall enhancement during the long-term follow-up after surgery.

Conclusions

Wall enhancement of intracranial vessels was significantly associated with intracranial hemorrhage in MMD patients. Our findings suggest that vessel wall enhancement may serve as a marker of intracranial hemorrhage.

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Abbreviations

MMD:

Moyamoya disease

HRMRI:

High-resolution magnetic resonance vessel wall imaging

MRI:

Magnetic resonance imaging

SAH:

Subarachnoid hemorrhage

ICH:

Intraparenchymal hemorrhage

IVH:

Intraventricular hemorrhage

ICA:

Internal carotid artery

MCA:

Middle cerebral artery

ACA:

Anterior cerebral artery

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Acknowledgments

This study was supported by the grants of National Natural Science Foundation of China (82001774), Beijing Natural Science Foundation (7212100) and Beijing Science and Technology Project (Z161100000516194).

Author information

Author notes

  1. Mingming Lu and Hongtao Zhang are co-first authors and contributed equally to this manuscript.

  2. Jianming Cai and Cong Han are co-corresponding authors and contributed equally to this manuscript

Authors and Affiliations

  1. Department of Radiology, Pingjin Hospital, Characteristic Medical Center of Chinese People’s Armed Police Force, Tianjin, China

    Mingming Lu, Peng Peng & Fei Yuan

  2. Department of Radiology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, 100853, China

    Hongtao Zhang, Dongqing Liu, Xu Liu, Lichen Zhang, Shitong Liu, Fugeng Sheng, Yuan Liu & Jianming Cai

  3. State Key Laboratory of Kidney Disease, Beijing Key Laboratory of Aging and Geriatrics, Institute of Geriatrics, The Second Medical Center, Chinese PLA General Hospital, Beijing, China

    Mingming Lu & Yao He

  4. Department of Neurosurgery, Chinese PLA General Hospital, Beijing, 100853, China

    Qian Zhang, Heguan Fu & Cong Han

  5. Department of Biomedical Engineering, Center for Biomedical Imaging Research, Tsinghua University School of Medicine, Beijing, China

    Xihai Zhao

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  1. Mingming Lu
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Corresponding authors

Correspondence to Cong Han or Jianming Cai.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

This study has been approved by the appropriate ethics committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All persons gave their informed consent prior to their inclusion in the study.

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Lu, M., Zhang, H., Liu, D. et al. Association of intracranial vessel wall enhancement and cerebral hemorrhage in moyamoya disease: a high-resolution magnetic resonance imaging study. J Neurol 268, 4768–4777 (2021). https://doi.org/10.1007/s00415-021-10587-6

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  • DOI: https://doi.org/10.1007/s00415-021-10587-6

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