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The diagnostic performance of high-resolution magnetic resonance-vessel wall imaging in differentiating atherosclerosis-associated moyamoya vasculopathy from moyamoya disease

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

A Commentary to this article was published on 10 August 2023

Abstract

Objectives

To evaluate the diagnostic performance of high-resolution magnetic resonance-vessel wall imaging (HRMR-VWI) in differentiating moyamoya disease (MMD) from atherosclerosis-associated moyamoya vasculopathy (AS-MMV) and investigate an accurate approach for the differential diagnosis.

Methods

Adult patients who were diagnosed as MMD or AS-MMV and underwent HRMR-VWI were retrospectively included. The three vessel wall features (outer diameter (OD), remodeling index (RI), and pattern of vessel wall thickening) of middle cerebral artery (MCA) in identifying MMD from AS-MMV were assessed and compared. Furthermore, subgroup analysis stratified by degree of luminal stenosis was performed and the cutoff values of different vessel wall features in differentiating MMD from AS-MMV were also calculated.

Results

A total of 265 patients (160 cases of MMD and 105 AS-MMV) were included. Patients with AS-MMV had greater OD and RI and were more likely to exhibit eccentric thickening of vessel wall compared to those with MMD (all p < 0.001). The ROC analysis showed that the AUC value of OD was greater than that of RI (0.912 vs. 0.889, p = 0.007) in differentiating MMD from AS-MMV, and their corresponding cutoff values were 1.77 mm and 0.27, respectively. And the AUC value of pattern of vessel wall thickening was 0.786 in non-occluded patients. With the increase of lumen stenosis, the discrimination power of the three indicators enhanced correspondingly.

Conclusions

HRMR-VWI is valuable in distinguishing MMD from AS-MMV. The OD of MCA has better diagnostic performance in differentiating AS-MMV from MMD compared to RI and pattern of vessel wall thickening.

Clinical relevance statement

The outer diameter of the involved artery proved to be both accurate and convenient in distinguishing atherosclerosis-associated moyamoya vasculopathy from moyamoya disease and may provide a quantitative reference for clinical diagnosis.

Key Points

  • High-resolution magnetic resonance-vessel wall imaging is valuable in distinguishing atherosclerosis-associated moyamoya vasculopathy from moyamoya disease.

  • Compared to remodeling index and pattern of vessel wall thickening, outer diameter is more accurate in differentiating atherosclerosis-associated moyamoya vasculopathy from moyamoya disease.

  • With the increase of lumen stenosis, the discrimination power of outer diameter, remodeling index, and pattern of vessel wall thickening enhanced correspondingly.

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Abbreviations

AS-MMV:

Atherosclerosis-associated moyamoya vasculopathy

BA:

Basilar artery

HRMR-VWI:

High-resolution magnetic resonance-vessel wall imaging

ICC:

Interclass correlation coefficient

MCA:

Middle cerebral artery

MMD:

Moyamoya disease

OD:

Outer diameter

RI:

Remodeling index

T2WI:

T2-weighted imaging

TIA:

Transient ischemic attack

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Funding

This study has received funding by the grants of National Natural Science Foundation of China (82001774), Beijing Natural Science Foundation (7212100), Tianjin Science and Technology Project (TJWJ2021MS043), and Health Care Special Project (21BJZ31).

Author information

Author notes

  1. Shitong Liu and Mingming Lu are co-first authors and contributed equally to this manuscript.

  2. Jianming Cai and Hongtao Zhang are co-corresponding authors and contributed equally to this manuscript.

Authors and Affiliations

  1. Medical School of Chinese PLA, Beijing, 100039, China

    Shitong Liu

  2. Department of Radiology, the Fifth Medical Center, Chinese PLA General Hospital, Beijing, 100071, China

    Shitong Liu, Xianya Gao, Yuan Liu, Fugeng Sheng, Dongqing Liu, Hongtao Zhang & Jianming Cai

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

    Mingming Lu

  4. Department of Radiology, 928th Hospital of the PLA Joint Logistics Support Force, Hainan, China

    Caimei Wen

  5. Senior Department of Neurology, the First Medical Center of PLA General Hospital, Beijing, 100039, China

    Binbin Sun

  6. Department of Neurosurgery, Chinese PLA General Hospital, Beijing, 100039, China

    Cong Han & Fangbin Hao

Authors
  1. Shitong Liu
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Correspondence to Hongtao Zhang or Jianming Cai.

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The scientific guarantor of this publication is Jianming Cai.

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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

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Written informed consent was obtained from all subjects (patients) in this study.

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  • performed at one institution

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Liu, S., Lu, M., Gao, X. et al. The diagnostic performance of high-resolution magnetic resonance-vessel wall imaging in differentiating atherosclerosis-associated moyamoya vasculopathy from moyamoya disease. Eur Radiol 33, 6918–6926 (2023). https://doi.org/10.1007/s00330-023-09951-z

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