• Shih-Yüng WangSophieS0000-0001-9632-2909Department of Neurosurgery and Neurotechnology, Eberhard Karls University of Tübingen, Tübingen, Germany.Center for Moyamoya and Cerebral Revascularization, Eberhard Karls University of Tübingen, Tübingen, Germany., Till-Karsten Hauser, Patrick Haas, Jonas Tellermann, Helene Hurth, Ulrike Ernemann, Marcos Tatagiba, Benjamin Bender, Nadia Khan, and Constantin Roder.
• Department of Neurosurgery and Neurotechnology, Eberhard Karls University of Tübingen, Tübingen, Germany.
• Neurosurgery. 2024 Apr 30.

Background And ObjectivesThe underlying pathophysiological cause of moyamoya angiopathy (MMA) is still unclear. High-resolution vessel wall imaging has become a useful tool. The aim was to study vessel wall contrast-enhancement (VW-CE) as an imaging marker to predict disease progression in MMA.MethodsPatients with MMA, who had undergone serial contrast-enhanced high-resolution MRI with concomitant and follow-up digital subtraction angiography, were analyzed retrospectively. VW-CE was semiquantified by measurement of the signal intensity of the vessel wall in in contrast-enhanced high-resolution MRI. A comparative quotient with the contrast-intensity of the pituitary stalk was calculated and graded accordingly from grade 1 to 5. VW-CE status was correlated with disease status, stroke, cerebrovascular reactivity in CO2-triggered blood-oxygen level-dependent MRI, angiographic disease progression, revascularization surgery, and follow-up imaging.ResultsForty eight patients met the inclusion criteria. N = 56 MRI and digital subtraction angiography time-intervals were evaluated for 12 vessel sections per hemisphere each (N = 1344). N = 38 (79%) patients showed VW-CE and N = 10 (21%) did not. VW-CE was only observed in the terminal internal carotid artery and the proximal circle of Willis (N = 96/1344). Notably, patients with VW-CE significantly more often presented with acute infarction in the concomitant MRI. The incidence of angiographically proven disease progression was significantly associated with the incidence of VW-CE, and time to disease progression was earlier in higher grades of VW-CE compared with lower grades.ConclusionVW-CE is a semiquantifiable marker for disease activity in patients with MMA and associated with disease progression and increased risk of stroke. VW-CE analysis can be routinely performed in patients with MMA to estimate the risk for disease progression and stroke.Copyright © Congress of Neurological Surgeons 2024. All rights reserved.

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