Abstract WMP71: Moyamoya-atherosclerosis Syndrome: Clinical and High-resolution Magnetic Resonance Imaging Features

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Lian Duan ◽  
Wei-Hai Xu ◽  
Cong Han
Keyword(s):  
Magnetic Resonance Imaging ◽  
Risk Factors ◽  
Magnetic Resonance ◽  
High Resolution ◽  
Moyamoya Disease ◽  
Treatment Strategies ◽  
Diagnostic Process ◽  
Imaging Features ◽  
Intracranial Atherosclerosis ◽  
Resonance Imaging

Introduction: The diagnosis in the patients with angiographic moyamoya findings and atherogenic risk factors is challenging. In this study, we try to incorporate high-resolution magnetic resonance imaging (HRMRI) into the diagnostic process of intracranial atherosclerosis associated moyamoya syndrome. Methods: From March 2013 to March 2014, HRMRI was consecutively performed on adult patients with angiographic moyamoya. The patients were classified as moyamoya - plaques (MMD-P) if a plaque could be identified or as moyamoya - no plaques (MMD-NP) if a plaque could not be identified. The angiography, HRMRI findings and atherogenic risk factors of these patients were analyzed. Results: Fifty-one patients (mean age 39±9, 20 males) were enrolled. On traditional angiography, probable intracranial atherosclerosis was identified in 5 patients, no definite diagnosis in 12 patients, and moyamoya disease in 34 patients. On HRMRI, 15 out of 32 patients with risk factors and 4 out of 19 patients without risk factors were found to have plaques and were diagnosed as MMD-P, while the other 32 patients were diagnosed as MMD-NP. The MMD-P patients were more likely to be older and male and were less likely to have cerebral hemorrhage and a history of disease progression. Conclusions: Our study suggests that HRMRI can help diagnose intracranial atherosclerosis more accurately in moyamoya disease patients with atherogenic risk factors. The distinct clinical features between MMD-P and MMD-NP patients suggest different underlying pathophysiology and therefore potentially different treatment strategies.

scholarly journals Role of the RNF213 Variant in Vascular Outcomes in Patients With Intracranial Atherosclerosis

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Hyung Jun Kim ◽  
Eun‐Hyeok Choi ◽  
Jong‐Won Chung ◽  
Jae‐Hwan Kim ◽  
Ye Sel Kim ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
High Resolution ◽  
East Asian ◽  
Ring Finger ◽  
Imaging Features ◽  
Intracranial Atherosclerosis ◽  
Resonance Imaging ◽  
Cerebrovascular Events ◽  
Tandem Lesions

Background The RNF213 ( ring finger protein 213 gene) variant R4810K is a susceptibility allele not only for Moyamoya disease (MMD) but also for intracranial atherosclerosis (ICAS) in East Asian populations. We hypothesized that this variant would affect the distribution of ICAS and recurrence of cerebrovascular events. Methods and Results We conducted a prospective study of patients with ICAS and MMD using high‐resolution magnetic resonance imaging and RNF213 R4810K genotyping. Patients were included in the ICAS group when relevant plaques existed on high‐resolution magnetic resonance imagingand in the MMD group when they carried the variant and high‐resolution magnetic resonance imaging showed no plaques but characteristic features of MMD. We compared clinical and neuroimaging features of patients with ICAS‐ RNF213 + with patients with ICAS‐ RNF213 − and of patients with MMD. Of 477 patients, 238 patients were in the ICAS group and 239 were in the MMD group. Among patients with ICAS, 79 patients (33.2%) were in the ICAS‐ RNF213 + group and 159 (66.8%) in the ICAS‐ RNF213 − group. Tandem lesions were significantly more common in the ICAS‐ RNF213+ group than in the ICAS‐ RNF213 − group (40.3% versus 72.2%, P <0.001), and their distributions were similar between the ICAS‐ RNF213+ and MMD groups. The presence of the R4810K variant (hazard ratio [HR], 3.203; 95% CI, 1.149–9.459; P =0.026) and tandem lesions (≥3) (HR, 8.315; 95% CI, 1.930–39.607; P =0.005) were independently associated with recurrent cerebrovascular events. Conclusions Patients with ICAS carrying the RNF213 R4810K variant showed clinical and imaging features distinct from patients with ICAS without the variant, suggesting that the R4810K variant plays a role in intracranial atherosclerosis in East Asian patients.

scholarly journals High-Resolution Vessel Wall Magnetic Resonance Imaging of Small Unruptured Intracranial Aneurysms

2021 ◽  
Vol 10 (2) ◽  
pp. 225
Author(s):  
Łukasz Zwarzany ◽  
Ernest Tyburski ◽  
Wojciech Poncyljusz
Keyword(s):  
Magnetic Resonance Imaging ◽  
Risk Factors ◽  
Magnetic Resonance ◽  
High Resolution ◽  
Vessel Wall ◽  
Intracranial Aneurysms ◽  
Aneurysm Rupture ◽  
Resonance Imaging ◽  
Aneurysm Wall ◽  
Conventional Risk Factors

Background: We decided to investigate whether aneurysm wall enhancement (AWE) on high-resolution vessel wall magnetic resonance imaging (HR VW-MRI) coexists with the conventional risk factors for aneurysm rupture. Methods: We performed HR VW-MRI in 46 patients with 64 unruptured small intracranial aneurysms. Patient demographics and clinical characteristics were recorded. The PHASES score was calculated for each aneurysm. Results: Of the 64 aneurysms, 15 (23.4%) showed wall enhancement on post-contrast HR VW-MRI. Aneurysms with wall enhancement had significantly larger size (p = 0.001), higher dome-to-neck ratio (p = 0.024), and a more irregular shape (p = 0.003) than aneurysms without wall enhancement. The proportion of aneurysms with wall enhancement was significantly higher in older patients (p = 0.011), and those with a history of prior aneurysmal SAH. The mean PHASES score was significantly higher in aneurysms with wall enhancement (p < 0.000). The multivariate logistic regression analysis revealed that aneurysm irregularity and the PHASES score are independently associated with the presence of AWE. Conclusions: Aneurysm wall enhancement on HR VW-MRI coexists with the conventional risk factors for aneurysm rupture.

scholarly journals High-resolution Magnetic Resonance Imaging of Moyamoya Disease

2015 ◽  
Vol 128 (23) ◽  
pp. 3231-3237 ◽  
Author(s):  
Le-Bao Yu ◽  
Qian Zhang ◽  
Zhi-Yong Shi ◽  
Ming-Qiu Wang ◽  
Dong Zhang
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
High Resolution ◽  
Moyamoya Disease ◽  
Resonance Imaging

scholarly journals Luminal and Wall Changes in Intracranial Arterial Lesions for Predicting Stroke Occurrence

Stroke ◽  
2020 ◽  
Vol 51 (8) ◽  
pp. 2495-2504 ◽  
Author(s):  
Hyung Jun Kim ◽  
Eun-Hyeok Choi ◽  
Jong-Won Chung ◽  
Jae-Hwan Kim ◽  
Ye Sel Kim ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
High Resolution ◽  
Moyamoya Disease ◽  
Ring Finger ◽  
Stroke Recurrence ◽  
Large Artery ◽  
Gene Variant ◽  
Resonance Imaging ◽  
Asian Patients

Background and Purpose: Luminal imaging (degree of stenosis) currently serves as the gold standard to predict stroke recurrence and guide therapeutic strategies in patients with intracranial large artery diseases (ILADs). We comparatively evaluated the importance of vessel wall and luminal changes in predicting stroke occurrence. Methods: Consecutive patients with ILAD in the proximal middle cerebral artery or distal internal carotid artery without proximal sources of embolism from the carotid and heart underwent time-of-flight magnetic resonance angiography, high-resolution magnetic resonance imaging, and the ring finger protein 213 ( RNF213 ) gene variant test. Patients were followed up for >3 months. Results: Of the 675 patients, 241 (35.7%) had atherosclerotic ILAD and 434 (64.3%) showed nonatherosclerotic ILAD (315 [46.7%] moyamoya disease cases and 119 [17.6%] dissection cases). The RNF213 variant was detected in 74.9%, 33.6%, and 3.4% patients with moyamoya disease, atherosclerosis, and dissection, respectively. Three hundred (44.4%) patients had asymptomatic ILAD, whereas 375 (55.6%) patients had symptomatic ILAD. Multivariate analysis showed that vessel enhancement and etiological subtypes, not degree of stenosis, determined by high-resolution magnetic resonance imaging and RNF213 gene variant analysis were independently associated with symptomatic ILAD. The presence of the RNF213 variant was also independently associated with recurrent cerebrovascular events. Conclusions: This study demonstrates the prevalence of nonatherosclerotic ILAD in East Asian patients with ILAD. Unlike luminal changes, wall changes determined by high-resolution magnetic resonance imaging and presence of the RNF213 variant could predict stroke occurrence in patients with ILADs.

Application of High-Resolution Magnetic Resonance Imaging in the Classification of Trial of ORG 10172 in Acute Stroke Treatment in Cerebral Infarction in Posterior Circulation Ischemia

2020 ◽  
Vol 10 (9) ◽  
pp. 2090-2095
Author(s):  
Xiangfu Meng ◽  
Wei Liu
Keyword(s):  
Magnetic Resonance Imaging ◽  
Risk Factors ◽  
Magnetic Resonance ◽  
High Resolution ◽  
Cerebral Infarction ◽  
Posterior Circulation ◽  
Resonance Imaging ◽  
Traditional Risk Factors ◽  
Toast Classification

Objective: To analyze the relationship between TOAST classification of cerebral infarction after cerebral ischemia and traditional risk factors by high-resolution NMR. Methods: A total of 942 patients with cerebral infarction who were hospitalized in our hospital from January 2012 to October 2019 were enrolled. After performing brain magnetic resonance examination, they were classified according to magnetic resonance imaging, and the patient’s age was recorded. Clinical data such as gender and disease history, and routine examination of diabetes, blood lipids, etc., according to the results of the test, TOAST classification, comparison with magnetic resonance imaging classification results, and correlation analysis of risk factors affecting cerebral infarction. Results: The results of the study showed that 942 patients with posterior circulation ischemic cerebral infarction had aortic atherosclerosis (49.04%), small artery occlusion (39.49%), cardiogenic embolism (6.16%), and unexplained type. (5.20%), other reasons (0.11%). There was a significant correlation between DWI imaging characteristics and TOAST classification (χ = 397.785, P = 0.000). Cortical.cortical infarction, unilateral anterior circulation infarction, large perforating infarction, and anterior.posterior circulation infarction were associated with LAA type, and the difference was statistically significant (P < 0.05). Conclusion: The results of the study fully demonstrate that the characteristics of high-resolution NMR imaging are related to the TOAST classification of patients with cerebral infarction caused by posterior circulation ischemia. Traditional risk factors such as age, NIHSS score, coronary heart disease and atrial fibrillation have certain characteristics on DWI imaging. Impact. Therefore, patients with posterior circulation ischemic cerebral infarction need early high-resolution MRI and combined with traditional risk factors to choose treatment options to reduce the disability and mortality of patients.

scholarly journals Quantitative Histogram Analysis on Intracranial Atherosclerotic Plaques

Stroke ◽  
2020 ◽  
Vol 51 (7) ◽  
pp. 2161-2169 ◽  
Author(s):  
Zhang Shi ◽  
Jing Li ◽  
Ming Zhao ◽  
Wenjia Peng ◽  
Zakaria Meddings ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
High Resolution ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Basilar Artery ◽  
Coefficient Of Variation ◽  
Intraplaque Hemorrhage ◽  
Intracranial Atherosclerosis ◽  
Resonance Imaging

Background and Purpose: Intracranial atherosclerosis is one of the main causes of stroke, and high-resolution magnetic resonance imaging provides useful imaging biomarkers related to the risk of ischemic events. This study aims to evaluate differences in histogram features between culprit and nonculprit intracranial atherosclerosis using high-resolution magnetic resonance imaging. Methods: Two hundred forty-seven patients with intracranial atherosclerosis who underwent high-resolution magnetic resonance imaging sequentially between January 2015 and December 2016 were recruited. Quantitative features, including stenosis, plaque burden, minimum luminal area, intraplaque hemorrhage, enhancement ratio, and dispersion of signal intensity (coefficient of variation), were analyzed based on T2-, T1-, and contrast-enhanced T1-weighted images. Step-wise regression analysis was used to identify key determinates differentiating culprit and nonculprit plaques and to calculate the odds ratios (ORs) with 95% CIs. Results: In total, 190 plaques were identified, of which 88 plaques (37 culprit and 51 nonculprit) were located in the middle cerebral artery and 102 (57 culprit and 45 nonculprit) in the basilar artery. Nearly 90% of culprit lesions had a degree of luminal stenosis of <70%. Multiple logistic regression analyses showed that intraplaque hemorrhage (OR, 16.294 [95% CI, 1.043–254.632]; P =0.047), minimum luminal area (OR, 1.468 [95% CI, 1.032–2.087]; P =0.033), and coefficient of variation (OR, 13.425 [95% CI, 3.987–45.204]; P <0.001) were 3 significant features in defining culprit plaques in middle cerebral artery. The enhancement ratio (OR, 9.476 [95% CI, 1.256–71.464]; P =0.029), intraplaque hemorrhage (OR, 2.847 [95% CI, 0.971–10.203]; P =0.046), and coefficient of variation (OR, 10.068 [95% CI, 2.820–21.343]; P <0.001) were significantly associated with plaque type in basilar artery. Coefficient of variation was a strong independent predictor in defining plaque type for both middle cerebral artery and basilar artery with sensitivity, specificity, and accuracy being 0.79, 0.80, and 0.80, respectively. Conclusions: Features characterized by high-resolution magnetic resonance imaging provided complementary values over luminal stenosis in defined lesion type for intracranial atherosclerosis; the dispersion of signal intensity in histogram analysis was a particularly effective predictive parameter.

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