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Review
. 2024 Apr 11:18:1375645.
doi: 10.3389/fnins.2024.1375645. eCollection 2024.

High-resolution magnetic resonance vessel wall imaging provides new insights into Moyamoya disease

Hui Yang #  1   2   3 , Guilan Huang #  1   2 , Xi Li  4 , Moxin Wu  2 , Weixin Zhou  2 , Xiaoping Yin  1   2 , Manqing Zhang  3 , Zhiying Chen  1   2
Affiliations
Review

High-resolution magnetic resonance vessel wall imaging provides new insights into Moyamoya disease

Hui Yang et al. Front Neurosci. .

Abstract

Moyamoya disease (MMD) is a rare condition that affects the blood vessels of the central nervous system. This cerebrovascular disease is characterized by progressive narrowing and blockage of the internal carotid, middle cerebral, and anterior cerebral arteries, which results in the formation of a compensatory fragile vascular network. Currently, digital subtraction angiography (DSA) is considered the gold standard in diagnosing MMD. However, this diagnostic technique is invasive and may not be suitable for all patients. Hence, non-invasive imaging methods such as computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are often used. However, these methods may have less reliable diagnostic results. Therefore, High-Resolution Magnetic Resonance Vessel Wall Imaging (HR-VWI) has emerged as the most accurate method for observing and analyzing arterial wall structure. It enhances the resolution of arterial walls and enables quantitative and qualitative analysis of plaque, facilitating the identification of atherosclerotic lesions, vascular entrapment, myofibrillar dysplasia, moyamoya vasculopathy, and other related conditions. Consequently, HR-VWI provides a new and more reliable evaluation criterion for diagnosing vascular lesions in patients with Moyamoya disease.

Keywords: Moyamoya disease; cerebral artery occlusion; high-resolution magnetic resonance vessel wall imaging; intracranial vessel wall; moyamoya vasculopathy.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
(A,D) Showed the simplified image of the three-layer membrane of the normal arterial wall and the actual HR-VWI of the normal artery wall. (B) Showed the damaged arterial wall in MMD, characterized by enhancement and bending of the intima and thinning of the media (blue triangles for fibroblast proliferation, green triangles for smooth muscle cell displacement and proliferation, black arrows for extremely curved and thickened intima, and gray arrows for fewer smooth muscle cells in the media). (C) Showed the atherosclerotic arterial wall, including subcutaneous lipid deposition, foam cell formation (purple triangle), smooth muscle cell displacement and proliferation (yellow triangle), and internal bleeding (red triangle) as well as rupture of the inner elastic membrane (red arrow). By Figdraw. (E,F) Showed the actual HR-VWI of patients with MMD or atherosclerosis. HR-VWI, High-Resolution Magnetic Resonance Vessel Wall Imaging; MMD, moyamoya disease.
Figure 2
Figure 2
These are the HR-VWI of two MMD patients acquired using a 3.0 T MR scanner. Case A depicts bilateral MMD. A1,A2 show revealing occlusion of bilateral internal carotid arteries to the middle cerebral arteries. A3,A4 are high-resolution thin-slice scans of the middle cerebral arteries, where the red arrows indicate circular high signals. Case B is a patient with unilateral MMD. B1,B2 show occlusion of the right middle cerebral artery. B3,B4 present high-resolution thin-slice scans of the right middle cerebral artery, where the red arrows indicate circular high signals.
Figure 3
Figure 3
Progression of diagnosis and treatment of Moyamoya disease. Shows the process of diagnosing and treating a patient with a cerebrovascular disease that is eventually diagnosed as a Moyamoya disease after multiple detection methods have been performed. By figdraw. CTA, Computed tomography angiography; MRA, Magnetic resonance angiography; CTPI, Computed tomography perfusion imaging; DSA, Digital subtraction angiography; HR-VWI, High-Resolution Magnetic Resonance Vessel Wall Imaging.
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Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was supported partially by the National Natural Science Foundation of China (81960221 and 82260249 to XY), and Jiangxi Provincial Health Commission Science and Technology Plan project (202311506 to ZC), Jiangxi Provincial Administration of Traditional Chinese Medicine science and technology plan project (2022A322 to ZC), Key Projects of Jiangxi Provincial Department of Education (GJJ2201902 to ZC), Youth Foundation of Natural Science Foundation of Jiangxi Province (20224BAB216045 to ZC).

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