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Twenty-nine patients with Moyamoya disease were enrolled in this study. The median age at symptom onset was 12 years. A total of 166 steno-occlusive lesions were detected by high-resolution intracranial vessel wall imaging. Eleven lesions with concentric wall thickening (6.6%) were noted in 9 patients. Ten concentric contrast-enhancing lesions were observed in 8 patients, of which 4 lesions in 3 patients showed grade II enhancement. The presence of contrast enhancement and wall thickening showed a statistically significant association with ischemic events within 3 months before and after the vessel wall imaging. The presence of wall thickening and enhancement may predict future ischemic events in patients with MMD.