Vessel Wall Thickening and Enhancement in High-Resolution Intracranial Vessel Wall Imaging: A Predictor of Future Ischemic Events in Moyamoya Disease

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FIGURE.
A, Flair axial section showing right ACA and MCA territory cortical infarct and multiple discrete MCA-ACA watershed infarct on the left side. B, DSA, showing tight stenosis of the distal ICA, with concomitant narrowing of proximal MCA and ACA, with leptomeningeal collaterals. C, Axial T1 noncontrast, HRVWI, showing circumferential wall thickening (arrow) and narrowing of the lumen of right distal ICA. D, Axial T1 contrast-enhanced, HRVWI, showing circumferential grade II enhancement (arrow) of a right distal ICA (Note:—Enhancement is graded by comparing with pituitary infundibulum).

Table 1:

Demographic and clinical characteristics (N = 29)

Patient Characteristics	Results
Sex, n (%)
Males	17 (58.6)
Females	12 (41.6)
Age, n (%)
<18 y	15 (51.7)
≥18 y	14 (48.3)
Age at first event^a, median (IQR), y	−12 (6–36)
Initial clinical presentation, n (%)
Ischemic stroke	10 (34.5)
Intracerebral bleed	5 (17.2)
TIA	7 (24.2)
Syncope	1 (3.4)
Seizure	6 (20.7)
Recurrent events, n (%)	22 (75.9)
Ischemic stroke	10 (34.5)
Intracranial bleed (intraventricular hemorrhage)	2 (6.9)
Positive family history of MMD, n (%)	2 (6.9)
NIHSS on admission, median (IQR)	1 (0–3)
mRS on admission, median (IQR)	1 (0–3)

Note:–IQR indicates interquartile range; mRS, modified Rankin scale.
↵a The mean ± SD interval between the first symptom and HRVWI was 64.7 ± 80.7 months.

Table 2:

Imaging characteristics of patients with MMD

Table 3:

HRVWI characteristics of MMD

HRVWI Characteristics	Contrast Enhancement (8 Patients, 10 Lesions)	T1 Wall Thickening (9 Patients, 11 Lesions)
Pattern, n (%)
Concentric	10 (100)	11 (100)
Eccentric	0 (0)	0 (0)
Vessel involved, n (%)
Distal ICA	8 (80)	9 (81.8)
Proximal MCA	2 (20)	2 (18.2)
Events within 3 mo before and after the imaging, n (%)	7 (87.5) (P = .01)	9 (100) (P ≤ .001)
Recent events (DWI positive) within 4 wk of imaging, n (%)		4 (44.4) (P = .20)
Grade I contrast enhancement	0 (0)
Grade II contrast enhancement	3 (100) (P = .02)
Suzuki stage	Grade 2 enhancement (4 lesions)	Wall thickening (11 lesions)
I	1 (25)	1 (9.1)
II	1 (25)	2 (18.2)
III	0	4 (36.4)
IV	2 (50)	4 (36.4)
Remodeling index, mean ± SD	Right, 0.71 ± 0.13	Left, 0.69 ± 0.13