The Study Of The Character Of Vessel Wall Of Adult Moyamoya Disease And Differentiating From Moyamoya Syndrome

Objective:To investigate the characteristic vessel wall and the remodeling form of Moyamoya Disease(MMD)and Moyamoya Syndrome(MMS)using High Resolution Magnetic Resonance Imaging(HR-MRI),and to discuss the role of HR-MRI in differentiating MMD from MMS.Methods:Digital Subtraction Angiography(DSA)confirmed patients,20 MMD and 20 MMS,were recruited and underwent HR-MRI from June 2015 to December 2016 in the neurosurgery department of the first affiliated hospital of Nanchang University.The size of the outer diameter of Middle Cerebral Artery(MCA),the remodeling rate,the morphology of lumen,the signal of vessel wall and the enhancement of vessel wall revealed by HR-MRI in order to compare the technologies of DSA and HR-MRI.Then,receiver operating characteristic(ROC)curve was used to analyze the outer diameters of MCA of two groups.Results:1.HR-MRI confirmed that the patient of MMS group was Atherosclerosis Moyamoya Syndrome(AS-MMS).The outer diameter of MCA and the remodeling rate of MMD group was lower than AS-MMS group(2.30±0.43 mm VS 3.38±0.50mm;0.77±0.15 VS 1.10±0.07,P<0.05).Contrast with AS-MMS group,the signal of vessel wall of MMD group was homogeneous(84% VS 6.7%,P<0.05)with concentric stenosis(92% VS 0%,P<0.001)and the number of enhancement of vessel wall was less than AS-MMS group(16% VS 86.67%,P<0.01).2.The area under curve of the ROC was 0.936(P<0.001).When the outer diameter of MCA was 2.77 mm,the sensitivity of differential diagnosis was 93%,the specificity was 92%.3.Among the 20 patients with MMD,HR-MRI confirmed the diagnosis of MMD in 18;the remaining 2 patients were considered to be MMS.Among the 20 pa-tients with MMS,HR-MRI confirmed MMS in 13 patients;the remaining 7 patients were considered to be MMD.Conclusions:1.The character of vessel wall of MMD group presents smaller outer diameter,negative remodeling,homogeneous signal and concentric stenosis.Most of the vessel wall of MMD has no obvious enhancement,few has mild enhancement.2.Contrast with AS-MMS,when the outer diameter of MCA was no more than 2.77 mm,we can probably diagnose to MMD.The sensitivity of differential diagnosis was 93%,the specificity was 92%.3.Diagnosis of MMD just by DSA may cause misdiagnosis.The imaging of the vessel wall observed by HR-MRI can improve the accuracy of diagnosis of MMD,and provide a significant reference for the differentiation of MMD from MMS.