High-resolution MR technique can distinguish moyamoya disease from atherosclerotic occlusion

Moyamoya disease (MMD) is an idiopathic progressive narrowing of distal internal carotid arteries and secondary development of small collaterals.¹ The distinction between MMD and intracranial atherosclerosis is not easy when a patient has concomitant vascular risk factors. We attempted to differentiate the 2 disease conditions by applying high-resolution plaque MRI in the occluded segment.² High-resolution MRI of MMD disclosed blunted obliteration of the vessel lumen without eccentric plaque, and black-blood image delineated the occlusion site with homogeneous material and multiple spring-like vascular structures (figure, A). Intracranial atherosclerosis showed eccentric plaque with heterogeneous signals and enhancement (figure, B).

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Figure MRI

High-resolution MRI findings of intracranial internal carotid artery (ICA) occlusion. Patient A with moyamoya disease had blunted distal ICA with homogeneous signal material and no enhancement (arrow). Multiple round vascular structures suggesting remnant vessels or developing collaterals were detected in black-blood image (arrowheads) (A). Patient B had a heterogeneous eccentric lesion along the vessel wall with enhancement, suggesting active atherosclerosis involving the intracranial vessel (B).

• © 2013 American Academy of Neurology