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“Brush Sign” on Susceptibility-Weighted MR Imaging Indicates the Severity of Moyamoya Disease

“Brush Sign” on Susceptibility-Weighted MR Imaging Indicates the Severity of Moyamoya Disease BACKGROUND AND PURPOSE: SWI is a high spatial resolution MR imaging technique showing magnetic inhomogeneity that could demonstrate increased oxygen extraction in focal cerebral ischemia. The aim of this study was to investigate the characteristics in the signal intensity of DMVs by using SWI and to determine whether this method could indicate the severity of the hemodynamics in MMD by evaluating the correlation between SWI stage and hemodynamics on SPECT. MATERIALS AND METHODS: Consecutive MMD patients were prospectively analyzed before treatment. Routine MR imaging including SWI was performed, and the number of the conspicuous DMVs draining into the subependymal veins was classified: stage 1, mild (<5); stage 2, moderate (5–10); and stage 3, severe (>10). The SWI stage was evaluated in correlation with clinical presentations, and CBF and CVR were quantified by using a SPECT iodine 123 N -isopropyl-p-iodoamphetamine split-dose method. RESULTS: Patients were 12 males and 21 females (range, 8–66 years), consisting of 4 asymptomatic patients, 13 patients with TIA, 9 patients with infarct, and 7 patients with hemorrhage. There was a significant difference in CVR among clinical presentations, though there was no difference in age, Suzuki stage, or CBF. Conversely, SWI stage was significantly higher in patients with TIA and infarct than asymptomatic patients ( P < .01). Higher SWI stage significantly had lower CBF and CVR in the middle cerebral artery area ( P < .05). CONCLUSIONS: SWI stage strongly correlates with ischemic presentations in MMD and also correlates with hemodynamics on SPECT, especially CVR. Increased conspicuity of DMVs, known as “brush sign”, could predict the severity of MMD. Abbreviations ACA anterior cerebral artery ASL arterial spin-labeling CBF cerebral blood flow CBV cerebral blood volume CVR cerebrovascular reserve DMV deep medullary vein DSC dynamic susceptibility contrast 123 IMP iodine 123 N -isopropyl-p-iodoamphetamine MB microbleed MCA middle cerebral artery MMD Moyamoya disease OEF oxygen extraction fraction PET positron-emission tomography PSI phase shift image ROI region of interest SPECT single-photon emission CT STA superficial temporal artery SWI susceptibility-weighted image TIA transient ischemic attack http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Neuroradiology American Journal of Neuroradiology

“Brush Sign” on Susceptibility-Weighted MR Imaging Indicates the Severity of Moyamoya Disease

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Publisher
American Journal of Neuroradiology
Copyright
Copyright © 2011 by the American Society of Neuroradiology.
ISSN
0195-6108
eISSN
1936-959X
DOI
10.3174/ajnr.A2568
pmid
21799039
Publisher site
See Article on Publisher Site

Abstract

BACKGROUND AND PURPOSE: SWI is a high spatial resolution MR imaging technique showing magnetic inhomogeneity that could demonstrate increased oxygen extraction in focal cerebral ischemia. The aim of this study was to investigate the characteristics in the signal intensity of DMVs by using SWI and to determine whether this method could indicate the severity of the hemodynamics in MMD by evaluating the correlation between SWI stage and hemodynamics on SPECT. MATERIALS AND METHODS: Consecutive MMD patients were prospectively analyzed before treatment. Routine MR imaging including SWI was performed, and the number of the conspicuous DMVs draining into the subependymal veins was classified: stage 1, mild (<5); stage 2, moderate (5–10); and stage 3, severe (>10). The SWI stage was evaluated in correlation with clinical presentations, and CBF and CVR were quantified by using a SPECT iodine 123 N -isopropyl-p-iodoamphetamine split-dose method. RESULTS: Patients were 12 males and 21 females (range, 8–66 years), consisting of 4 asymptomatic patients, 13 patients with TIA, 9 patients with infarct, and 7 patients with hemorrhage. There was a significant difference in CVR among clinical presentations, though there was no difference in age, Suzuki stage, or CBF. Conversely, SWI stage was significantly higher in patients with TIA and infarct than asymptomatic patients ( P < .01). Higher SWI stage significantly had lower CBF and CVR in the middle cerebral artery area ( P < .05). CONCLUSIONS: SWI stage strongly correlates with ischemic presentations in MMD and also correlates with hemodynamics on SPECT, especially CVR. Increased conspicuity of DMVs, known as “brush sign”, could predict the severity of MMD. Abbreviations ACA anterior cerebral artery ASL arterial spin-labeling CBF cerebral blood flow CBV cerebral blood volume CVR cerebrovascular reserve DMV deep medullary vein DSC dynamic susceptibility contrast 123 IMP iodine 123 N -isopropyl-p-iodoamphetamine MB microbleed MCA middle cerebral artery MMD Moyamoya disease OEF oxygen extraction fraction PET positron-emission tomography PSI phase shift image ROI region of interest SPECT single-photon emission CT STA superficial temporal artery SWI susceptibility-weighted image TIA transient ischemic attack

Journal

American Journal of NeuroradiologyAmerican Journal of Neuroradiology

Published: Oct 1, 2011

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