Value of MR high-resolution vessel wall imaging in the Moyamoya-like collateral vessels diseases at the base of the brain.

This study aims to evaluate 3T magnetic resonance high-resolution vessel wall imaging (HR-VWI) in characterizing Moyamoya-like collateral vessels. A retrospective analysis of 58 patients with angiographically confirmed Moyamoya-like vessels (32 Moyamoya disease [MMD]; 26 intracranial atherosclerotic disease-Moyamoya syndrome [ICAD-MMS]). HR-VWI and digital subtraction angiography (n = 45) were performed. Quantified metrics included bilateral middle cerebral artery (MCA) stenosis/occlusion, ischemic/hemorrhagic lesions, and internal carotid artery terminus stenosis. MMD patients were younger than ICAD-MMS (31.1 ± 12.3 vs 42.5 ± 4.0 years, P = .001). Hemorrhage incidence was higher in MMD (28.1% vs 7.7%, P = .027), with more internal carotid artery terminus involvement (90.6% vs 19.2%, P = .006). HR-VWI and digital subtraction angiography showed 88.9% stenosis concordance (κ = 0.82), resolving diagnostic uncertainty in mild stenosis. HR-VWI provides critical vessel wall insights complementary to luminal angiography, aiding etiological differentiation of Moyamoya-like diseases.