Association of intravascular enhancement sign on 3D T1- weighted TSE sequences with cerebral perfusion and infarction events in moyamoya disease.

OBJECTIVE

To investigate the relationship between intravascular enhancement sign (IVES) on high-resolution magnetic resonance vessel wall imaging (HR-VWI) and cerebral perfusion indicators and stroke events in patients with moyamoya disease (MMD).

METHOD: Retrospective analysis of clinical and imaging data of patients diagnosed with MMD by digital subtraction angiography from May 2021 to November 2024, all patients completed HR-VWI examination. Paired comparisons, correlation analysis, and logistic regression analysis were performed to explore the relationship between IVES with cerebral perfusion and infarction.

RESULTS

A total of 47 cases with MMD were analyzed, comprising 20 females and 27 males with an average age of 53.4 years. The IVES was visible in 74 hemispheres, 91.9 % showed severe stenosis or occlusion of the internal carotid artery or middle cerebral artery among them, and cerebral infarction lesions were found in 10 of these cases. IVES score (odd ratio, 1.11; 95 % CI, 1.01 to 1.24; p = 0.042) was independently associated with ipsilateral infarction events after controlling for the stenosis degree, enhanced grade, posterior cerebral artery diameter, integrity of the posterior communicating artery, and MRA score. Among 33 cases underwent CT perfusion, it was found that the hemisphere with a higher score had significantly higher values in cerebral blood volume (CBV), mean transit time (MTT), time to peak (TTP), and T-max. And IVES score was moderately positively correlated with MTT, TTP, T-max, Suzuki stage, and Houkin's MRA score. Furthermore, the higher the IVES score, the decreasing tendency the perfusion status of the corresponding brain region.

CONCLUSION

The IVES score is related to the cerebral perfusion level in MMD patients, and an increased IVES score may indicate an increased risk of cerebral infarction.