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Moyamoya Disease: Evaluation with Diffusion-weighted and Perfusion Echo-planar MR Imaging¹

¹ From the Departments of Radiology (I.Y., Y.H., H.S.) and Neurosurgery (T.N., H.A., Y.M.), Faculty of Medicine, and the Department of Neuropathology (T.K.), Medical Research Institute, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan. Received June 2, 1998; revision requested August 5; final revision received November 10; accepted February 22, 1999. Address reprint requests to I.Y. (e-mail: yamada.crad@med.tmd.ac.jp).

PURPOSE: To determine the clinical efficacy of diffusion-weighted and perfusion echo-planar magnetic resonance (MR) imaging in the evaluation of moyamoya disease.

MATERIALS AND METHODS: Seventeen patients with moyamoya disease were examined prospectively with diffusion-weighted and perfusion echo-planar MR imaging and conventional angiography. The change in the effective transverse relaxation rate (R2*) peak value, R2* peak time, and R2* integral were calculated to assess regional cerebral perfusion. The MR images were compared with angiographic images.

RESULTS: Of the 34 posterior cerebral arteries (PCAs) of the 17 patients, 14 PCAs (41%) in 11 patients showed stenosis or occlusion. The R2* peak value ratio in the cerebral hemispheres decreased significantly, and the R2* peak time ratio increased significantly, with PCA stenosis and occlusion. However, no correlation was apparent between perfusion and extent of the stenotic or occlusive lesions of the internal carotid artery bifurcation. The frequency of cerebral infarctions was significantly increased in patients with stenotic or occlusive PCA lesions. For three acute infarctions, a decrease in the apparent diffusion coefficient was significantly correlated with a decrease in the R2* peak value, an increase in the R2* peak time, and a decrease in the R2* integral.

CONCLUSION: Regional cerebral perfusion in moyamoya disease is decreased and delayed with PCA stenosis, with greater decrease and delay with PCA occlusion. Diffusion-weighted and perfusion imaging are useful for evaluating cerebral ischemia in moyamoya disease.

Index terms: Carotid arteries, MR, 17.121416, 17.12144 • Cerebral angiography, 17.1243, 17.1246, 17.1247 • Cerebral blood vessels, MR, 17.121416, 17.12144 • Cerebral blood vessels, stenosis or obstruction, 17.72134 • Moyamoya disease, 17.72134, 17.781

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