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73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

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Predictive value of quantified vessel wall contrast enhancement to monitor disease progression in Moyamoya Angiopathy

Prädiktiver Wert von quantifizierter Kontrastmittelaufnahme in den Gefäßwänden von Moyamoya Angiopathie, um die Krankheitsprogression zu monitorisieren

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  • presenting/speaker Sophie Wang - Universitätsklinikum Tübingen, Department für Neurochirurgie und Neurotechnologie, Tübingen, Deutschland
  • Helene Hurth - Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland; Universitätsklinikum Tübingen, Zentrum für Moyamoya und cerebrale Revaskularisation, Tübingen, Deutschland
  • Patrick Haas - Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland; Universitätsklinikum Tübingen, Zentrum für Moyamoya und cerebrale Revaskularisation, Tübingen, Deutschland
  • Ulrike Ernemann - Universitätsklinikum Tübingen, Neuroradiologie, Tübingen, Deutschland
  • Marcos Tatagiba - Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland
  • Benjamin Bender - Universitätsklinikum Tübingen, Neuroradiologie, Tübingen, Deutschland
  • Nadia Kahn - Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland; Universitätsklinikum Tübingen, Zentrum für Moyamoya und cerebrale Revaskularisation, Tübingen, Deutschland; Universitätskinderspital Zürich, Moyamoya Center, Zürich, Schweiz
  • Constantin Roder - Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland; Universitätsklinikum Tübingen, Zentrum für Moyamoya und cerebrale Revaskularisation, Tübingen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocV200

doi: 10.3205/22dgnc194, urn:nbn:de:0183-22dgnc1949

Published: May 25, 2022

© 2022 Wang et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Vessel wall contrast enhancement (VW-CE) has been shown to possibly predict disease progression in Moyamoya patients. Aim of this study was to investigate the predictive value of vessel wall contrast enhancement (CE) in Moyamoya Angiopathy (MMA) and its association with local disease progression as seen in conventional angiography, MR-graphic stroke, and cerebrovascular reactivity (CVR) in blood-oxygen level dependent (BOLD) MRI by a quantitative grading syste

Methods: This retrospective blinded cohort study included all consecutive MMA patients at our department with availability of contrast-enhanced high-resolution magnetic resonance imaging and concomitant digital substraction angiography at at least 2 different time-points/follow-up examinations. Intensity of CE was measured at the vessel wall and pituitary stalk to compute a comparable quotient (vessel wall/pituitary stalk). According to this quotient, vessel wall CE was graded “none” (<25%), “grade 1” (25-40%), “grade 2” (41-60%), “grade 3” (61-80%) and “grade 4” (>81%). CE was then analyzed for association with new or progredient angiographic stenosis, MR-graphic stroke, worsening in CVR in BOLD- MRI and status of a possible bypass. All images were rated blinded by a neuroradiologist.

Results: In total, 38 MRI (76 hemispheres) of 29 MMA patients were included in our analysis. Incidence of CE in the VW was significantly associated with a concomitant acute infarction (diffusion restriction in MRI) (p<0.001) and incidence of angiographic stenosis (p<0.001) in a Kaplan-Meier-Analysis. Patients with CE developed worse CVR status in the course of their disease, this however did not reach statistical significance in the Kaplan-Meier-Analysis (p=0.64). The area under the curve of receiver operating characteristic curve of VW-CE for the prediction of new or progredient angiographic stenosis was 77.7% and therefore a good indicator for disease progression.

Conclusion: Vessel wall contrast enhancement in MMA is a sign for disease activity and may predict progression of local stenosis early. We have found a method to quantify CE in the vessel wall. Higher grades of CE were associated with shorter time to progression of local stenosis. High-resolution vessel wall imaging may be an important examination for early prediction of disease progression in MMA patients and should be used for screening and follow-up examinations. The pathophysiological process causing the contrast enhancement has to be investigated in the future.