BACKGROUND AND PURPOSE: Although progression of anterior cerebral artery (ACA) stenosis may represent part of disease evolution in moyamoya disease (MMD), predicting such progression remains challenging. We aimed to assess whether the quantitative measure of arterial wall enhancement at baseline was associated with subsequent progression of ACA stenosis. METHODS: This longitudinal study included 262 hemispheres from patients with MMD who underwent baseline vessel wall MRI (DANTE T1-SPACE). Wall enhancement of the A1 segment of the ACA was quantified using an enhancement ratio (ER), calculated as the ratio of contrast-enhanced to non-contrast-enhanced vessel wall signal intensity normalized to that of the brain parenchyma. Progression of ACA stenosis within 24 months was defined as either an increase in the 3-point ACA signal score (A2 and distal branches) or the occurrence of new or progressive A1 stenosis. Marginal Cox models were used to assess the association between ER and time to progression, adjusting for age, hemodynamic status, and RNF213 genotype. The optimal ER cutoff was determined using time-dependent receiver operating characteristic curve analysis. RESULTS: Stenosis progression occurred in 35 of 262 ACAs (13.4%). Inter-rater agreement for ER measurement at the A1 segment was excellent (intraclass correlation coefficient, 0.90). ACAs with subsequent stenosis progression showed higher baseline ER values than those without progression (median, 2.27 IQR, 2.03–2.63 vs 1.18 IQR, 1.07–1.33; P CONCLUSIONS: Our findings suggest that quantitative assessment of ACA wall enhancement is feasible and that ER of the A1 segment is associated with subsequent progression of ACA stenosis. Vessel wall MRI may facilitate the assessment of local disease activity in MMD; further studies in this field are required.
Chihara et al. (Wed,) studied this question.
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