Correlation Between Contrast-Enhanced Magnetic Resonance Vessel Wall Imaging and Cerebral Hemodynamic Reserve in Moyamoya Disease

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BACKGROUND: In Moyamoya disease (MMD), enhanced sulci on contrast-enhanced (CE) magnetic resonance (MR) vessel wall imaging (VWI) are more sensitive to blood flow changes than the fluid-attenuated inversion recovery (FLAIR) ivy sign. FLAIR ivy sign is associated with cerebral blood flow and cerebrovascular reserve (CVR) but this remains controversial. We aimed to clarify the correlation between the number of enhanced sulci on CE-MR VWI or FLAIR ivy signs and CVR, which is essential for treatment planning. METHODS: We retrospectively analyzed patients with MMD who underwent CE-MR VWI and acetazolamide single-photon emission computed tomography in 2020-2025. Enhanced sulci on CE-MR VWI and FLAIR ivy signs were quantified in basal ganglia slices, divided into 4 regions per hemisphere. Correlations with CVR in corresponding regions were assessed. RESULTS: Among 58 patients, both enhanced sulci on CE-MR VWI and FLAIR ivy signs were most common in the middle cerebral artery territory and least in the posterior cerebral artery territory. The correlation coefficient between the number of enhanced sulci and mean CVR across all regions was -0.718 (P < 0.05) (strong correlation), while that between the number of FLAIR ivy signs and mean CVR was -0.473 (P < 0.05) (weak correlation). Enhanced sulci on CE-MR VWI correlated strongly with CVR in bilateral anterior middle cerebral artery regions (|r| > 0.7), while the correlation between FLAIR ivy signs and CVR was weaker in these regions (|r| ≤ 0.4). CONCLUSIONS: The number of enhanced sulci on CE-MR VWI correlates more with reduced CVR than FLAIR ivy sign. CE-MR VWI may aid CVR estimation and guide MMD treatment.

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