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MR Angiography of Moyamoya Disease Before and After Encephaloduroarteriosynangiosis

Hye-Kyung Yoon1, Hyung-Jin Shin2, Munhyang Lee3, Hong Sik Byun1, Dong Gyu Na1 and Bokyung Kim Han1

1 Department of Radiology, Samsung Medial Center, Sungkyunkwan University School of Medicine, 50 Irwon-Dong, Kangnam-Gu, Seoul 135-230, Koreay.
2 Department of Neurosurgery, Samsung Medial Center, Sungkyunkwan University School of Medicine, Seoul 135-230 Korea.
3 Department of Pediatrics, Samsung Medial Center, Sungkyunkwan University School of Medicine, Seoul, 135-230, Korea.



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  		Fig. 1. —2-year-old boy with moyamoya disease.

A, Conventional angiogram shows mild stenosis (arrows) of both supraclinoid internal carotid arteries (ICAs). Severe stenosis of middle cerebral artery (MCA) and anterior cerebral artery (ACA) is noted. Posterior cerebral artery was normal (not shown). Degree of moyamoya vessels (MMVs) is mild bilaterally.

 


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  		Fig. 1. —2-year-old boy with moyamoya disease.

B, Axial projected three-dimensional time-of-flight MR angiogram shows severe stenosis (arrows) of ICAs, MCAs, and ACAs. Degree of MMVs is mild bilaterally and well correlated with A. Vascular supply in MCA territory was interpreted as fair bilaterally.

 


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  		Fig. 1. —2-year-old boy with moyamoya disease.

C, Follow-up MR angiogram obtained 6 months after right encephaloduroarteriosynangiosis (EDAS) and 10 months after left EDAS shows good transdural collateral vessels (arrowheads) supplying MCA territories, which was interpreted as good bilaterally. Postoperative neurologic status was good for both hemispheres.

 


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  		Fig. 2. —10-year-old girl with unilateral moyamoya disease.

A, Axial projected three-dimensional time-of-flight MR angiogram shows total occlusion of right distal internal carotid artery, anterior cerebral artery, and middle cerebral artery (MCA). Right MCA vascular supply is poor compared with uninvolved left side. Moyamoya vessels (MMVs) are prominent (arrows).

 


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  		Fig. 2. —10-year-old girl with unilateral moyamoya disease.

B, Follow-up MR angiogram obtained 4 months after surgery shows development of transdural collateral vessels (arrowheads) to right MCA territory, which was interpreted as good. Right superficial temporal artery (arrow) is prominent. Interval decrease in MMVs is noted.

 


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  		Fig. 3. —3-year-old boy with poor clinical outcome after encephaloduroarteriosynangiosis (EDAS).

A, Axial projected three-dimensional time-of-flight MR angiogram shows severe stenosis of right internal carotid artery (ICA) and near total occlusion of left ICA, consistent with moyamoya disease. Posterior cerebral artery is normal and moyamoya vessels (MMVs) are mild bilaterally. Right middle cerebral artery (MCA) vascular supply is fair, whereas left MCA vascular supply is poor.

 


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  		Fig. 3. —3-year-old boy with poor clinical outcome after encephaloduroarteriosynangiosis (EDAS).

B, Follow-up MR angiogram obtained 3 months after left EDAS and 2 months after right EDAS shows poor vascular supply in right MCA territory. ICA stenosis has progressed and MMVs are decreased, suggesting disease progression. Postoperative evaluation for neurologic status revealed poor outcome for both sides.

 


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  		Fig. 4. —7-year-old boy with prominent superficial temporal artery after encephaloduroarteriosynangiosis (EDAS).

A, Anteroposterior MR angiogram shows both superficial temporal arteries (STAs) are barely visible (arrows).

 


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  		Fig. 4. —7-year-old boy with prominent superficial temporal artery after encephaloduroarteriosynangiosis (EDAS).

B, Follow-up MR angiogram obtained 11 months after right EDAS and 9 months after left EDAS shows markedly enlarged STAs bilaterally (arrows).

 

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