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2D Cine Phase-Contrast MRI for Volume Flow Evaluation of the Brain-Supplying Circulation in Moyamoya Disease

K. Wolfgang Neff1, Peter Horn2, Peter Schmiedek2, Christoph Düber1 and Dietmar J. Dinter1

1 Department of Clinical Radiology, University of Heidelberg, Universitätsklinikum Mannheim, Theodor-Kutzer Ufer 1-3, 68167 Mannheim, Germany.
2 Department of Neurosurgery, University of Heidelberg, Universitätsklinikum Mannheim, 68167 Mannheim, Germany.


Figure 1
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  		Fig. 1A —31-year-old woman with bilateral moyamoya disease. Right internal carotid artery (ICA) arteriogram in frontal (A) and lateral (B) projections shows severely stenosed ICA and thus middle cerebral and anterior cerebral arteries are highly stenosed. Marked moyamoya vessels at level of basal ganglia are evident. Peripheral branches of middle and anterior cerebral arteries are filled via collateral vessels.

 

Figure 2
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  		Fig. 1B —31-year-old woman with bilateral moyamoya disease. Right internal carotid artery (ICA) arteriogram in frontal (A) and lateral (B) projections shows severely stenosed ICA and thus middle cerebral and anterior cerebral arteries are highly stenosed. Marked moyamoya vessels at level of basal ganglia are evident. Peripheral branches of middle and anterior cerebral arteries are filled via collateral vessels.

 

Figure 3
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  		Fig. 1C —31-year-old woman with bilateral moyamoya disease. Left ICA arteriogram in frontal (C) and lateral (D) projections reveals distal ICA stenosis, middle cerebral artery occlusion, and anterior cerebral artery stenosis. Basal cerebral moyamoya vessels are evident. Peripheral branches of left middle and anterior cerebral arteries are delineated by collateral vessels.

 

Figure 4
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  		Fig. 1D —31-year-old woman with bilateral moyamoya disease. Left ICA arteriogram in frontal (C) and lateral (D) projections reveals distal ICA stenosis, middle cerebral artery occlusion, and anterior cerebral artery stenosis. Basal cerebral moyamoya vessels are evident. Peripheral branches of left middle and anterior cerebral arteries are delineated by collateral vessels.

 

Figure 5
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  		Fig. 1E —31-year-old woman with bilateral moyamoya disease. Left vertebral arteriogram in frontal (E) and lateral (F) projections shows collateralization from posterior to anterior circulation with filling of middle and anterior cerebral artery peripheral branches via developed leptomeningeal collaterals.

 

Figure 6
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  		Fig. 1F —31-year-old woman with bilateral moyamoya disease. Left vertebral arteriogram in frontal (E) and lateral (F) projections shows collateralization from posterior to anterior circulation with filling of middle and anterior cerebral artery peripheral branches via developed leptomeningeal collaterals.

 

Figure 7
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  		Fig. 2A —31-year-old woman with bilateral moyamoya disease depicted in Figures 1A, 1B, 1C, 1D, 1E, and 1F. Single sections of 2D cine phase-contrast MR images show levels at which measurements were obtained for determination of blood volume flow. Anatomic reference image (A) and single 2D cine phase-contrast image (B) show both common carotid arteries (arrows) 20-30 mm proximal to carotid artery bifurcation.

 

Figure 8
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  		Fig. 2B —31-year-old woman with bilateral moyamoya disease depicted in Figures 1A, 1B, 1C, 1D, 1E, and 1F. Single sections of 2D cine phase-contrast MR images show levels at which measurements were obtained for determination of blood volume flow. Anatomic reference image (A) and single 2D cine phase-contrast image (B) show both common carotid arteries (arrows) 20-30 mm proximal to carotid artery bifurcation.

 

Figure 9
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  		Fig. 2C —31-year-old woman with bilateral moyamoya disease depicted in Figures 1A, 1B, 1C, 1D, 1E, and 1F. Single sections of 2D cine phase-contrast MR images show levels at which measurements were obtained for determination of blood volume flow. Anatomic reference image (C) and single 2D cine phase-contrast image (D) show both internal carotid arteries (arrows) at at level of C3 segment.

 

Figure 10
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  		Fig. 2D —31-year-old woman with bilateral moyamoya disease depicted in Figures 1A, 1B, 1C, 1D, 1E, and 1F. Single sections of 2D cine phase-contrast MR images show levels at which measurements were obtained for determination of blood volume flow. Anatomic reference image (C) and single 2D cine phase-contrast image (D) show both internal carotid arteries (arrows) at at level of C3 segment.

 

Figure 11
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  		Fig. 2E —31-year-old woman with bilateral moyamoya disease depicted in Figures 1A, 1B, 1C, 1D, 1E, and 1F. Single sections of 2D cine phase-contrast MR images show levels at which measurements were obtained for determination of blood volume flow. Anatomic reference image (E) and single 2D cine phase-contrast image (F) show upper portion of basilar artery (arrows) between origins of anterior inferior cerebellar artery and superior cerebellar artery.

 

Figure 12
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  		Fig. 2F —31-year-old woman with bilateral moyamoya disease depicted in Figures 1A, 1B, 1C, 1D, 1E, and 1F. Single sections of 2D cine phase-contrast MR images show levels at which measurements were obtained for determination of blood volume flow. Anatomic reference image (E) and single 2D cine phase-contrast image (F) show upper portion of basilar artery (arrows) between origins of anterior inferior cerebellar artery and superior cerebellar artery.

 

Figure 13
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  		Fig. 3A —31-year-old woman with bilateral moyamoya disease. Blood flow velocity in systolic-diastolic modulation obtained by 2D cine phase-contrast MR measurements for patient in Figures 1A, 1B, 1C, 1D, 1E, 1F, 2A, 2B, 2C, 2D, 2E, and 2F. With integration over vessel diameter with respect to baseline correction, blood volume flow for each vessel was obtained. Both common carotid arteries.

 

Figure 14
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  		Fig. 3B —31-year-old woman with bilateral moyamoya disease. Blood flow velocity in systolic-diastolic modulation obtained by 2D cine phase-contrast MR measurements for patient in Figures 1A, 1B, 1C, 1D, 1E, 1F, 2A, 2B, 2C, 2D, 2E, and 2F. With integration over vessel diameter with respect to baseline correction, blood volume flow for each vessel was obtained. Both common carotid arteries.

 

Figure 15
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  		Fig. 3C —31-year-old woman with bilateral moyamoya disease. Blood flow velocity in systolic-diastolic modulation obtained by 2D cine phase-contrast MR measurements for patient in Figures 1A, 1B, 1C, 1D, 1E, 1F, 2A, 2B, 2C, 2D, 2E, and 2F. With integration over vessel diameter with respect to baseline correction, blood volume flow for each vessel was obtained. Both internal carotid arteries.

 

Figure 16
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  		Fig. 3D —31-year-old woman with bilateral moyamoya disease. Blood flow velocity in systolic-diastolic modulation obtained by 2D cine phase-contrast MR measurements for patient in Figures 1A, 1B, 1C, 1D, 1E, 1F, 2A, 2B, 2C, 2D, 2E, and 2F. With integration over vessel diameter with respect to baseline correction, blood volume flow for each vessel was obtained. Both internal carotid arteries.

 

Figure 17
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  		Fig. 3E —31-year-old woman with bilateral moyamoya disease. Blood flow velocity in systolic-diastolic modulation obtained by 2D cine phase-contrast MR measurements for patient in Figures 1A, 1B, 1C, 1D, 1E, 1F, 2A, 2B, 2C, 2D, 2E, and 2F. With integration over vessel diameter with respect to baseline correction, blood volume flow for each vessel was obtained. Basilar artery. Collateralization via basilar artery circulation in moyamoya disease that results in basilar artery blood flow approximately 250% of normal basilar artery blood flow corresponds to extensive increase in basilar artery blood flow velocity, which is approximately 130 cm/s.

 

Figure 18
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  		Fig. 4 —Blood volume flow (BVF) values (mean ± standard error of the mean [SEM], median) of 30 patients with bilateral idiopathic moyamoya disease in comparison with values for healthy subjects serving as controls. Symptomatic (moyamoya) internal carotid arteries have lower blood volume flow than controls. Moyamoya patients had basilar artery blood volume flow approximately 2.5-fold greater than that of controls. All results were highly significant. Bars indicate blood volume flow within arteries studied. **Statistically significant difference between groups (p < 0.05). MM = patients with bilateral moyamoya disease, CON = controls, ICA L = left internal carotid artery, ICA R = right internal carotid artery, BA = basilar artery.

 

Figure 19
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  		Fig. 5 —Blood volume flow (BVF) values (mean ± standard error of the mean [SEM], median) of five patients with probable unilateral moyamoya disease in comparison with values for healthy subjects serving as controls. Symptomatic (moyamoya) internal carotid arteries (ICA) have significantly lower blood volume flow than control arteries and contralateral ICAs. Blood volume flow was greater in contralateral (normal) ICA and basilar artery than in controls. All results were highly significant. Bars indicate blood volume flow within arteries studied. **Statistically significant difference between groups (p < 0.05). PMM = probable (unilateral) moyamoya disease, CON = controls, ICA S = symptomatic (moyamoya) internal carotid artery, ICA C = contralateral (normal) internal carotid artery, ICA = internal carotid artery, BA = basilar artery.

 

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