Predicative Value of Multimodal MRI in Moyamoya Disease

Study Overview
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Brief Summary
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Moyamoya disease (MMD) is a nonatherosclerotic cerebrovascular abnormality, characterized by a progressive stenosis or occlusion of the intracranial internal carotid arteries (ICAs) and their proximal branches, with subsequent formation of collateral vessels (puff of smoke). In some cases, the posterior circulation can also be involved. MMD has been discovered around the world, but Asians carry the most possibility to develop this disease. Current treatment designed to prevent strokes by improving blood flow to the affected cerebral hemisphere including medical therapy and surgery. In particular, surgery included two general methods: direct and indirect revascularization. Compared with direct bypass, indirect procedures are more technically accessible and may reduce the possibility of complications, such as hyperperfusion. In addition, magnetic resonance imaging (MRI) with derived parameters have shown great potential in evaluating perfusion in patients, and could possibly predict surgical outcome. However, there is still lack of evidence of the predictive value of MRI in evaluating clinical and angiography improvement in patients with MMD.

Detailed Description
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Imaging protocols: 3D TOF 3SLAB; SWAN; 3D ASL 2.0s; T1; T2; T2 Flair; DWI; tASL 2.0s; DCE; APT-CEST Imaging evaluation: Transfer contrast volume value measured by DCE; ASL shows CBF in associated regions; Stoke area measured by DWI and Flair; PH values reflected by APT-CEST. Treatment: Surgery-indirect revascularization Follow-up: Baseline (MRI+DSA); 3-months follow-up (MRI); 6-months follow-up (MRI+DSA)

Official Title
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Multimodal Magnetic Resonance Imaging Predicting Outcome After Surgical Revascularization in Patients With Moyamoya Disease

Conditions
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Moyamoya Disease, Magnetic Resonance Imaging

Intervention / Treatment
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* Procedure: surgical revascularization


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: DSA/MRA shows stenosis or occlusion in the distal internal carotid artery or the proximal portion of anterior/middle cerebral artery; Abnormal vascular network appeared in the brain; With the onset of cerebral ischemia/hemorrhage/TIA; No cerebral infarction or cerebral hemorrhage occurred within the last month; All MRI examination performed according to study protocol; Signed informed consent obtained from the patient or patient's legally authorized representative; Having complete medical history and clinical follow up; Imaging data can be processed. Exclusion Criteria: Patients with moyamoya syndrome secondary to systemic diseases such as arteriosclerosis, sickle cell anemia, radiation therapy, etc.; Patients with severe mental disorders such as psychosis, liver and kidney dysfunction, poor blood pressure or blood glucose control, severe depression and substance abuse, low IQ, and acute phase of severe stroke with definite limb dysfunction should also be excluded. Pregnancy
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Moyamoya disease<br>The cohort includes patients with Moyamoya disease diagnosed by DSA examination who are treated by surgical revascularization. | Procedure: surgical revascularization<br>* Indirect revascularization procedure<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patients selection/stratification | Finding the effect of imaging biomarkers/patterns to provide therapy decision support | Three months to 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Surgical outcome | Finding the effect of imaging biomarkers/patterns to reflect modified Rankin scale | Three months to 6 months | 
| Surgical response | Finding the effect of imaging biomarkers/patterns to reflect revascularized blood flow | Three months to 6 months |