Background: Magnetic resonance angiography (MRA) has been acknowledged as a noninvasive diagnostic modality for moyamoya disease. However, in terms of staging of moyamoya disease, conventional angiography is still the gold standard. Therefore, the purpose of this study was to establish MRA grades for moyamoya disease as an alternative to conventional angiography. Methods: Twenty-two patients (44 sides) with moyamoya disease diagnosed by conventional angiography were evaluated by MRA during the past 5 years. MRA scores were assigned based on the severity of occlusive changes of the internal carotid artery, the horizontal portion of the middle cerebral artery, the anterior and the posterior cerebral arteries and the signals of the distal branches of these arteries. Total points ranged from 0 (normal) to 10 (most severe). Results: MRA scores (0–10) were significantly consistent with the conventional angiographic staging. Four grades based on this novel MRA scores correlated well with Suzuki’s stages, with high sensitivity and specificity. Conclusions: These novel MRA grades can be a reliable alternative to conventional staging. By employing these novel MRA grades, the use of conventional angiography can be avoided for the purpose of evaluation of the stages of moyamoya disease.

Keywords:
Moyamoya disease, Magnetic resonance angiography, Staging, Angiography
1.
Fukui M: Current state of study on moyamoya disease in Japan. Surg Neurol 1997;47:138–143.
2.
Fukui M: Guidelines for the diagnosis and treatment of spontaneous occlusion of the circle of Willis (‘moyamoya’ disease). Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) of the Ministry of Health and Welfare, Japan. Clin Neurol Neurosurg 1997;99(suppl 2):238–240.
3.
Houkin K, Aoki T, Takahashi A, Abe H: Diagnosis of moyamoya disease with magnetic resonance angiography. Stroke 1994;25:2159–2164.
4.
Yamada I, Suzuki S, Matsushima Y: Moyamoya disease: comparison of assessment with MR angiography and MR imaging versus conventional angiography. Radiology 1995;196:211–218.
5.
Kikuchi M, Asato M, Sugahara S, Nakajima K, Sato M, Nagao K, Kumagai N, Muraosa Y, Ito K, Hoshino H: Evaluation of surgically formed collateral circulation in moyamoya disease with 3D-CT angiography: comparison with MR angiography and X-ray angiography. Neuropediatrics 1996;27:45–49.
6.
Hasuo K, Mihara F, Matsushima T: MRI and MR angiography in moyamoya disease. J Magn Reson Imaging 1998;8:762–766.
7.
Shirane R, Mikawa S, Ebina T: A case of adult moyamoya disease showing progressive angiopathy on cerebral angiography. Clin Neurol Neurosurg 1999;101:210–214.
8.
Takanashi JI, Sugita K, Niimi H: Evaluation of magnetic resonance angiography with selective maximum intensity projection in patients with childhood moyamoya disease. Eur J Paediatr Neurol 1998;2:83–89.
9.
Aoki S, Yoshikawa T, Hori M, Ishigame K, Nambu A, Kumagai H, Araki T: Two-dimensional thick-slice MR digital subtraction angiography for assessment of cerebrovascular occlusive diseases. Eur Radiol 2000;10:1858–1864.
10.
Thibaud C, Garnier-Viarouge MP, De Kersaint-Gilly A, Desal H: Moyamoya disease: importance of the MRI-MRA combination and difficulties in management and follow-up in 7 cases. J Neuroradiol 2001;28:84–91.
11.
Yamada I, Nakagawa T, Matsushima Y, Shibuya H: High-resolution turbo magnetic resonance angiography for diagnosis of moyamoya disease. Stroke 2001;32:1825–1831.
12.
Yamada I, Murata Y, Umehara I, Suzuki S, Matsushima Y: SPECT and MRI evaluations of the posterior circulation in moyamoya disease. J Nucl Med 1996;37:1613–1617.
13.
Mugikura S, Takahashi S, Higano S, Shirane R, Sakurai Y, Yamada S: Predominant involvement of ipsilateral anterior and posterior circulations in moyamoya disease. Stroke 2002;33:1497–1500.
14.
Kuroda S, Ishikawa T, Houkin K, Iwasaki Y: Clinical significance of posterior cerebral artery stenosis/occlusion in moyamoya disease. No Shinkei Geka 2002;30:1295–1300.
15.
Suzuki J, Takaku A: Cerebrovascular ‘moyamoya’ disease. Disease showing abnormal net-like vessels in base of brain. Arch Neurol 1969;20:288–299.
16.
Suzuki J, Kodama N: Moyamoya disease – a review. Stroke 1983;14:104–109.
17.
Suzuki J, Kodama N: Cerebrovascular ‘moyamoya’ disease. 2. Collateral routes to forebrain via ethmoid sinus and superior nasal meatus. Angiology 1971;22:223–236.
18.
Lee YS, Jung KH, Roh JK: Diagnosis of moyamoya disease with transcranial Doppler sonography: correlation study with magnetic resonance angiography. J Neuroimaging 2004;14:319–323.
19.
Yoon HK, Shin HJ, Lee M, Byun HS, Na DG, Han BK: MR angiography of moyamoya disease before and after encephaloduroarteriosynangiosis. AJR 2000;174:195–200.
20.
Houkin K, Kuroda S, Nakayama N: Cerebral revascularization for moyamoya disease in children. Neurosurg Clin North Am 2001;12:575–584.
21.
Houkin K, Nakayama N, Kuroda S, Ishikawa T, Nonaka T: How does angiogenesis develop in pediatric moyamoya disease after surgery? A prospective study with MR angiography. Childs Nerv Syst 2004;20:734–741.
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2005
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