Comparative Analysis of Magnetic Resonance Angiography and 4-Vessel Angiography in the Diagnosis of Pediatric Moyamoya Disease

Lee, Kyung Won; Kim, Sung Hwan

Abstract

PURPOSE: Conventional 4-vessel cerebral angiography has been considered as a gold standard for the diagnosis of Moyamoya disease. However, it is an invasive procedure requiring general anesthesia and various neurologic complications such as TIA and cerebral infarction are ocassionally reported during the procedure in children with unstable Moyamoya disease. This study was performed to evaluate the diagnostic efficacy of safe and non-invasive magnetic resonance angiography(MRA) with compared to the cerebral angiography in children with Moyamoya disease.
METHODS
MRA and 4-vessel angiography of 9 patients admitted at Ajou University Hospital from June 1994 to December 2000 with Moyamoya disease were comparatively reviewed retrospectively. Diagnostic accuracy, predictive value of evaluating the disease progress, and differential estimation of the stenosis of cerebral vessels from occlusion were comparatively analyzed.
RESULTS
The sensitivity and specificity of the brain MRA in the diagnosis of Moyamoya disease was 100%. There is no statistically significant difference in the estimation of Suzuki stage between MRA and cerebral angiography(P=0.180). The sensitivity and specificity of the brain MRA to differentiate occlusion from the stenosis of cerebral vessel were 33% and 100%. In patients with stage III and IV Moyamoya disease, MRA showed sensitivity of 100% and specificity of 100% to predict vascular occlusion, and sensitivity of 100% and specificity of 66.7% to differentiate the degree of stenosis.
CONCLUSION
In our study, MRA was proved to be a very accurate diagnostic tool in children with Moyamoya disease. Therefore, MRA will be an alternative, safe, and non-invasive diagnostic tool to substitude the cerebral angiography in the near future.