Asymptomatic microbleeds in moyamoya disease: T2*-weighted gradient-echo magnetic resonance imaging study

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Object. The aim of this study was to investigate the incidence of asymptomatic microbleeds (MBs) in patients with moyamoya disease (MMD) by using a 3-tesla magnetic resonance (MR) imaging unit.

Methods. Data on 63 patients hospitalized with MMD between 1999 and 2004 were retrospectively examined to determine the incidence of asymptomatic MBs. Gradient-echo T2*-weighted MR imaging studies obtained using 3- and 1.5-tesla units were available in 25 patients. These patients consisted of five men and 20 women, ranging in age from 17 to 66 years (mean age 41 ± 14 years). Ischemic MMD was diagnosed in 18 patients, and hemorrhagic MMD in seven. The incidence of MBs was also evaluated using the same 3-tesla MR imaging unit in 34 healthy volunteers including seven men and 27 women, ranging in age from 18 to 71 years (mean age 33 ± 12 years). Using the 3-tesla MR unit, asymptomatic MBs were demonstrated in 11 patients (44%); they were detected in seven patients (28%) by using the 1.5-tesla unit. In the 3-tesla MR studies in healthy individuals, MBs were found in two patients (5.8%). Based on 3-tesla MR studies, the incidence of MBs was significantly higher in patients with MMD compared with that in healthy individuals. Asymptomatic MBs were demonstrated in eight (44%) of 18 patients with ischemic MMD and three (43%) of seven patients with hemorrhagic MMD.

Conclusions. Microbleeds are significantly more common in patients with MMD than in healthy individuals regardless of the disease type. The evaluation of MBs with T2*-weighted 3-tesla MR imaging might contribute to the treatment of MMD.

Article Information

Address reprint requests to: Ken-ichiro Kikuta, M.D., Ph.D., Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606–8507, Japan. email: kikuta@kuhp.kyoto-u.ac.jp.

© AANS, except where prohibited by US copyright law.

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Figures

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    Chart demonstrating patient age and sex, disease diagnosis, clinical course, dates of surgery and MR imaging studies, and T2*-weighted gradient-echo images, obtained using the 3-tesla unit in the 11 patients, revealing hypointense dot spots. Magnified versions of the T2*-weighted images are featured below each original image. EDAS = encephaloduroarterio synangiosis; EMS = encephalomyosynangiosis; STA—MCA = superficial temporal artery—middle cerebral artery; — = not applicable.

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    Case 5. A: An 123I-IMP SPECT scan revealing decreased rCBF in the bilateral frontal lobes. B: A FLAIR 1.5-tesla MR image demonstrating mild ischemic lesions in the deep white matter of the frontal lobes. C: A CT scan displaying no hemorrhagic lesion. D: A T2*-weighted 3-tesla MR image revealing multiple MBs in the periventricular regions.

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    A T2*-weighted 3-tesla image (A) and T2-weighted images (B and C) obtained in a 26-year-old healthy female volunteer. The former image demonstrates an MB (arrow) in the right occipital lobe, which was described as a heterogeneous intensity mass on T2-weighted imaging, indicating that the lesion can be diagnosed as cavernous angioma. Note that C is a magnified version of the image in B.

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    Case 3. A T2*-weighted image (A) obtained with a 3-tesla MR unit, demonstrating an MB in the white matter of the right parietal lobe, which was not revealed on an image (B) obtained using the 1.5-tesla unit. Case 8. A T2*-weighted image (C) obtained with a 3-tesla MR unit, revealing an MB in the left occipital lobe, which could not be detected on an image (D) obtained using the 1.5-tesla unit.

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