BACKGROUND AND PURPOSE: Very few data are available with regard to high-resolution intracranial vessel wall imaging characteristics of Moyamoya disease and their relation to ischemic stroke risk. We investigated the high resolution imaging characteristics of MMD and its correlation with recent ischemic events. MATERIALS AND METHODS: Patients with Moyamoya disease confirmed by DSA, including patients after revascularization, were enrolled. All the patients underwent high-resolution intracranial vessel wall imaging. Vessel wall thickening, enhancement, and the remodeling index of the bilateral distal ICA and proximal MCA were noted. The patients were followed up at 3 months and 6 months after high-resolution intracranial vessel wall imaging and the association of ischemic events with imaging characteristics was assessed. RESULTS: Twenty-nine patients with Moyamoya disease were enrolled. The median age at symptom onset was 12 years (range, 1–51 years). A total of 166 steno-occlusive lesions were detected by high-resolution intracranial vessel wall imaging. Eleven lesions with concentric wall thickening (6.6%) were noted in 9 patients. Ten concentric contrast-enhancing lesions were observed in 8 patients, of which 3 patients (4 lesions) showed grade II enhancement. The presence of contrast enhancement (P = .01) and wall thickening (P ≤ .001) showed a statistically significant association with ischemic events within 3 months before and after the vessel wall imaging. Grade II enhancement showed a statistically significant (P = .02) association with ischemic events within 4 weeks of high-resolution intracranial vessel wall imaging. The mean ± standard deviation outer diameter of the distal ICA (right, −3.3 ± 0.68 mm; left, 3.4 ± 0.60 mm) and the remodeling index (right, 0.71 ± 0.13; left, 0.69 ± 0.13) were lower in Moyamoya disease. CONCLUSIONS: High-resolution intracranial vessel wall imaging characteristics of concentric wall thickening and enhancement are relatively rare in our cohort of patients with Moyamoya disease. The presence of wall thickening and enhancement may predict future ischemic events in patients with Moyamoya disease.

Recent advancements in medical imaging techniques have enabled the accurate identification of unruptured intracranial aneurysms. To facilitate a proper patient management strategy, it is important to develop suitable mathematical models for their rupture prediction. To this end, the development of high-fidelity computational fluid dynamics (CFD) simulations with patient-specific boundary conditions will be useful in providing reliable hemodynamic parameters. In recent review articles, researchers have pointed out that, among several clinical and image-based indicators, morphological parameters, such as aspect ratio (AR) and size ratio (SR) of the aneurysm, correlated consistently with the rupture mechanism. However, it is not clear how these morphological indicators influence the hemodynamics-based CFD predictions. In the present work, the effect of these top-ranked morphological parameters on aneurysm hemodynamics and rupture prediction is investigated. Three patient-specific models have been used for analysis with the patient-specific inlet boundary conditions. We found that with an increase in AR and SR, the maximum value of wall shear stress (WSS) near the aneurysm neck is increased. Oscillatory shear index and relative residence time values are also increased with an increase in AR and SR. Furthermore, it was observed that an aneurysm with a multilobed structure shows complex flow, low WSS, and higher residence time over the secondary lobe. The turbulent kinetic energy and vorticity near the aneurysm neck are also increased with an increase in AR and SR.

Clinical observations indicate that the shape and tortuosity of the carotid siphon are some of the contributing factors to the initiation and growth of an aneurysm. The present study explores the validity of this observation by performing systematic numerical simulations. Computational fluid dynamics (CFD) based calculations are performed to compare and contrast four different types of patient-specific carotid siphons, viz., C-, S-, U-, and helical shape, to investigate the hemodynamic influences on flow features, secondary flow patterns, and helicity. Fewer curved regions and the presence of local acute curvature were found to result in higher velocity magnitude, leading to giant sidewall aneurysms in the distal end of this curvature. In contrast, a larger number of curved regions in the parent vessel resulted in disturbed flow and reduced maximum streamwise velocity. When the velocity is lower, smaller aneurysms are observed at the bifurcation carina. The influence of siphon tortuosity, which is exemplified through the Dean number and linked to secondary flows, causes higher helicity when the vessel is more tortuous. It is hypothesized that a highly tortuous vessel protects the further growth of an aneurysm. This is in contrast to a less tortuous vessel with single acute curvature and prone to further expansile behavior of an aneurysm.