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Our group read the study by Ryoo et al1 with great interest. They applied a vessel wall high-resolution MRI technique and were able to distinguish the vessel wall enhancement pattern in Moyamoya disease (MMD) from intracranial atherosclerotic disease. Concentric or focal eccentric enhancement of the internal carotid artery or middle cerebral artery was observed in patients with MMD or patients with symptomatic intracranial atherosclerotic disease, respectively. Authors proposed that the concentric enhancement in MMD could represent the hyperproliferation of vessel wall components, whereas the focal eccentric enhancement in intracranial atherosclerotic disease could represent atherosclerotic plaques.We agree that different vessel wall enhancement patterns could represent distinct underlying pathology in various intracranial artery diseases. A more in-depth discussion elucidating the patterns and mechanisms of enhancement may be of interest. It …

Letter by Shang et al Regarding Article, “High-Resolution Magnetic Resonance Wall Imaging Findings of Moyamoya Disease”