Comparative Performance of Magnetic Resonance Angiography and Digital Subtraction Angiography in Vessel Involvement of Pediatric Moyamoya Disease

Background: Recently, magnetic resonance angiography (MRA) has been widely used for the detection of moyamoya disease (MMD). However, the diagnostic performance of MRA in the detection of the affected artery in MMD remains unclear. Objectives: To assess the diagnostic performance of MRA in detecting internal carotid artery (ICA), anterior cerebral artery (ACA), middle cerebral artery (MCA) or posterior cerebral artery (PCA) involvement (including stenosis and occlusion) compared with digital subtraction angiography (DSA) in pediatric MMD. Patients and Methods: Fifty-eight pediatric patients diagnosed with MMD by MRA and DSA within one week from September 2010 to September 2011 were evaluated. Results: Among 261 vessels of occlusion demonstrated by MRA, 48 vessels of stenosis were confirmed by DSA. There was a similar detection rate of vascular lesions by MRA and DSA in ICA, ACA and PCA. More lesions in MCA were detected as occlusion by MRA than DSA. MRA was more sensitive and accurate in diagnosing vascular lesions, including ICA, ACA and MCA, while it was most specific and lowest sensitive was found in diagnosing PCA. In addition, MRA was moderate to highly consistent with DSA in diagnosing MCA and PCA. Conclusion: MRA had an important diagnostic value in the detection of the affected ICA, ACA, MCA and PCA with DSA as the gold standard, but with an overestimated evaluation of stenosis severity in pediatric MMD.