155 Preoperative and Postoperative MRA
for evaluating the stage of the disease. The evaluation of moyamoya vessels is indispensable for the primary diagnosis of the disease using MRA. However, once it is diagnosed, the evaluation of its steno-occlusive change is more practical for its staging.
It is true that careful observation of the signal intensity of main branches by an imaging condition is required to apply this MRA score because overestimation of the stenosis and occlusion are occasionally observed on MRA, as reported in numerous papers. In this MRA scoring method, this overestimation is also considered.
Suzuki’s angiographical staging does not necessarily relate to the clinical severity and cerebral blood flow. This point is also considered in this MRA scoring method.
156 T. Mikami et al.
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Fig. 4 ( a )–( d ) Sequential follow-up MRAs. ( a ) Preoperative MRA shows basal moyamoya vessels. ( b ) MRA 1 month after surgery demonstrates the reduction of moyamoya vessels and the STA signal increase is shown. ( c ) MRA 3 months after surgery reveals DTA/MMA signal increase shown in addition to the STA signal increase. ( d ) MRA 6 months after surgery more obviously shows the increase in the DTA/MMA signal and progression of the steno-occlusive change in ICA (bilateral sides) and the MCA (left side)
157 Preoperative and Postoperative MRA
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Introduction
The recent advent of magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) has contributed significantly to the diagnosis of moyamoya disease. According to the guidelines for the diagnosis and treatment of spontaneous occlusion of the circle of Willis, i.e., moyamoya disease, cerebral angiography is not mandatory, if MRI and MRA identify all the findings required for diagnosis [1] .
This section will present the latest knowledge concerning MRI/MRA findings of moyamoya disease and their contribution to the management of this entity.