Cerebral blood flow velocities measured by transcranial doppler are associated with magnetic resonance imaging biomarkers in moyamoya arteriopathy

Abstract

Purpose

In individuals with moyamoya arteriopathy, transcranial Doppler (TCD) may be a useful complement to MRI because of its safety, cost effectiveness, and ability to be performed without anesthesia in children. We evaluated associations between various MR-based moyamoya biomarkers and cerebral blood flow velocity (CBFV) as measured by TCD in individuals with moyamoya.

Methods

Participants ≤ 26-years-old with moyamoya who had not had surgical revascularization underwent TCDs within 14 days of surveillance brain MRIs. Associations between MRI parameters (Suzuki scores, cerebrovascular stenosis score, ivy sign, brush sign) and CBFV of the MCA and ICA were assessed.

Results

Twenty-six TCD-MRI pairs from 16 participants were analyzed. Median participant age was 7.3 (IQR 5.9–8.9) years. No associations between CBFV and Suzuki score or cerebrovascular stenosis score were identified. There was a significant positive association between MCA CBFV and degree of MCA stenosis between 0 % and 99 % stenosis (p = 0.02). Hemispheres without ivy sign had higher MCA CBFV compared with hemispheres with ivy sign (144 cm/s v. 105 cm/s, p = 0.02). Hemispheres with brush sign had higher CBFV compared with hemispheres without brush sign in both the MCA (232 cm/s v. 122 cm/s, p = 0.009) and ICA (213 cm/s v. 131 cm/s, p = 0.03).

Conclusion

In this cohort of children and young adults with moyamoya, higher MCA CBFV were associated with higher degrees of stenosis (but not complete occlusion), the presence of a brush sign, and the absence of the ivy sign. TCD may have an important role as an adjunct to traditional neuroimaging in moyamoya arteriopathy.