MRI-Based Assessment of Risk for Stroke in Moyamoya Angiopathy (MARS-MMA): An MRI-Based Scoring System for the Severity of Moyamoya Angiopathy

Before revascularization, moyamoya patients require hemodynamic evaluation. In this study, we evaluated the scoring system , (PIRAMID). We also devised a new scoring system, (MARS-MMA), and compared the scoring systems with respect to the capability to predict impaired [ O]water PET cerebral perfusi...

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Published in:Diagnostics (Basel) 2024-07, Vol.14 (13), p.1437
Main Authors: Zerweck, Leonie, Roder, Constantin, Blazhenets, Ganna, Martus, Peter, Thurow, Johannes, Haas, Patrick, Estler, Arne, Gohla, Georg, Ruff, Christer, Selo, Nadja, Würtemberger, Urs, Khan, Nadia, Klose, Uwe, Ernemann, Ulrike, Meyer, Philipp T, Hauser, Till-Karsten
Format: Article
Language:English
Subjects:
[15O]water PET
cerebral perfusion reserve capacity
Clinical decision making
Datasets
Ischemia
Mars
Medical imaging
moyamoya angiopathy
MRI
scoring system
Stroke
Transient ischemic attack
Veins & arteries
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Summary:Before revascularization, moyamoya patients require hemodynamic evaluation. In this study, we evaluated the scoring system , (PIRAMID). We also devised a new scoring system, (MARS-MMA), and compared the scoring systems with respect to the capability to predict impaired [ O]water PET cerebral perfusion reserve capacity (CPR). We evaluated 69 MRI, 69 DSA and 38 [ O]water PET data sets. The PIRAMID system was validated by ROC curve analysis with neurological symptomatology as a dependent variable. The components of the MARS-MMA system and their weightings were determined by binary logistic regression analysis. The comparison of PIRAMID and MARS-MMA was performed by ROC curve analysis. The PIRAMID score correlated well with the symptomatology (AUC = 0.784). The MARS-MMA system, including impaired breath-hold-fMRI, the presence of the Ivy sign and arterial wall contrast enhancement, correlated slightly better with CPR impairment than the PIRAMID system (AUC = 0.859 vs. 0.827, Akaike information criterion 140 vs. 146). For simplified clinical use, we determined three MARS-MMA grades without loss of diagnostic performance (AUC = 0.855). The entirely MRI-based MARS-MMA scoring system might be a promising tool to predict the risk of stroke.
ISSN:2075-4418
2075-4418
DOI:10.3390/diagnostics14131437