Enhanced Blood Vessel Visualization and Accelerated Image Acquisition Using Spiral MRA in Moyamoya Disease: A Comparative Study with Cartesian MRA

To compare the blood vessel visualization with spiral MRA (MRAspiral) and compressed SENSE accelerated Cartesian MRA (MRACS) in moyamoya disease (MMD) patients, with digital subtraction angiography (DSA) as the reference standard. We prospectively collected MRAspiral with different acquisition windows (τ = 4, 6, 10 ms), MRACS and DSA in MMD patients. Contrast-to-noise ratio (CNR) was measured in the M1, M2, M3, and M4 segments of the middle cerebral artery (MCA) for each MRA sequence. Vessel visualization of the distal MCA, leptomeningeal artery (LMA) collaterals, distal external carotid artery (ECA), and internal carotid artery (ICA) steno-occlusion was qualitatively analyzed using 3- and 4-point likert scales compared to DSA. A linear fixed-effects model was used to determine differences among the four sequences. A total of 98 hemispheres from 55 MMD patients were included. CNR in the M2, M3 and M4 segments of the MCA was not significantly different between MRACS and MRAτ4 or MRAτ6, but it was significantly higher in MRACS than MRAτ10 (M2: P < 0.001, M3: P < 0.001, M4: P = 0.013). MRAspiral sequences provided better visualization of the distal MCA, LMA collaterals and distal ECA compared to MRACS (all P < 0.001). MRAspiral offers improved vessel visualization in distal arteries with adequate image quality for patients with MMD. Compared to MRACS, MRAspiral can reduce scan time by 32.31% when the τ value is set to 6 ms, while also providing superior image quality. Spiral MRA performs well in visualizing collateral vessels in moyamoya disease with shorter scan time.