Diagnostic accuracy of digital subtraction angiography (dsa) in correlation with computed tomography (ct) and magnetic resonance angiography (mra) in evaluation of moyamoya disease: a comparative study in a tertiary care hospital

Introduction: Moyamoya disease (MMD) is an idiopathic, non-inflammatory, non-atherosclerotic progressive vasculo-occlusive disease involving the circle of Willis, typically the supraclinoid internal carotid arteries. MMD is most prevalent in Japan and Korea where its estimated incidence is 0.35-0.54 per 100,000 people. It has bimodal peak of presentation – two-third in early childhood and one-third in 3rd-4th decade.
Purpose: We assessed the performance of NCCT and MRA in diagnosis, evaluation and staging (Suzuki and Takaku) of Moyamoya disease as the cause of recurrent cerebral strokes compared to DSA and effects of above parameters on the sensitivity of these imaging modalities, taking DSA as gold standard.
Materials and Methods: We investigated 60 patients (120 hemispheres) of recurrent strokes referred to our department between May 2018 and July 2019 after they met the inclusion criteria. Each patient underwent NCCT, MRA and DSA. The findings were recorded in predesigned and pretested case record sheet and were analysed later.
Results: A total of 9 cases of Moyamoya disease (Male- 3, Female- 6) were diagnosed on DSA. Among 18 examined hemispheres of 9 confirmed cases of MMD on DSA, MRA missed 2 and incorrectly diagnosed 4 hemispheres. Out of the 9 cases, 8 showed recurrent ischaemic strokes while only one showed haemorrhagic stroke which both NCCT and MRI could localise and diagnose with 100% efficacy. Out of 7 ICA occlusions, 10 ICA narrowing, 17 cases of anterior circulation involvement and 8 cases of posterior circulation involvement, MRA correctly diagnosed all cases of ICA occlusion and narrowing, 11 cases of anterior circulation involvement and only 1 case of posterior circulation involvement. The overall sensitivity of MRA for diagnosis and correct staging of Moyamoya disease were 77.8 % and 44.4 % respectively.
Conclusion: Digital Subtraction Angiography (DSA) is more sensitive and accurate than Magnetic Resonance Angiography (MRA) in evaluation of Moyamoya disease. Staging of Moyamoya disease is best done by DSA study.