MOYAMOYA: NHỮNG ĐIỀU BÁC SĨ CHẨN ĐOÁN HÌNH ẢNH CẦN BIẾT

Abstract

Background: Moyamoya disease and moyamoya syndrome are chronic progressive cerebrovascular disorders characterized by stenosis or occlusion of the terminal internal carotid arteries and the development of abnormal collateral networks. Early diagnosis remains challenging due to nonspecific clinical presentation and subtle initial imaging findings.

Purpose: To provide an updated neuroradiological overview of moyamoya vasculopathy, emphasizing the 2021 diagnostic criteria and the role of MRI in diagnosis, disease stratification, and clinical decision-making.

Methods: Narrative review based on the 2021 revised diagnostic criteria and recent literature on advanced MRI techniques, including vessel wall imaging and perfusion imaging.

Main findings: According to the 2021 criteria, Moyamoya can be diagnosed even in unilateral cases if typical imaging features are present. A key update is the role of heavy T2-weighted sequences in detecting the reduction of the outer diameter of the terminal internal carotid artery and the middle cerebral artery. Magnetic resonance imaging (MRI) provides a comprehensive assessment of the vessel lumen, parenchyma, and hemodynamics through advanced techniques such as vessel wall imaging and Arterial Spin Labeling (ASL), which further enhance the evaluation of disease activity and cerebral perfusion. Distinguishing between Moyamoya disease and Moyamoya syndrome requires the exclusion of underlying etiologies, which is crucial for clinical management and prognosis.

Conclusion: MRI plays a important role in the modern evaluation of moyamoya vasculopathy. A multiparametric approach enables accurate diagnosis, early detection, and improved risk stratification, ultimately supporting optimal treatment planning.