IMAGINE Moyamoya - Imaging in Moyamoya Disease

• Applicants: Professor Dr. Philipp Tobias Meyer; Professor Dr. Constantin Roder
• Subject Area: Clinical Neurology; Neurosurgery and Neuroradiology
• Term: since 2024
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 528291394

Moyamoya disease is a rare disease that often leads to strokes in young patients and, after diagnosis, may have to be treated with bypass surgery (revascularization). For indicating the revascularization of the respective cerebrovascular territory, special diagnostics are required, including a so-called water PET-CT with acetazolamide challenge, which is not covered by the German health insurance (Methoden vertragsärztlicher Versorgung). As a specialized treatment center, we have set the goal of standardizing the preoperative diagnostics with establishing an expert recommendation and also developed a procedure (CO2-triggered BOLD fMRI) which could reduce or eliminate the need to use PET-CT in the future. This method is to be validated in the context of this project in comparison to PET-CT. As an additional experimental imaging method, the possible use of resting-state fMRI to examine the cerebral blood flow will be compared with PET-CT, too. Also, a long-lasting discussion on the value of conventional MR-perfusion imaging might be ended by comparing this imaging method with the functional ones mentioned in this proposal. Furthermore, we were the first center worldwide to show the chronological context between a contrast enhancement of the vessel wall in high-resolution MRI and an active progression of Moyamoya disease in precisely the segment of contrast enhancement. This knowledge should be further researched and understood in the context of this project. In addition, suitable biomarkers will be analyzed chronologically and in relation with the contrast enhancement of the vessel wall to better understand the etiology of Moyamoya disease and likely find prognostic markers. Insights already gained in neuropsychological deficits in Moyamoya patients will be additionally recorded and analyzed by means of specific test batteries in relation to the cerebrovascular deficits Thus, this project consists of the following components: Primary objective: - Does CO2-triggered or resting-state BOLD MRI provide results comparable to those of PET-CT with acetazolamide challenge and can it replace this examination? - Identification of biomarkers correlated with disease progression seen on vessel-wall imaging to identify prognostic markers and better understand the etiology of the disease. Secondary aims: - Prognostic value of conventional MR-perfusion imaging compared to functional perfusion imaging in Moyamoya patients. - How are neurospychological changes related to blood flow deficits in specific vascular territories? - To establish an expert opinion recommendation on preoperative diagnostics in Moyamoya patients.

• DFG Programme: Research Grants