Numerous recent technological advances offer the potential to substantially enhance the MRI evaluation of moyamoya disease (MMD). These include high-resolution volumetric imaging, high-resolution vessel wall characterization, improved cerebral angiographic and perfusion techniques, high-field imaging, fast scanning methods, and artificial intelligence. This review discusses the current state-of-the-art MRI applications in these realms, emphasizing key imaging findings, clinical utility, and areas that will benefit from further investigation. Although these techniques may apply to imaging of a wide array of neurovascular or other neurological conditions, consideration of their application to MMD is useful given the comprehensive multidimensional MRI assessment used to evaluate MMD. These MRI techniques span from basic cross-sectional to advanced functional sequences, both qualitative and quantitative.The aim of this review was to provide a comprehensive summary and analysis of current key relevant literature of advanced MRI techniques for the evaluation of MMD with image-rich case examples. These imaging methods can aid clinical characterization, help direct treatment, assist in the evaluation of treatment response, and potentially improve the understanding of the pathophysiology of MMD.
Keywords: 3D-TOF = 3D time-of-flight; ASL = arterial spin labeling; BOLD = blood oxygen level–dependent; CBF = cerebral blood flow; CBV = cerebral blood volume; CVR = cerebrovascular reactivity; DKI = diffusion kurtosis imaging; DSC = dynamic susceptibility contrast; DTI = diffusion tensor imaging; DWI = diffusion-weighted imaging; ECA = external carotid artery; ICA = internal carotid artery; MCA = middle cerebral artery; MIP = maximum intensity projection; MMD = moyamoya disease; MMS = moyamoya syndrome; MTT = mean transit time; OEF = oxygen extraction fraction; PD = proton density; STA = superficial temporal artery; SWI = susceptibility-weighted imaging; TTP = time to peak; VWI = vessel wall imaging; cerebral perfusion; cerebrovascular reactivity; fMRI = functional MRI; magnetic resonance angiography; moyamoya disease; rsfMRI = resting-state fMRI; vessel wall imaging.