Vertebral Basilar Artery Research Articles

Application value of transcranial Doppler diagnosis for intracranial posterior circulation artery stenosis or occlusion

Objective To investigate the sensitivity and specificity of transcranial Doppler (TCD) diagnosis for intracranial posterior circulation artery stenosis or occlusion.Methods Seventy-two cases of patients treated for posterior circulation intracranial artery stenosis or occlusion were chosen,TCD and CT angiography (CTA) tests were carried out and the results were compared and analyzed.Results Compared with CTA,the sensitivity for period of posterior circulation intracranial arteries by TCD was 82.50％,while specificity reached 94.64％.Positive predictive value attained 91.67％,while negative predictive value reached 88.33％ and the accuracy was 89.58％.Conclusions TCD diagnosis for period of posterior circulation intracranial arterial has high specificity,normal sensitivity,and the highest diagnosis accuracy for intracranial segment of vertebral artery.TCD can serve as early inspecting method for intracranial artery. Key words: Vertebral-basilar artery stenosis or occlusion; Posterior cerebral artery stenosis; Transcranial Doppler; CT angiography

Long-term Magnetic Resonance Angiography Follow-up for Recanalized Vessels after Mechanical Thrombectomy

Mechanical thrombectomy is an effective revascularization therapy for acute intracranial large vessel occlusion. We retrospectively evaluated magnetic resonance angiography (MRA) follow-up data to assess the long-term patency of recanalized vessels after mechanical thrombectomy. We retrospectively reviewed medical records of consecutive patients who had undergone mechanical thrombectomy for intravenous tissue plasminogen activator-failed/ineligible acute intracranial major vessel occlusion between October 2010 and April 2013 at our institution. MRA follow-up was performed at baseline and at 24 ± 6 hours and 3 months after mechanical thrombectomy. Forty-nine patients underwent mechanical thrombectomy for acute intracranial major vessel occlusion. Mean age was 69.7 ± 11.5 years, and baseline median National Institute of Health Stroke Scale score was 15 (range, 8-24). Occlusion was found in the internal carotid artery in 18 patients (36.7%), middle cerebral artery in 26 patients (53%), and vertebral-basilar arteries in 5 patients (10.2%). Successful recanalization, as defined by a thrombolysis in cerebral infarction flow grade of 2b or 3, was achieved in 40 patients (81.6%). MRA follow-up at 24 hours after the treatment revealed that reocclusion of recanalized vessels was observed in 3 of 38 patients (7.9%). Long-term MRA follow-up showed that 2 of 27 patients (8.3%) developed diffuse severe stenosis of treated vessels. Both the patients had undergone treatment for middle cerebral artery occlusion with the Merci retriever and had been administered only anticoagulants, but not any antiplatelets. Reocclusion or late stenosis of successfully recanalized vessels was observed in 16.2% of patients. Long-term MRA follow-up of recanalized vessels will be useful, in particular, for the patient with middle cerebral artery occlusion who undergoes mechanical thrombectomy.

Transcondylar Fossa Approach for Cerebellopontine Angle and Ventral Brainstem Lesions: Microsurgical Experiences and Avoidance of Complications

To treat the large tumors located in cerebellopontine angle (CPA) and vascular pathologies including aneurysms and dissection located around the ventral brainstem, transcondylar fossa approach (TCFA) has been regarded as less invasive one. Overall 10 patients had large tumors (D> 3 cm) including schwannomas (n = 8) and meningiomas (n = 2) located in the CPA and 17 patients had vascular pathologies including vertebra-basilar artery aneurysms (n = 14) and dissection (n = 3). Anatomical aspects of the condylar fossa, occipital condyle, and adjacent neurovascular structures were evaluated preoperatively and postoperatively using a three-dimensional computed tomography and magnetic resonance imaging. Gross-total removals in tumor patients achieved without resection of the occipital condyle. In 10 patients with saccular aneurysms, the aneurysms were clipped without resection of the occipital condyle and in 4 patients, partial resection of the condyle and jugular tubercle was necessary to obtain proximal control of the vertebral artery. We met two cases with vertebral artery injury and one case with postoperative cerebrospinal fluid. Transcondylar fossa approach was less invasive technique with minimal or no resection of the occipital condyle comparing with other approaches to ventral brainstem. To avoid complications, anatomical knowledge on the joint and the condylar veins should be reviewed.

40 ml And 50 ml Contrast Volume Comparison in 256-Slice Craniocervical Computed Tomography Angiography

Objective: The main objective of this study is to reduce attenuation profiles and decrease the perivenous artifacts by decreasing the contrast amount used than used regularly. Material and methods: Sixty six patients were randomly assigned into two groups (Group A and B), each comprising 33 patients. Group A (21 men, 12 women) received the department’s standard protocol of 50 ml intravenous contrast volume, whereas Group B (19 men, 14 women) received 40 ml of contrast volume and underwent craniocervical CTA (computed tomographic angiography). Quantitatively, mean attenuation values for both groups were measured in arteries and veins of the craniocervical region. Attenuation values of veins and arteries were measured at four points. Qualitatively, two radiologists independently evaluated the axial source and maximum intensity projection (MIP) images for the occurrence of artifacts at the subclavian vein using a four-point scale. Probability values less than 0.05 were considered statistically significant. Results: Although there were no statistically significant differences in mean arterial attenuation profiles (aortocarotid artery (p=0.87) and vertebra-basilar artery (p=0.72)) in Group A versus Group B, mean venous attenuation values were lower in Group B than in Group A (110 ± 19.61 HU vs. 188.27 ± 57.4 HU; p<0.001). When compared with Group A qualitatively, the perivenous artifacts in the subclavian veins were evaluated as less prominent (p<0.001) in Group B, whereas there was no significant difference during the qualitative assessment of the arterial images. Conclusion: Use of 40 ml contrast medium on cervical CTA can reduce venous attenuation profiles and decrease perivenous artifacts in the subclavian veins when compared with 50 ml.

Obstructive sleep apnea syndrome as a novel cause for Ménièreʼs disease

Several recent reports have described the relation between sleep disorders and inner ear function. There are also many reports that insomnia is observed in Ménière's patients. However, the possibility that obstructive sleep apnea syndrome (OSAS) might affect Ménière's disease or other neurotological consequences was not noticed, until studies using polysomnography for these patients. OSAS may cause not only vestibular but also auditory dysfunction. Several reports suggest that insufficient supply of blood via the vertebral basilar artery, which supplies the inner ear, may cause hydropic distension of the endolymphatic system and lead to Ménière's disease. However, few people noticed that in OSAS this insufficient supply might be exacerbated in the night while patients are sleeping. Even more, we should note that Ménière's patients may not only suffer from insomnia, but also that the impaired sleep might be caused by OSAS. Physicians routinely prescribe benzodiazepines or other drugs that have hypnotic, muscle relaxing, antianxiety, and anticonvulsant properties for insomnia, but these properties may have the effect of aggravating OSAS symptoms. Continuous positive airway pressure (CPAP) is an effective therapy used worldwide for the treatment of OSAS. CPAP or surgeries for OSAS may also be useful as one aspect of treatment for Ménière's disease patients with OSAS.

Electrical neurocoagulation may be effective for intractable trigeminal neuralgia caused by vertebrobasilar dolichoectasia

In most cases of trigeminal neuralgia, vascular compression is caused by the superior cerebellar artery (SCA) or anterior inferior cerebellar artery. Compression of the vertebral artery (VA) or basilar artery (BA) is rarely reported, accounting for approximately 2 % [13]. Surgical treatment of trigeminal neuralgia was firstly proposed by Jannetta et al. [9], and microvascular decompression via a suboccipital approach is the most frequently used procedure. However, it may be difficult to perform this procedure when an elongated VA or BA compresses the trigeminal nerve. This report documents a case in which severe trigeminal neuralgia caused by vertebrobasilar dolichoectasia (VBD) was successfully treated by electrical neurocoagulation (ENC) of a depressed nerve. This surgical procedure could be one of the options when transposition of responsible vessel is technically or anatomically difficult. Case report

Dolichoectasia of the vertebral basilar and internal carotid arteries: A case report and literature review

Background:Dolichoectasia is a rare disorder of the cerebral vasculature consisting of vascular elongation, widening, and tortuosity, usually involving the vertebral and basilar arteries. Its neurological symptoms and signs are highly variable.Case Description:We present a case of dolichoectasia of the vertebrobasilar system in a patient with a long standing history of multiple falls. Repeat neuroimaging revealed an increase in size of the dolichoectatic segment. In addition, a new fusiform dilatation of the contralateral petrous segment of the internal carotid artery and isolated ventriculomegaly had developed.Conclusion:Vertebrobasilar dolichoectasia can cause multiple clinical manifestations, with hydrocephalus being less common. In addition, having dolichoectasia of both posterior and anterior circulation is extremely rare.

Movements after the clinical diagnosis of brain death: supraspinal motor responses or spinal reflexes

In a recent issue of Critical Care, Wu and Orizaola Balaguer [1] hypothesized that nociceptive head turning after brain death (BD) is a spinal reflex. We argue that it can be a supraspinal response, which would invalidate a diagnosis of BD. The sternocleidomastoid and trapezius are innervated by the spinal nucleus of the accessory nerve extending from the lower medulla to the ventral horn of the spinal cord (C1-C4) [2]. Lower motor neurons from the lower medulla to C2 project to the sternocleidomastoid [2], contributing to the reported motor responses. The spinal nerve roots of the accessory nerve ascend through the foramen magnum and descend through the jugular foramen. Compression of the vertebral-basilar arteries (causing intracranial circulatory arrest) and the spinal nerve roots by cerebellar tonsillar herniation at the foramen magnum would abolish the spinal accessory nerve reflex as well as cause cervicomedullary infarction. The pyramidal tract projecting from the telencephalon controls voluntary movements. Subcortical nuclei in the diencephalon, mesencephalon, and rhombencephalon control non-voluntary movements. Complex movements are generally explained as spinal reflexes rather than supraspinal motor responses, despite an incidence of 40% to 50% in heart-beating donors [3]. Dismissal of supraspinal motor responses is incongruent with the finding [4] that, on histopathological examination, about 60% of heart-beating donors have normal or minimal ischemic injury to the brainstem. If (as these histopathological findings show) the subcortical nuclei are possibly uninjured, then the supraspinal origin of movements cannot be excluded [5]. The absence of brainstem injury at autopsy raises doubt that all movements in BD are spinal motor reflexes. Additional histopathological data are needed to determine whether movements originate from supraspinal or spinal nuclei.

A Hemodynamic study of canine vertebral-basilar artery aneurysm models

Objective To establish canine vertebral-basilar artery aneurysm models and evaluate hemodynamics in the models.Methods Partially anastomose right common carotid artery (CCA) and left CCA (end to side anastomosis) to create inverted Y-junction of arteries,and then suture a harvested segment of external jugular vein to the notch of anastomosis to create a vertebral-basilar artery aneurysm.These animals were examined by using 3D digital subtraction angiography 4 weeks after surgery.Geometry parameters of the aneurysm and surrounding vasculature,specific double inlet profiles were analyzed by simulation of computational fluid dynamics (CFD) on these animal models.Results All 9 aneurysm models were created successfully.Completely patency was observed in 8 cases,partial patency in 1 case.The aneurysm height was (8.83 ±2.61) mm,the width was (5.62±1.38) mm,the neck width was (3.92 ±1.68)mm,and the AR was 1.98 ± 0.53.Geometric and hemodynamic environments created in vertebral-basilar artery aneurysm models are similar to those reported for human vertebrobasilar junction aneurysms.Conclu-sion This study documents possibility and feasibility of creating vertebral-basilar artery aneurysm models in the canine.This model may be useful in preclinical studies targeting various complex vertebral vertebralbasilar artery aneurysm. Key words: Aneurysm; Model, animal; Canine; Hemodynamics

Efficacy observation on cervical spondylosis of vertebral artery type treated with warm needling and rehabilitation physiotherapy therapy

ObjectiveTo compare the differences in the efficacy on cervical spondylosis of the vertebral artery type (CSA) treated with the warm needling therapy combined with the rehabilitation physiotherapy, the simple warm needling therapy and the simple rehabilitation physiotherapy separately and observe the impacts of them on the vertebral basilar artery (VBA) in hemodynamics. MethodsNinety cases of CSA patients were randomized divided into an acupuncture plus rehabilitation group, a warm needling group and a rehabilitation group, 30 cases in each. In the acupuncture + rehabilitation group, the warm needling therapy was used at Jiájľ (▪ EX-B 2) from C3 to C7 in combination with the rehabilitation physiotherapy such as traction and magnetic therapy. In the warm needling group, the simple warm needling therapy was applied. In the rehabilitation group, the simple rehabilitation physiotherapy was adopted. The VBA hemodynamic parameters, Vp, Vd, Vm and PI values were detected under the transcranial Doppler and taken as the indexes for the efficacy assessment of the groups. The efficacy of each group was assessed in association with the clinical curative rate. ResultsAfter treatment, the VBA hemodynamic parameters, Vp, Vd, Vm and PI values were all remarkably improved as compared with those before treatment in the three groups (P<0.01, P<0.05). The improvement of the indexes in the acupuncture plus rehabilitation group were more significant as compared with either of the other two groups (all P<0.01). The clinical curative rate was 70.0% (21/30) in the acupuncture plus rehabilitation group, which was superior to 53.3% (16/30) in the warm needling group and 53.3% (16/30) in the rehabilitation group (all P<0.01). ConclusionThe warm needling in combination with the rehabilitation physiotherapy significantly improves in VBA hemodynamic parameters for CSA and its clinical efficacy is superior to either the simple warm needling or the rehabilitation physiotherapy. Hence, this combined therapy was highly deserved to be promoted in clinical practice.

Evaluation of Age‐Related White Matter Changes Using Transcranial Doppler Ultrasonography

Age-related white matter changes (WMC) increase risk of cognitive and functional decline. They are considered as target for preventive trials. However, using magnetic resonance imaging (MRI) to screen for subclinical WMC is not cost-effective. We explored the clinical utility of transcranial Doppler ultrasound (TCD) in the evaluation of WMC. We hypothesized that the pulsatility index (PI) of TCD correlates with severity of WMC. Among 100 stroke patients with WMC, we obtained the mean PI of middle cerebral artery (MCA) and vertebral basilar artery (VB). We investigated the association between PI and WMC volume. We also obtained PI of 50 subjects who had no WMC on MRI and explored the ability of PI values in differentiating subjects with and without WMC. Multivariate linear regressions found that mean MCA PI and mean VB PI were independent predictors for total WMC volume (beta = .43, P < .001 and beta = .37, P < .001, respectively). Mean MCA PI significantly differentiated patients with WMC from those without WMC (area under curve [AUC] .85 [95% confidence interval .78-.91]) with an optimal cut-off value at 1.15 that yielded sensitivity and specificity of 73.7% and 82%, respectively. AUC for mean VB PI was .81 (95% confidence interval .74-.88) with cut-off value at 1.06 that yielded sensitivity and specificity of 70% and 75%, respectively. PI correlates with volume of WMC. It may help to differentiate those with and without WMC in stroke patients. Further study evaluating the clinical utility of TCD in screening for subclinical WMC among community elderly is warranted.

A case report of intracranial vertebral-basilar artery hypoplasia presenting with episodic dizziness

Basilar artery hypoplasia (BAH) is usually accompanied with unilateral vertebral artery hypoplasia (VAH); however, BAH with bilateral VAHs composing vertebral-basilar artery hypoplasia (VBAH) is indeed a rare curiosity. A 61-year-old woman presented with episodic dizziness for ten years. It accompanied with headache, bilateral tinnitus and blurred vision. Time-of-flight magnetic resonance angiogram with T2 true fast imaging in steady state precession confirmed the VBAH, rather than a stenosis. Symptoms subsided after daily oral aspirin and life-style change has been recommended for three months. The following one year was uneventful, and hearing improved. Finally, we conclude that the episodic dizziness with sensori-neural hearing impairment might attribute to the VBAH. It appears that life-style change was the main therapy and the antiplatelet was simply a supplementary one.

Far lateral -combined presigmoid approach in microsurgical treatment for giant petroclival and ventral brain stem lesions

Objective To study the outcome of the far lateral -combined presigmoid approach in microsurgical treatment for patients with giant petroclival tumors and vertebral - basilar artery aneurysms.Methods The clinical features,imaging data,surgical approach,outcome of operation and postoperative complications of two cases of giant vertebral - basilar artery aneurysms and one giant intra - and extracranial petroelival glomus jugulare tumor resected via the far lateral - combined presigmoid approach were analyzed retrospectively.Results Subtotal resection of the tumor was achieved in one patient.Postoperatively,this patient had drinking irritating,phonal hoarseness and peripheral facial paralysis.The first two complications of this patient were fully recovered 10 days later,and his facial paralysis was transiently getting worse,and recovered to basic level three months after surgery.Drinking irritating of two cases of giant vertebral - basilar artery aneurysms was fully recovered without limb paralysis.Conclusions The far lateral - combined presigmoid approach is a safe and effective minimal invasive surgical treatment for patient with giant petroclival tumors and vertebral- basilar artery aneurysms. Key words: Far lateral approach presigmoid approach ; Giant petroclival tumors ; Giant vertebral-basilar artery aneurysms ;

Medial medullary infarction with occlusion of distal vertebral arteryand basilar artery: A case report

症例は64歳の男性で，散歩中，突然の右片麻痺と構音障害を自覚し，当院へ緊急入院となった．頭部CTでは明らかな異常所見を指摘できず，MRI拡散強調画像を行ったところ，延髄左傍正中部に淡い高信号域を認めた．発症6日後に行ったMRI拡散強調画像では，延髄左傍正中部に強い高信号域を認めた．発症7日後の脳血管撮影では，左遠位椎骨動脈と脳底動脈で閉塞を認め，これがMMIの原因と考えられた．発症14日後に行ったbasi-parallel anatomical scanning MR imaging （BPAS-MRI）では，左遠位椎骨動脈に狭小化を認めた．MMIの原因として，遠位椎骨動脈の動脈硬化が重要で，多くはbranch occlusionの様式で梗塞を発症するといわれている．われわれの経験から，MMIの症例においてBPAS-MRIを行うことは，MMIの発症機序の推定に有用であることが示唆された．

Bow Hunter's Syndrome Masquerading as Definite Ménière's Disease

Bow Hunter's syndrome (BHS) results from vertebral-basilar insufficiency secondary to mechanical stenosis or occlusion of the unilateral vertebral artery at the atlanto-axis during head rotation. It is sometimes difficult to detect BHS, which is often ignored at other processes. A 44-year-old woman had up to 13 episodes of acute vertigo with left tinnitus, which was related to head rotation. Pure tone audiometry documented left side hearing impairment, so definite Ménière's disease was impressed; however, electronys-tagmography, a caloric test, posturagraphy, a cervical vestibular evoked myogenic potential, color-coded duplex sonography and magnetic resonance imaging/angiography disproved this. Ménière's disease was impressed and was attributed to BHS, which was related to a vertebral-basilar artery anomaly. The patient was treated conservatively and changed her work-style, and the symptoms did not recur over the following half year. Therefore, BHS can masquerade as Ménière's disease. We report this condition because of its rarity.

Clinical observation of Flunarizine combined with Duxil treating with vertebra basilar insufficiency

Objective To observe the therapeutic effects of Flunarizine combined with Duxil on patients with vertebra basilar insufficiency. Methods 138 patients with vertebra basilar insufficiency were randomly divided into two groups. 65 patients in control group were treated by Dextran 40 injection 500ml with Danshen injection 20ml was given once everyday. 73 patients in treatment group were treated by Flunarizine and Duxil on the basis of giving the same treatment as the control group, Flunarizine 5mg was taken before sleep everynight, Duxil 1 tablet was taken twice everyday. The therapeutic effects were observed 14 days later.Results The healing rate and the obvious effective rate in treatment group were 52% and 41%,The healing rate and the obvious effective rate in control group were 34% and 32%.There were significant difference between treatment group and control group in the healing rate and the obvious effective rate( P<0.01 and P< 0.05 ). We had found by check with TCD ( Trans-cranial Doppler ) the average velocity of blood in vertebral basilar artery was obviously additional after the treatment in treatment group and control group, but the addition was more significant in the treatment group ( P< 0.05 ).Conclusions Flunarizine and Duxil combined with Dextran 40 and Danshen injection have an obvious therapeutic effect on vertebra basilar insufficiency. And it is a good method and is worthy to popularizie clinically. Key words: Vertebra basilar insufficiency; Flunarizine; Duxil; United treatment

In Vivo Retrieval of a Trapped Merci Embolectomy Device

This technical note describes a complication related to the use of the Merci embolectomy device not previously reported. The device can induce critical flow limitation within an accessed vessel because of a combination of vasospasm and anatomic conformational changes. Furthermore, this can limit the safe removal of the device from intracranial vasculature. We present a novel rescue technique that can be used to safely retrieve the entrapped Merci device without inciting localized vessel injury. A 51-year-old male with embolic occlusion of the distal basilar artery and dissection-related occlusion of the left cervical vertebral underwent mechanical thrombolysis. Flow-limiting vasospasm and/or anatomic conformational changes/ telescoping of the intracranial right vertebral artery segment was induced during deployment with subsequent entrapment of the device. Reclamation of the entrapped device was performed by initially removing the Merci microcatheter. The entrapped and fixated device was then resheathed into a 4F slip catheter within the intracranial vertebral artery. The Merci device and the slip catheter were then removed. Right vertebral and proximal basilar artery flow was reestablished after removal of the Merci device. Successful clot extraction was thereafter performed using a microsnare. In vitro assessment of the device has demonstrated its propensity to induce vasospasm. In vivo entrapment of the device has not been previously reported. Successful retrieval can be achieved if the Merci device becomes entrapped and fixated. This may be an important consideration as increased utilization of the device occurs.

Giant brain aneurysm in a two–year–old girl

Brain aneurysm is an abnormal outward bulging of one of the brain arteries. Brain aneurysms are often discovered when they rupture, causing bleeding into the brain or the space surrounding the brain called the subarachnoid space. This subarachnoid hemorrhage can lead to hemorrhagic stroke, brain damage and death.1The aneurysm can present in all ages, but mainly after 50 year of age (ages 35 – 60), and exists a greater predisposition in females, with a ratio 3:2.2 Intracranial aneurysms in children are rare. About 0.5-4.6% of all aneurysms in children distinctly differ from adult, especially in male (2:1 to 3:1).3,4,5,6These injuries are located mainly in any cerebral artery specifically in those related to the well-known Circles of Willis such as internal carotid, middle cerebral and anterior cerebral artery as well as anterior communicating artery that corresponds to anterior circulatory circuit. In the posterior region they can be observed above the posterior cerebral artery, vertebral and basilar arteries, mainly. Aneurysm in children is mostly located at the bifurcation of ICA or vertebra-basilar artery posterior circulation, yet disproportionately with high incidence of posterior circulation aneurysm (40-50%) and of giant aneurysm (30-45%)

Clinical observation onthe treatment of 68 cases of insufficient blood supply of basilar artery with needle-knifetherapy

：Objective To evaluateclinical curative effect of debonding debridement trigonum submentale with needle-knife onvertebro-basilar artery insufficiency (VBI). Methods 131 cases of VBI sufferers wererandomly recruited into a control group (63 cases) and a treatment group (68 cases). Thetreatment group was treated by debonding debridement trigonum submentale withneedle-knife; while the control group was treated with puerarin intravenous injection.Observed the changes of clinical symptoms before and after the treatment and examinechanges of average of blood flowing speed in left vertebral artery, right vertebralartery, and basilar artery by TCD. Results The total effective rate was 89.71% and 85.71%in the treatment group and the control group respectively. Blood flowing speed of the leftvertebral artery, right vertebral artery,and basilar artery average showed remarkablechange (P＜0.01) after the treatment in the treatment group,, whose effectswere better than the control group (P＜0.05). Conclusion Debonding debridement trigonumsubmentale with needle-knife has remarkable curative effects on VBI. Key words: C-shaped Arm X-ray; Vertebro-basilar arteryinsufficiency; Needle-knife; Trigonum submentale

Evaluation of 64-slice spiral digital subtraction CT angiography in the diagnosis of Moyamoya disease

Objective To evaluate the diagnostic value of digital subtraction CT angiography (DSCTA) in Moyamoya disease.Methods The cerebral vascular CTA data of 54 patients with Moyamoya disease were analyzed retrospectively. All the original data were processed with non-subtraction and subtraction method.Student t-test was used to compare the post-processing time difference between DSCTA and routine CTA. Chi-square test was used to compare the differences between the detection rates of the stenosis or occlusion in the internal carotid artery (ICA) terminal,the initials of anterior cerebial artery (ACA) and middle cerebral artery (MCA),abnormal vascular network at skull base,and compensatory enlargement of vertebral-basilar artery system.The quality of DSCTA images was also evaluated.Results The quality of DSCTA images could meet the needs of demonstrating intracranial vascular lesions.DSCTA and conventional CTA imaging demonstrated 46 lesions and 32 lesions in ICA terminal,respectively.There was significant difference between the two methods (X~2=9.05 ,P＜ 0.01).Forty-eight ACA initial lesions,52 MCA initial lesions,38 cases with abnormal vascular network at skull base and 17 cases with compensatory enlargement of vertebral-basilar artery system were detected on DSCTA images,while 41,47,34 and 13 cases were detected on conventional CTA,respectively.No difference was found between the two groups (P ＞0.05).The post-processing time was (8.5±2.5)min for DSCTA,which was significantly less than that in conventional CTA [(14.5±2.0) min](t=13.77,P＜0.01).Conclusion DSCTA is a fast,easy and reliable CTA technology,which can improve the demonstration of ICA terminal lesions in patients with Moyamoya disease,and it can be used as a safe and accurate diagnostic method for the diagnosis of Moyamoya disease. Key words: Moyamoya disease ; Tomography; X-ray computed; Angiography; digital subtraction