Reversible Dilation of Cerebral Macrovascular Changes in MELAS Episodes

PurposeTo investigate the cerebral macrovascular changes as well as the relationship of large vessels and cerebral blood flow (CBF) in mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS) using magnetic resonance angiography (MRA) and arterial spin labeling (ASL) perfusion MR imaging (MRI).MethodsA total of 20patients diagnosed with MELAS (12males, 8females; mean age, 23.3years) underwent conventional MRI, time-of-flight (TOF) MRA and three dimensional ASL. Follow-up scans were performed in 10patients. The changes of cerebral arteries and branches on MRA images from both acute and recovery patients were independently evaluated by two radiologists. Lesion distribution and CBF were observed on the integrated maps of MRA and ASL.ResultsIn 14patients with clinical onsets, increased CBF was observed in all stroke-like lesions. Dilations of a single artery (four middle cerebral arteries, two posterior cerebral arteries) were found in six patients. Dilations of multiple arteries (two anterior cerebral arteries, seven middle cerebral arteries, six posterior cerebral arteries) were found in seven patients. Normal angiography was shown in one acute patient. Cortical terminal branches feeding the lesion areas were more obviously dilated than the main trunks. The dilated vessels returned to normal on follow-up scans concurrently with decreased CBF in nine patients who were resuscitated from episode attacks. Vasodilation was even seen in one preclinical patient who suffered a recurrent episode 50days later.ConclusionReversible dilation of cerebral macrovascular changes could be a new feature of MELAS and a presumed reason for fluctuant CBF. It would shed new light on the mitochondrial angiopathy.