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Song JW, Frame MY, Sellers RT, Klahn C, Fitzgerald K, Pomponio B, Schnall MD, Kasner SE, Loevner LA. Implementation of a Clinical Vessel Wall MR Imaging Program at an Academic Medical Center. AJNR Am J Neuroradiol 2024; 45:554-561. [PMID: 38514091 PMCID: PMC11288535 DOI: 10.3174/ajnr.a8191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/12/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND AND PURPOSE The slow adoption of new advanced imaging techniques into clinical practice has been a long-standing challenge. Principles of implementation science and the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework were used to build a clinical vessel wall imaging program at an academic medical center. MATERIALS AND METHODS Six phases for implementing a clinical vessel wall MR imaging program were contextualized to the RE-AIM framework. Surveys were designed and distributed to MR imaging technologists and clinicians. Effectiveness was measured by surveying the perceived diagnostic value of vessel wall imaging among MR imaging technologists and clinicians, trends in case volumes in the clinical vessel wall imaging examination, and the number of coauthored vessel wall imaging-focused publications and abstracts. Adoption and implementation were measured by surveying stakeholders about workflow. Maintenance was measured by surveying MR imaging technologists on the value of teaching materials and online tip sheets. The Integration dimension was measured by the number of submitted research grants incorporating vessel wall imaging protocols. Feedback during the implementation phases and solicited through the survey is qualitatively summarized. Quantitative results are reported using descriptive statistics. RESULTS Six phases of the RE-AIM framework focused on the following: 1) determining patient and disease representation, 2) matching resource availability and patient access, 3) establishing vessel MR wall imaging (VWI) expertise, 4) forming interdisciplinary teams, 5) iteratively refining workflow, and 6) integrating for maintenance and scale. Survey response rates were 48.3% (MR imaging technologists) and 71.4% (clinicians). Survey results showed that 90% of the MR imaging technologists agreed that they understood how vessel wall MR imaging adds diagnostic value to patient care. Most clinicians (91.3%) reported that vessel wall MR imaging results changed their diagnostic confidence or patient management. Case volumes of clinical vessel wall MR imaging performed from 2019 to 2022 rose from 22 to 205 examinations. Workflow challenges reported by MR imaging technologists included protocoling examinations and scan length. Feedback from ordering clinicians included the need for education about VWI indications, limitations, and availability. During the 3-year implementation period of the program, the interdisciplinary teams coauthored 27 publications and abstracts and submitted 13 research grants. CONCLUSIONS Implementation of a clinical imaging program can be successful using the principles of the RE-AIM framework. Through iterative processes and the support of interdisciplinary teams, a vessel wall MR imaging program can be integrated through a dedicated clinical pipeline, add diagnostic value, support educational and research missions at an academic medical center, and become a center for excellence.
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Affiliation(s)
- Jae W Song
- From the Department of Radiology (J.W.S., M.Y.F., R.T.S., B.P., M.D.S., L.A.L.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Megan Y Frame
- From the Department of Radiology (J.W.S., M.Y.F., R.T.S., B.P., M.D.S., L.A.L.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rob T Sellers
- From the Department of Radiology (J.W.S., M.Y.F., R.T.S., B.P., M.D.S., L.A.L.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Connie Klahn
- Department of Radiology, (C.K.), Penn Presbyterian Hospital, Philadelphia, Pennsylvania
| | - Kevin Fitzgerald
- Department of Radiology (K.F.), Penn Radnor, Philadelphia, Pennsylvania
| | - Bridget Pomponio
- From the Department of Radiology (J.W.S., M.Y.F., R.T.S., B.P., M.D.S., L.A.L.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mitchell D Schnall
- From the Department of Radiology (J.W.S., M.Y.F., R.T.S., B.P., M.D.S., L.A.L.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Scott E Kasner
- Department of Neurology (S.E.K.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Laurie A Loevner
- From the Department of Radiology (J.W.S., M.Y.F., R.T.S., B.P., M.D.S., L.A.L.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Li J, Tian Y, Shi Y, Cui Y, Lian J, Liu P. Association of vulnerable plaques with white matter hyperintensities on high-resolution magnetic resonance imaging. Quant Imaging Med Surg 2024; 14:3606-3618. [PMID: 38720851 PMCID: PMC11074730 DOI: 10.21037/qims-23-1856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/21/2024] [Indexed: 05/12/2024]
Abstract
Background One of the widespread manifestations of cerebral small vessel disease (CSVD) of the brain parenchyma is white matter lesion, which appears as white matter hyperintensities (WMHs) on magnetic resonance imaging (MRI). Previous studies have illustrated that large artery atherosclerosis is related to CSVD, but the precise progress of pathogenesis remains unknown. High-resolution MRI (HR-MRI) has the ability to delineate intracranial vascular walls, enabling a thorough exploration of the structure and composition of unstable plaques. This study aimed to apply HR-MRI to characterize the wall changes and plaque characteristics of middle cerebral arteries in patients with WMHs and to investigate the correlation between plaque vulnerability parameters and different degrees of WMHs. Methods In this study, 138 patients with acute ischemic stroke at Harbin Medical University's First Clinical Hospital (May 2021 to October 2023) were cross-sectionally reviewed and underwent conventional brain and HR-MRI using T1-weighted 3D volumetric isotropic turbo spin echo acquisition (T1W-3D-VISTA) of the unilateral middle cerebral artery (MCA). According to Fazekas grade (0-6), the patients were divided into two groups: Fazekas score 0-2, no-or-mild WMHs; and Fazekas 3-6, moderate-to-severe WMHs. The intraplaque hemorrhage, plaque distribution, plaque enhancement, plaque load, remodeling pattern, and stenosis of the two groups were measured. Binary logistic regression analysis was conducted to evaluate the relationship between vulnerable plaques and WMHs. Results Of the participants who were initially considered for inclusion, 71 were deemed eligible, among whom 34 were placed in the no-or-mild WMH group and 37 in the moderate-to-severe WMH group. Between the two groups, there were significant differences in intraplaque hemorrhage (P=0.01), a wide distribution (P=0.02), and plaque enhancement (P=0.02). Univariate analysis showed that WMHs were associated with age [odds ratio (OR) =1.080; 95% confidence interval (CI): 1.020-1.144; P=0.008], hypertension (OR =3.500; 95% CI: 1.276-9.597; P=0.01), intraplaque hemorrhage (OR =3.955; 95% CI: 1.247-12.538; P=0.02), a wide distribution (OR =3.067; 95% CI: 1.159-8.115; P=0.02), and significant plaque enhancement (OR =4.372; 95% CI: 1.101-17.358; P=0.03); however, the multivariate results showed that the only independent factors associated with WMHs were age (OR =1.095; 95% CI: 1.019-1.176; P=0.01) and intraplaque hemorrhage (OR =5.88; 95% CI: 1.466-23.592; P=0.01). Conclusions Our findings suggest that age and intraplaque hemorrhage may be associated with more severe WMHs in patients with acute ischemic stroke, which may be helpful for further clinical examination and intervention treatment.
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Affiliation(s)
- Jiayu Li
- Department of Magnetic Resonance, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yuan Tian
- Department of Magnetic Resonance, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ying Shi
- Department of Magnetic Resonance, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yingzhe Cui
- Department of Magnetic Resonance, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | | | - Pengfei Liu
- Department of Magnetic Resonance, the First Affiliated Hospital of Harbin Medical University, Harbin, China
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Sun B, Wang L, Li X, Zhang J, Zhang J, Tian J, Mossa-Basha M, Xu J, Zhou Y, Zhao H, Zhu C. Delayed Enhancement of Intracranial Atherosclerotic Plaque Can Better Differentiate Culprit Lesions: A Multiphase Contrast-Enhanced Vessel Wall MRI Study. AJNR Am J Neuroradiol 2024; 45:262-270. [PMID: 38388686 DOI: 10.3174/ajnr.a8132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 12/05/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND AND PURPOSE Intracranial plaque enhancement (IPE) identified by contrast-enhanced vessel wall MR imaging (VW-MR imaging) is an emerging marker of plaque instability related to stroke risk, but there was no standardized timing for postcontrast acquisition. We aim to explore the optimal postcontrast timing by using multiphase contrast-enhanced VW-MR imaging and to test its performance in differentiating culprit and nonculprit lesions. MATERIALS AND METHODS Patients with acute ischemic stroke due to intracranial plaque were prospectively recruited to undergo VW-MR imaging with 1 precontrast phase and 4 consecutive postcontrast phases (9 minutes and 13 seconds for each phase). The signal intensity (SI) values of the CSF and intracranial plaque were measured on 1 precontrast and 4 postcontrast phases to determine the intracranial plaque enhancement index (PEI). The dynamic changes of the PEI were compared between culprit and nonculprit plaques on the postcontrast acquisitions. RESULTS Thirty patients with acute stroke (aged 59 ± 10 years, 18 [60%] men) with 113 intracranial plaques were included. The average PEI of all intracranial plaques significantly increased (up to 14%) over the 4 phases. There was significantly increased PEI over the 4 phases for culprit plaques (an average increase of 23%), but this was not observed for nonculprit plaques. For differentiating culprit and nonculprit plaques, we observed that the performance of IPE in the second postcontrast phase (cutoff = 0.83, AUC = 0.829 [0.746-0.893]) exhibited superior accuracy when compared with PEI in the first postcontrast phase (cutoff = 0.48; AUC = 0.768 [0.680-0.843]) (P = .022). CONCLUSIONS A 9-minute delay of postcontrast acquisition can maximize plaque enhancement and better differentiate between culprit and nonculprit plaques. In addition, culprit and nonculprit plaques have different enhancement temporal patterns, which should be evaluated in future studies.
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Affiliation(s)
- Beibei Sun
- From the Department of Radiology, Ren Ji Hospital (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai China
- College of Health Science and Technology (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Radiology (M.M., C.Z.), University of Washington, Seattle, Washington
| | - Lingling Wang
- From the Department of Radiology, Ren Ji Hospital (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai China
- College of Health Science and Technology (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao Li
- From the Department of Radiology, Ren Ji Hospital (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai China
- College of Health Science and Technology (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jin Zhang
- From the Department of Radiology, Ren Ji Hospital (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai China
- College of Health Science and Technology (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianjian Zhang
- From the Department of Radiology, Ren Ji Hospital (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai China
- College of Health Science and Technology (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiaqi Tian
- From the Department of Radiology, Ren Ji Hospital (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai China
- College of Health Science and Technology (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mahmud Mossa-Basha
- Department of Radiology (M.M., C.Z.), University of Washington, Seattle, Washington
| | - Jianrong Xu
- From the Department of Radiology, Ren Ji Hospital (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai China
- College of Health Science and Technology (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Zhou
- From the Department of Radiology, Ren Ji Hospital (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai China
- College of Health Science and Technology (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huilin Zhao
- From the Department of Radiology, Ren Ji Hospital (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai China
- College of Health Science and Technology (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chengcheng Zhu
- Department of Radiology (M.M., C.Z.), University of Washington, Seattle, Washington
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Simaan N, Jubeh T, Shalabi F, Jubran H, Metanis I, Parag Y, Schwartzman Y, Magadlla J, Gomori JM, Beiruti KW, Cohen JE, Leker R. Diagnostic Yield of High-Resolution Vessel Wall Magnetic Resonance Imaging in the Evaluation of Young Stroke Patients. J Clin Med 2023; 13:189. [PMID: 38202196 PMCID: PMC10779627 DOI: 10.3390/jcm13010189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/16/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
(1) Background: The mechanism responsible for stroke in patients younger than 50 often remains unknown. This study was designed to assess whether high-resolution intracranial vessel wall MR imaging (icVWI) may be instrumental in determining stroke cause. (2) Methods: Young stroke patients with and without an identified cause of stroke despite an exhaustive investigation were prospectively included. Patients who underwent icVWI were compared to those who did not. We next compared patients with and without intracranial vulnerable plaques on icVWI. (3) Results: Overall, 47 young stroke patients were identified over the span of 2 years and included in this study. Of those, 20 (42%) underwent intracranial icVWI. Cancer prevalence was higher among patients who did not have an icVWI study (19% vs. 0% p = 0.042) but there were no other significant differences between patients who had an icVWI study and those who did not have an icVWI. Among patients who had an icVWI, 11 (55%) had vulnerable plaques and the remaining nine studies were negative. Patients with positive icVWI scans had significantly higher stroke severity at admission (mean ± SD NIHSS score 5.5 ± 3.5 vs. 1.7 ± 2.3, p = 0.012). Patients with positive icVWI scans were more often treated with antiplatelets upon discharge (100% vs. 67%, p = 0.038). (4) Conclusions: icVWI can add significant information relevant to stroke pathogenesis and secondary prevention among young stroke patients with a negative exhaustive diagnostic workup.
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Affiliation(s)
- Naaem Simaan
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem 9112102, Israel; (N.S.); (F.S.); (H.J.); (I.M.); (Y.S.); (J.M.)
- Azrieli Faculty of Medicine, Bar Ilan University, Safed 1311502, Israel
- Department of Neurology, Ziv Medical Center, Safed 1311001, Israel;
| | - Tamer Jubeh
- Department of Neurology, Ziv Medical Center, Safed 1311001, Israel;
| | - Fatma Shalabi
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem 9112102, Israel; (N.S.); (F.S.); (H.J.); (I.M.); (Y.S.); (J.M.)
| | - Hamza Jubran
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem 9112102, Israel; (N.S.); (F.S.); (H.J.); (I.M.); (Y.S.); (J.M.)
| | - Issa Metanis
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem 9112102, Israel; (N.S.); (F.S.); (H.J.); (I.M.); (Y.S.); (J.M.)
| | - Yoav Parag
- Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem 9112102, Israel; (Y.P.); (J.M.G.)
| | - Yoel Schwartzman
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem 9112102, Israel; (N.S.); (F.S.); (H.J.); (I.M.); (Y.S.); (J.M.)
| | - Jad Magadlla
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem 9112102, Israel; (N.S.); (F.S.); (H.J.); (I.M.); (Y.S.); (J.M.)
| | - John. M. Gomori
- Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem 9112102, Israel; (Y.P.); (J.M.G.)
| | | | - Jose E. Cohen
- Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem 9112102, Israel;
| | - Ronen Leker
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem 9112102, Israel; (N.S.); (F.S.); (H.J.); (I.M.); (Y.S.); (J.M.)
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Simaan N, Shalabi F, Schwartzmann Y, Jubeh T, Parag Y, Honig A, Metanis I, Joubran H, Magadlla J, Gomori JM, Cohen JE, Leker RR. Impact of high-resolution intracranial vessel wall magnetic resonance imaging on diagnosis in patients with embolic stroke of unknown source. J Neurol Sci 2023; 454:120863. [PMID: 37931444 DOI: 10.1016/j.jns.2023.120863] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 09/05/2023] [Accepted: 10/27/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND The mechanism responsible for stroke in patients with embolic stroke of unknown source (ESUS) often remains unknown despite extensive investigations. We aimed to test whether high-resolution intracranial vessel wall MR imaging (icVWI) can add to the diagnostic yield in these patients. PATIENTS AND METHODS Patients with ESUS were prospectively included into an ongoing registry. Patients that underwent icVWI as part of their diagnostic workup were compared to those that did not have an icVWI. Patients with icVWI positive for intracranial vulnerable plaques were than compared to those without evidence of plaque vulnerability on VWI. RESULTS A total of 179 patients with ESUS were included and 48 of them (27%) underwent icVWI. Patients that had an icVWI scan were significantly younger, had lower rates of ischemic heart disease and prior disability as well as significantly lower stroke severity. On regression analysis the only factor that remained associated with not obtaining an icVWI scan was increasing age (Odds ratio [OR] 0.97/year, 95% confidence intervals [CI] 0.95-0.97). Among patients that had an icVWI scan 28 (58%) had evidence of plaque enhancement on VWI in the same distribution of the stroke and the remaining 20 studies were negative. The relative proportion of stroke presumed to be secondary to intracranial non-stenotic atheromatous disease increased from 15% in patients without icVWI scans to 58% among patients with icVWI scans (p = 0.001). On regression analysis the only factor that was associated with vulnerable plaques on icVWI was smoking (OR 11.05 95% CI 1.88-65.17). CONCLUSIONS icVWI can add significant information relevant to stroke pathogenesis and treatment in patients with ESUS and a negative initial exhaustive diagnostic workup.
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Affiliation(s)
- Naaem Simaan
- Departments of Neurology, Ziv Medical Center, Zefat, Israel
| | - Fatma Shalabi
- Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Yoel Schwartzmann
- Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Tamer Jubeh
- Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Yoav Parag
- Departments of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Asaf Honig
- Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Issa Metanis
- Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Hamza Joubran
- Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Jad Magadlla
- Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - John M Gomori
- Departments of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Jose E Cohen
- Departments of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ronen R Leker
- Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
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Sakai Y, Lehman VT, Eisenmenger LB, Obusez EC, Kharal GA, Xiao J, Wang GJ, Fan Z, Cucchiara BL, Song JW. Vessel wall MR imaging of aortic arch, cervical carotid and intracranial arteries in patients with embolic stroke of undetermined source: A narrative review. Front Neurol 2022; 13:968390. [PMID: 35968273 PMCID: PMC9366886 DOI: 10.3389/fneur.2022.968390] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/01/2022] [Indexed: 11/13/2022] Open
Abstract
Despite advancements in multi-modal imaging techniques, a substantial portion of ischemic stroke patients today remain without a diagnosed etiology after conventional workup. Based on existing diagnostic criteria, these ischemic stroke patients are subcategorized into having cryptogenic stroke (CS) or embolic stroke of undetermined source (ESUS). There is growing evidence that in these patients, non-cardiogenic embolic sources, in particular non-stenosing atherosclerotic plaque, may have significant contributory roles in their ischemic strokes. Recent advancements in vessel wall MRI (VW-MRI) have enabled imaging of vessel walls beyond the degree of luminal stenosis, and allows further characterization of atherosclerotic plaque components. Using this imaging technique, we are able to identify potential imaging biomarkers of vulnerable atherosclerotic plaques such as intraplaque hemorrhage, lipid rich necrotic core, and thin or ruptured fibrous caps. This review focuses on the existing evidence on the advantages of utilizing VW-MRI in ischemic stroke patients to identify culprit plaques in key anatomical areas, namely the cervical carotid arteries, intracranial arteries, and the aortic arch. For each anatomical area, the literature on potential imaging biomarkers of vulnerable plaques on VW-MRI as well as the VW-MRI literature in ESUS and CS patients are reviewed. Future directions on further elucidating ESUS and CS by the use of VW-MRI as well as exciting emerging techniques are reviewed.
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Affiliation(s)
- Yu Sakai
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Vance T. Lehman
- Department of Radiology, The Mayo Clinic, Rochester, MN, United States
| | - Laura B. Eisenmenger
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States
| | | | - G. Abbas Kharal
- Department of Neurology, Cerebrovascular Center, Neurological Institute, Cleveland, OH, United States
| | - Jiayu Xiao
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Grace J. Wang
- Department of Vascular Surgery and Endovascular Therapy, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Zhaoyang Fan
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Brett L. Cucchiara
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Jae W. Song
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
- *Correspondence: Jae W. Song
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Li F, Wang Y, Hu T, Wu Y. Application and interpretation of vessel wall magnetic resonance imaging for intracranial atherosclerosis: a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:714. [PMID: 35845481 PMCID: PMC9279807 DOI: 10.21037/atm-22-2364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/01/2022] [Indexed: 11/06/2022]
Abstract
Background and Objective Atherosclerosis is a systemic disease that occurs in the arteries, and it is the most important causative factor of ischemic stroke. Vessel wall magnetic resonance imaging (VWMRI) is one of the best non-invasive methods for displaying the vascular features of intracranial atherosclerosis. The main clinical applications of this technique include the exploration of the pathogenesis of intracranial atherosclerotic lesions, follow-up monitoring, and treatment prognosis judgment. As the demand for intracranial VWMRI increases in clinical practice, radiologists should be aware of the selection of imaging parameters and how they affect image quality, clinical indications, evaluation methods, and limitations in interpreting these images. Therefore, this review focused on describing how to perform and interpret VWMRI of intracranial atherosclerotic lesions. Methods We searched the studies on the application of VWMRI in the PubMed database from January 1, 2000 to March 31, 2022, and focused on the analysis of related studies on VWMRI in atherosclerotic lesions, including technical application, expert consensus, imaging characteristics, and the clinical significance of intracranial atherosclerotic lesions. Key Content and Findings We reviewed and summarized recent advances in the clinical application of VWMRI in atherosclerotic diseases. Currently accepted principles and expert consensus recommendations for intracranial VWMRI include high spatial resolution, multiplanar two and three-dimensional imaging, multiple tissue-weighted sequences, and blood and cerebrospinal fluid suppression. Understanding the characteristics of VWMRI of normal intracranial arteries is the basis for interpreting VWMRI of atherosclerotic lesions. Evaluating VWMRI imaging features of intracranial atherosclerotic lesions includes plaque morphological and enhancement characteristics. The evaluation of atherosclerotic plaque stability is the highlight of VWMRI. Conclusions VWMRI has a wide range of clinical applications and can address important clinical questions and provide critical information for treatment decisions. VWMRI plays a key role in the comprehensive evaluation and prevention of intracranial atherosclerosis. However, intracranial VWMRI is still unable to obtain in vivo plaque pathological specimens for imaging—pathological comparison is the most significant limitation of this technique. Further technical improvements are expected to reduce acquisition time and may ultimately contribute to a better understanding of the underlying pathology of lesions on VWMRI.
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Affiliation(s)
- Fangbing Li
- Department of Radiology, Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Yilin Wang
- Department of Radiology, Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Tianxiang Hu
- Department of Radiology, Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Yejun Wu
- Department of Radiology, Fourth Affiliated Hospital of China Medical University, Shenyang, China
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Song JW, Xiao J, Cen SY, Liu X, Wu F, Schlick K, Li D, Yang Q, Song SS, Fan Z. Sex Differences in Intracranial Atherosclerosis in Patients With Hypertension With Acute Ischemic Stroke. J Am Heart Assoc 2022; 11:e025579. [PMID: 35574965 PMCID: PMC9238545 DOI: 10.1161/jaha.122.025579] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Studies suggest the presence of sex differences in hypertension prevalence and its associated outcomes in atherosclerosis and stroke. We hypothesized a higher intracranial atherosclerosis burden among men with hypertension and acute ischemic stroke compared with women. Methods and Results A multicenter retrospective study was performed from a prospective database identifying patients with hypertension presenting with intracranial atherosclerosis‐related acute ischemic stroke and imaged with intracranial vessel wall magnetic resonance imaging. Proximal and distal plaques on vessel wall magnetic resonance imaging were scored. Negative binomial models assessed the associations between plaque‐count and sex and the interaction between sex and treatment. Covariates were selected by a least absolute shrinkage and selection operator procedure. Sixty‐one patients (n=42 men) were included. There were no significant differences in demographic or cardiovascular risk factors except for smoking history (P=0.002). Adjusted total and proximal plaque counts for men were 1.6 (95% CI, 1.2–2.1; P<0.01) and 1.4 (95% CI, 1.0–1.9; P=0.03) times as high as women, respectively. Female sex was more protective for proximal plaque if treated for hypertension. The risk ratio of men versus women was 1.5 (95% CI, 1.0–2.1) for treated patients. The risk ratio of men versus women was 0.7 (95% CI, 0.4–1.3) for untreated patients. The relative difference between these 2 risk ratios was 2.0 (95% CI, 1.1–3.9), which was statistically significant from the interaction test, P=0.04. Conclusions Men with hypertension with acute ischemic stroke have significantly higher total and proximal plaque burdens than women. Women with hypertension on anti‐hypertensive medication showed a greater reduction in proximal plaque burden than men. Further confirmation with a longitudinal cohort study is needed and may help evaluate whether different treatment guidelines for managing hypertension by sex can help reduce intracranial atherosclerosis burden and ultimately acute ischemic stroke risk.
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Affiliation(s)
- Jae W. Song
- Department of Radiology University of Pennsylvania Philadelphia PA
| | - Jiayu Xiao
- Department of Radiology University of Southern California Los Angeles CA
| | - Steven Y. Cen
- Department of Radiology University of Southern California Los Angeles CA
| | - Xiao Liu
- Department of Radiology Chaoyang Hospital Beijing China
| | - Fang Wu
- Department of Radiology Xuanwu Hospital Beijing China
| | - Konrad Schlick
- Department of Neurology Cedars‐Sinai Medical Center Los Angeles CA
| | - Debiao Li
- Biomedical Imaging Research Institute Cedars‐Sinai Medical Center Los Angeles CA
| | - Qi Yang
- Department of Radiology Chaoyang Hospital Beijing China
| | - Shlee S. Song
- Department of Neurology Cedars‐Sinai Medical Center Los Angeles CA
| | - Zhaoyang Fan
- Department of Radiology University of Southern California Los Angeles CA
- Biomedical Imaging Research Institute Cedars‐Sinai Medical Center Los Angeles CA
- Department of Biomedical Engineering University of Southern California Los Angeles CA
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7T MRI for Intracranial Vessel Wall Lesions and Its Associated Neurological Disorders: A Systematic Review. Brain Sci 2022; 12:brainsci12050528. [PMID: 35624915 PMCID: PMC9139315 DOI: 10.3390/brainsci12050528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/16/2022] [Accepted: 04/20/2022] [Indexed: 11/24/2022] Open
Abstract
Intracranial vessel wall lesions are involved in a variety of neurological diseases. The advanced technique 7T MRI provides greater efficacy in the diagnosis of the pathology changes in the vessel wall and helps to identify potential subtle lesions. The purpose of this literature review was to systematically describe and evaluate the existing literature focusing on the use of 7T MRI in the detection and characterization of intracranial vessel wall lesions and their associated neurological disorders, to highlight the current knowledge gaps, and to formulate a framework to guide future applications and investigations. We systematically reviewed the existing articles up to July 2021, seeking the studies that assessed intracranial vessel wall lesions and their associated neurological disorders using 7T MRI. The literature search provided 12 studies that met the inclusion criteria. The most common intracranial vessel wall lesions were changes related to intracranial atherosclerosis (n = 8) and aneurysms (n = 4), such as intracranial atherosclerosis burden and aneurysm wall enhancement. The associated neurological disorders included aneurysms, ischemic stroke or TIA, small vessel disease, cognitive decline, and extracranial atherosclerosis. No paper studied the use of 7T MRI for investigating vessel wall conditions such as moyamoya disease, small vessel disease, or neurological disorders related to central nervous vasculitis. In conclusion, the novel 7T MRI enables the identification of a wider spectrum of subtle changes and associations. Future research on cerebral vascular diseases other than intracranial atherosclerosis and aneurysms may also benefit from 7T MRI.
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