1
|
Ouyang F, Wang B, Wu Q, Yu N, Liu J, Li L, Xu Z, Lv L, Zeng X. Association of intravascular enhancement sign on 3D-T1W TSE with collateral status in middle cerebral artery occlusion stroke. Magn Reson Imaging 2023; 103:139-144. [PMID: 37507028 DOI: 10.1016/j.mri.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/25/2023] [Accepted: 07/25/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVE The significance of the intravascular enhancement sign (IVES) on high-resolution magnetic resonance vascular wall imaging (HR-VWI) remains unclear. This study aimed to investigate the correlation between the IVES and collateral assessment derived from digital subtraction angiography (DSA). METHOD A total of 75 patients with occlusion of the first segment of the middle cerebral artery (MCA) who underwent HR-VWI and DSA examinations at our research institution between November 2016 and February 2023 were included. The number of vessels with IVES, IVES-Alberta Stroke Program Early Computed Tomography Score (ASPECTS), American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) collateral grade, and DSA collateral blood flow grade were retrospectively evaluated. Correlations between these indicators were assessed using Spearman's correlation. RESULTS Interrater agreement was good for the assessment of HR-VWI and DSA indicators. After adjustments for age, degree of wall enhancement, and hypertension, a multivariable ordinal logistic regression model identified both the number of IVES vessels (OR = 1.37; 95%CI [1.06-1.78]; P = 0.017) and IVES-ASPECTS (OR = 2.00; 95%CI [1.03-3.87]; P = 0.041) as independent predictors of ischemic stroke. In the patient group with acute ischemic stroke, we found weak correlations between the number of IVES vessels and the ASITN/SIR collateral grade (rho = -0.35; P = 0.002) and between the IVES-ASPECTS and ASITN/SIR collateral grade (rho = -0.27; P = 0.02). Moreover, there were strong correlations between the number of IVES vessels and the DSA collateral blood flow grade (rho = -0.74; P < 0.001) and between the IVES-ASPECTS and the DSA collateral blood flow grade (rho = -0.65; P < 0.001). The number of IVES vessels correlated strongly with the IVES-ASPECTS (rho = 0.92, P < 0.001). CONCLUSION We find that the IVES is closely associated with sluggish collateral blood flow, which further confirms the hemodynamic mechanism underlying the IVES in MCA occlusion.
Collapse
Affiliation(s)
- Feng Ouyang
- Department of Radiology, First Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China
| | - Bo Wang
- Department of Radiology, First Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China
| | - Qin Wu
- Department of Radiology, First Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China
| | - Nianzu Yu
- Department of Neurosurgery, First Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China
| | - Jie Liu
- Department of Radiology, First Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China
| | - Lin Li
- Department of Neurosurgery, First Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China
| | - Zihe Xu
- Department of Radiology, First Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China
| | - Lianjiang Lv
- Department of Radiology, First Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China
| | - Xianjun Zeng
- Department of Radiology, First Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China.
| |
Collapse
|
2
|
Liu S, Lu M, Gao X, Wen C, Sun B, Liu Y, Han C, Hao F, Sheng F, Liu D, Zhang H, Cai J. The diagnostic performance of high-resolution magnetic resonance-vessel wall imaging in differentiating atherosclerosis-associated moyamoya vasculopathy from moyamoya disease. Eur Radiol 2023; 33:6918-6926. [PMID: 37453985 DOI: 10.1007/s00330-023-09951-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 05/16/2023] [Accepted: 05/21/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVES To evaluate the diagnostic performance of high-resolution magnetic resonance-vessel wall imaging (HRMR-VWI) in differentiating moyamoya disease (MMD) from atherosclerosis-associated moyamoya vasculopathy (AS-MMV) and investigate an accurate approach for the differential diagnosis. METHODS Adult patients who were diagnosed as MMD or AS-MMV and underwent HRMR-VWI were retrospectively included. The three vessel wall features (outer diameter (OD), remodeling index (RI), and pattern of vessel wall thickening) of middle cerebral artery (MCA) in identifying MMD from AS-MMV were assessed and compared. Furthermore, subgroup analysis stratified by degree of luminal stenosis was performed and the cutoff values of different vessel wall features in differentiating MMD from AS-MMV were also calculated. RESULTS A total of 265 patients (160 cases of MMD and 105 AS-MMV) were included. Patients with AS-MMV had greater OD and RI and were more likely to exhibit eccentric thickening of vessel wall compared to those with MMD (all p < 0.001). The ROC analysis showed that the AUC value of OD was greater than that of RI (0.912 vs. 0.889, p = 0.007) in differentiating MMD from AS-MMV, and their corresponding cutoff values were 1.77 mm and 0.27, respectively. And the AUC value of pattern of vessel wall thickening was 0.786 in non-occluded patients. With the increase of lumen stenosis, the discrimination power of the three indicators enhanced correspondingly. CONCLUSIONS HRMR-VWI is valuable in distinguishing MMD from AS-MMV. The OD of MCA has better diagnostic performance in differentiating AS-MMV from MMD compared to RI and pattern of vessel wall thickening. CLINICAL RELEVANCE STATEMENT The outer diameter of the involved artery proved to be both accurate and convenient in distinguishing atherosclerosis-associated moyamoya vasculopathy from moyamoya disease and may provide a quantitative reference for clinical diagnosis. KEY POINTS High-resolution magnetic resonance-vessel wall imaging is valuable in distinguishing atherosclerosis-associated moyamoya vasculopathy from moyamoya disease. Compared to remodeling index and pattern of vessel wall thickening, outer diameter is more accurate in differentiating atherosclerosis-associated moyamoya vasculopathy from moyamoya disease. With the increase of lumen stenosis, the discrimination power of outer diameter, remodeling index, and pattern of vessel wall thickening enhanced correspondingly.
Collapse
Affiliation(s)
- Shitong Liu
- Medical School of Chinese PLA, Beijing, 100039, China
- Department of Radiology, the Fifth Medical Center, Chinese PLA General Hospital, Beijing, 100071, China
| | - Mingming Lu
- Department of Radiology, Pingjin Hospital, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, China
| | - Xianya Gao
- Department of Radiology, the Fifth Medical Center, Chinese PLA General Hospital, Beijing, 100071, China
| | - Caimei Wen
- Department of Radiology, 928th Hospital of the PLA Joint Logistics Support Force, Hainan, China
| | - Binbin Sun
- Senior Department of Neurology, the First Medical Center of PLA General Hospital, Beijing, 100039, China
| | - Yuan Liu
- Department of Radiology, the Fifth Medical Center, Chinese PLA General Hospital, Beijing, 100071, China
| | - Cong Han
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, 100039, China
| | - Fangbin Hao
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, 100039, China
| | - Fugeng Sheng
- Department of Radiology, the Fifth Medical Center, Chinese PLA General Hospital, Beijing, 100071, China
| | - Dongqing Liu
- Department of Radiology, the Fifth Medical Center, Chinese PLA General Hospital, Beijing, 100071, China
| | - Hongtao Zhang
- Department of Radiology, the Fifth Medical Center, Chinese PLA General Hospital, Beijing, 100071, China.
| | - Jianming Cai
- Department of Radiology, the Fifth Medical Center, Chinese PLA General Hospital, Beijing, 100071, China.
| |
Collapse
|
3
|
Wu XB, Liu YA, Huang LX, Guo X, Cai WQ, Luo B, Wang SW. Hemodynamics combined with inflammatory indicators exploring relationships between ischemic stroke and symptomatic middle cerebral artery atherosclerotic stenosis. Eur J Med Res 2023; 28:378. [PMID: 37752519 PMCID: PMC10523698 DOI: 10.1186/s40001-023-01344-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/05/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND AND PURPOSE Intracranial atherosclerotic stenosis (ICAS) is a major cause of ischemic stroke, and high-resolution vessel wall imaging (HR-VWI) can be used to assess the plaque characteristics of ICAS. This study combined HR-VWI, hemodynamics, and peripheral blood inflammatory indicators to investigate the role of these factors in symptomatic intracranial atherosclerotic stenosis (sICAS) and their inter-relationships. METHODS Patients diagnosed with atherosclerotic middle cerebral artery stenosis were recruited retrospectively from June 2018 to July 2022. Plaque enhancement was qualitatively and quantitatively analyzed, and the degree of plaque enhancement was graded according to the plaque-to-pituitary stalk contrast ratio (CR). Computational fluid dynamics models were constructed, and then hemodynamic parameters, including wall shear stress (WSS) and pressure ratio (PR), were measured and recorded. Univariate and multivariable analyses were performed to identify factors that can predict sICAS. In addition, the correlation analysis between the plaque characteristics on HR-VWI, hemodynamic parameters, and peripheral blood inflammatory indicators was performed to investigate the interrelationships between these factors. RESULTS Thirty-two patients were included. A higher proportion of plaque enhancement, maximum WSS, and WSS ratio (WSSR) were significantly associated with sICAS. The multiple logistic regression analysis showed that only the WSSR was an independent risk factor for sICAS. The correlation analysis revealed that both the CR and plaque burden showed linear positive correlation with the WSSR (R = 0.411, P = 0.022; R = 0.474, P = 0.007, respectively), and showed linear negative correlation with the lymphocyte to monocyte ratio (R = 0.382, P = 0.031; R = 0.716, P < 0.001, respectively). CONCLUSIONS The plaque enhancement and WSSR were significantly associated with sICAS, WSSR was an independent risk factor for sICAS. Plaque enhancement and plaque burden showed linear correlation with the WSSR and lymphocyte-to-monocyte ratio (LMR). Hemodynamics and inflammation combined to promote plaque progression.
Collapse
Affiliation(s)
- Xiao-Bing Wu
- Department of Neurosurgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, Guangdong, China
| | - Yi-Ao Liu
- Department of Neurosurgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, Guangdong, China
- Department of Neurosurgery, The Eighth Affiliated Hospital, Sun Yat-Sen University, 3025 Shennan Middle Road, Shenzhen, 518033, China
| | - Li-Xin Huang
- Department of Neurosurgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, Guangdong, China
- Department of Neurosurgery, The Eighth Affiliated Hospital, Sun Yat-Sen University, 3025 Shennan Middle Road, Shenzhen, 518033, China
- Department of Neurosurgery, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xin Guo
- Department of Neurosurgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, Guangdong, China
- Department of Neurosurgery, The Eighth Affiliated Hospital, Sun Yat-Sen University, 3025 Shennan Middle Road, Shenzhen, 518033, China
| | - Wang-Qing Cai
- Department of Neurosurgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, Guangdong, China
| | - Bin Luo
- Department of Neurosurgery, The Eighth Affiliated Hospital, Sun Yat-Sen University, 3025 Shennan Middle Road, Shenzhen, 518033, China.
| | - Sheng-Wen Wang
- Department of Neurosurgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, Guangdong, China.
| |
Collapse
|
4
|
Li RY, Zhao DL, Yu JW, Wu Y, Chen XH, Ge H, Li C, Ju S. Intracranial plaque characteristics on high-resolution MRI and high-sensitivity C-reactive protein levels: association and clinical relevance in acute cerebral infarction. Clin Radiol 2023; 78:e442-e450. [PMID: 36804273 DOI: 10.1016/j.crad.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/30/2022] [Accepted: 01/11/2023] [Indexed: 02/04/2023]
Abstract
AIM To investigate the association between intracranial plaque characteristics and high-sensitivity C-reactive protein (hs-CRP) levels, and their combined effects on the occurrence of acute cerebral infarction (ACI). MATERIALS AND METHODS One hundred and forty-three patients with recent ischaemic events in the territory of middle cerebral artery or basilar artery were enrolled and divided into the ACI group (n=93) and non-ACI group (n=50) according to clinical data and diffusion-weighting imaging (DWI) results. All recruited patients underwent high-resolution magnetic resonance imaging (MRI) to assess intracranial plaque characteristics, including plaque enhancement, standardised wall index, stenosis ratio, T1 hyperintense component, remodelling pattern, plaque area, plaque burden, and maximum wall thickness. hs-CRP levels were further grouped into the low group (<1 mg/l), the intermediate group (1-3 mg/l), and the high group (≥3 mg/l). Multivariate logistic regression and receiver operating characteristic curve were constructed to evaluate the association between intracranial plaque characteristics and hs-CRP levels, as well as their synergistic effects on determining the occurrence of ACI. RESULTS High hs-CRP levels were associated with strong plaque enhancement (p<0.001, odds ratio [OR] = 7.497). Strong plaque enhancement (p=0.002, OR=2.109) and high hs-CRP levels (p=0.009, OR=3.893) were independently associated with the occurrence of ACI after adjustments for sex, age, and other traditional atherosclerotic risk factors. The combination of hs-CRP levels and strong plaque enhancement provided incremental information to determine ACI with an AUC of 0.823, which was significantly higher than that of strong plaque enhancement (0.711) and hs-CRP levels (0.686), respectively. CONCLUSION High hs-CRP levels were associated with strong plaque enhancement. The synergistic effects of hs-CRP levels and strong plaque enhancement provided incremental effects on the occurrence of ACI.
Collapse
Affiliation(s)
- R-Y Li
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Gulou District, Nanjing, 210009, Jiangsu Province, China
| | - D-L Zhao
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Gulou District, Nanjing, 210009, Jiangsu Province, China.
| | - J-W Yu
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Gulou District, Nanjing, 210009, Jiangsu Province, China
| | - Y Wu
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Gulou District, Nanjing, 210009, Jiangsu Province, China
| | - X-H Chen
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Gulou District, Nanjing, 210009, Jiangsu Province, China
| | - H Ge
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Gulou District, Nanjing, 210009, Jiangsu Province, China
| | - C Li
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Gulou District, Nanjing, 210009, Jiangsu Province, China
| | - S Ju
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Gulou District, Nanjing, 210009, Jiangsu Province, China
| |
Collapse
|
5
|
Huang F, Luo L, Wu Y, Xia D, Xu F, Gao J, Shi J, Gong Q. Trilobatin promotes angiogenesis after cerebral ischemia-reperfusion injury via SIRT7/VEGFA signaling pathway in rats. Phytother Res 2022; 36:2940-2951. [PMID: 35537702 DOI: 10.1002/ptr.7487] [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: 09/05/2021] [Revised: 03/16/2022] [Accepted: 04/19/2022] [Indexed: 11/11/2022]
Abstract
Angiogenesis plays a pivotal role in the recovery of neurological function after ischemia stroke. Herein, we investigated the effect of trilobatin (TLB) on angiogenesis after cerebral ischemia-reperfusion injury (CIRI). The effect of TLB on angiogenesis after CIRI were investigated in mouse brain microvascular endothelium bEnd.3 cells and middle cerebral artery occlusion (MCAO)-induced CIRI rat model. The cell proliferation and angiogenesis were observed using immunofluorescence staining. The cell cycle, expressions of cell cycle-related proteins and SIRT 1-7 were determined by flow cytometry and western blot, respectively. The binding affinity of TLB with SIRT7 was predicted by molecular docking. The results showed that TLB concentration-dependently promoted bEnd.3 cell proportion in the S-phase. TLB significantly increased the protein expressions of SIRT6, SIRT7, and VEGFA, but not affected SIRT1-SIRT5 protein expressions. Moreover, TLB not only dramatically alleviated neurological impairment after CIRI, but also enhanced post-stroke neovascularization and newly formed functional vessels in cerebral ischemic penumbra. Furthermore, TLB up-regulated the protein expressions of CDK4, cyclin D1, VEGFA and its receptor VEGFR-2. Intriguingly, TLB not only directly bound to SIRT7, but also increased SIRT7 expression at day 28. Our findings reveal that TLB promotes cerebral microvascular endothelial cells proliferation, and facilitates angiogenesis after CIRI via mediating SIRT7/VEGFA signaling pathway in rats. Therefore, TLB might be a novel restorative agent to rescue ischemia stroke.
Collapse
Affiliation(s)
- Fengying Huang
- Key Laboratory of Basic Pharmacology of Ministry of Education and Guizhou Province, Zunyi Medical University, Zunyi, China.,Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, China
| | - Lingyu Luo
- Key Laboratory of Basic Pharmacology of Ministry of Education and Guizhou Province, Zunyi Medical University, Zunyi, China.,Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, China
| | - Yujia Wu
- Key Laboratory of Basic Pharmacology of Ministry of Education and Guizhou Province, Zunyi Medical University, Zunyi, China.,Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, China
| | - Dianya Xia
- Key Laboratory of Basic Pharmacology of Ministry of Education and Guizhou Province, Zunyi Medical University, Zunyi, China.,Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, China
| | - Fan Xu
- Spemann Graduate School of Biology and Medicine (SGBM), Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Jianmei Gao
- Key Laboratory of Basic Pharmacology of Ministry of Education and Guizhou Province, Zunyi Medical University, Zunyi, China.,Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, China.,Department of Pharmacology, School of Pharmacy, Zunyi Medical University, Zunyi, China
| | - Jingshan Shi
- Key Laboratory of Basic Pharmacology of Ministry of Education and Guizhou Province, Zunyi Medical University, Zunyi, China.,Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, China
| | - Qihai Gong
- Key Laboratory of Basic Pharmacology of Ministry of Education and Guizhou Province, Zunyi Medical University, Zunyi, China.,Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, China
| |
Collapse
|
6
|
Plasma ApoB/AI: An effective indicator for intracranial vascular positive remodeling. J Neurol Sci 2022; 436:120226. [DOI: 10.1016/j.jns.2022.120226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 02/08/2022] [Accepted: 03/07/2022] [Indexed: 11/22/2022]
|