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Huang J, Liu C, Jiao S, Chen Y, Xu L, Gong T, Zhu C, Song Y. Application of high-resolution MRI in evaluating statin efficacy on symptomatic intracranial atherosclerosis. Eur Radiol 2024:10.1007/s00330-024-10968-1. [PMID: 39030372 DOI: 10.1007/s00330-024-10968-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 05/28/2024] [Accepted: 06/30/2024] [Indexed: 07/21/2024]
Abstract
OBJECTIVES To investigate the efficacy of statins on symptomatic intracranial atherosclerotic plaques using high-resolution 3.0 T MR vessel wall imaging (HR-MRI). METHODS Patients with symptomatic intracranial atherosclerotic plaques (cerebral ischemic events within the last three months) confirmed by HR-MRI from July 2017 to August 2022 were retrospectively included in this study. The enrolled patients started statin therapy at baseline. All the patients underwent the follow-up HR-MRI examination after statin therapy for at least 3 months. A paired sample t-test and Wilcoxon rank sum test were used to evaluate the changes in plaque characteristics after statin therapy. Multivariate linear regression was further used to investigate the clinical factors associated with statin efficacy. RESULTS A total of 48 patients (37 males; overall mean age = 60.2 ± 11.7 years) were included in this study. The follow-up time was 7.0 (5.6-12.0) months. In patients treated with statins for > 6 months (n = 31), plaque length, wall thickness, plaque burden, luminal stenosis and plaque enhancement were significantly reduced. Similar results were found in patients with good lipid control (n = 21). Younger age, lower BMI and hypertension were associated with decreased plaque burden. Lower BMI, hypertension and longer duration of statin therapy were associated with decreased plaque enhancement. Younger age and hypertension were associated with decreased luminal stenosis (all p < 0.05). CONCLUSION HR-MRI can effectively evaluate plaques changes after statin therapy. Statins can reduce plaque burden and stabilize plaques. The effect of statin may have a relationship with age, BMI, hypertension, and duration of statin therapy. CLINICAL RELEVANCE STATEMENT High-resolution MRI can be applied to evaluate the efficacy of statins on symptomatic intracranial atherosclerotic plaques. Long-term statin use and well-controlled blood lipid levels can help reduce plaque burden and stabilize plaques. KEY POINTS High-resolution MRI provides great help evaluating the changes of plaque characteristics after statin therapy. Efficacy of statins is associated with duration of use, controlled lipid levels, and clinical factors. High-resolution MRI can serve as an effective method for following-up symptomatic intracranial atherosclerosis.
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Affiliation(s)
- Juan Huang
- Department of Radiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Cong Liu
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Sheng Jiao
- Department of Radiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yuhui Chen
- Department of Neurology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Lei Xu
- Department of Neurology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Tao Gong
- Department of Neurology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Chengcheng Zhu
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Yan Song
- Department of Radiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
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Oliveira R, Correia MA, Marto JP, Carvalho Dias M, Mohamed GA, Nguyen TN, Nogueira RG, Aboul-Nour H, Marin H, Bou Chebl A, Mohammaden MH, Al-Bayati AR, Haussen DC, Abdalkader M, Fifi JT, Ortega-Gutierrez S, Yavagal DR, Mayer SA, Tsivgoulis G, Neto LL, Aguiar de Sousa D. Reocclusion after successful endovascular treatment in acute ischemic stroke: systematic review and meta-analysis. J Neurointerv Surg 2023; 15:964-970. [PMID: 36328479 DOI: 10.1136/jnis-2022-019382] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Endovascular treatment (EVT) is the standard of care for selected patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO). OBJECTIVE To systematically review the available data on: (1) incidence, predictors, and outcomes of patients with reocclusion after successful EVT for AIS and, (2) the characteristics, complications, and outcomes of patients with reocclusion treated with repeated EVT (rEVT) within 30 days of the first procedure. METHODS PubMed was searched (between January 2012 and April 2021) to identify studies reporting reocclusion following successful EVT (Thrombolysis in Cerebral Infarction ≥2b) in patients with AIS due to LVO. Pooled incidence of reocclusion per 100 patients with successful recanalization following EVT was calculated using a random-effects model with Freeman-Tukey double arcsine transformation. Extracted incidences of reocclusion according to etiology and use of intravenous thrombolysis were pooled using random-effects meta-analytic models. RESULTS A total of 840 studies was identified and seven studies qualified for the quantitative analysis, which described 91 same-vessel reocclusions occurring within the first 7 days after treatment among 2067 patients (4.9%; 95% CI 3% to 7%, I2=70.2%). Large vessel atherosclerosis was associated with an increased risk of reocclusion (OR=3.44, 95% CI 1.12 to 10.61, I2=50%). We identified 90 patients treated with rEVT for recurrent LVO, described in five studies. The rates of procedural complications, mortality, and unfavorable functional outcome at 3 months were 18.0%, 18.9%, and 60.3%, respectively. CONCLUSION In cohorts of patients with AIS due to LVO, 5% of patients experienced reocclusion within 7 days after successful EVT. Repeated EVT can be a safe and effective treatment for selected patients with reocclusion.
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Affiliation(s)
- Renato Oliveira
- Department of Neurology, Hospital da Luz Lisboa, Lisboa, Portugal
- Department of Geriatrics, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Manuel A Correia
- Department of Neuroradiology, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal
| | - João Pedro Marto
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Lisboa, Portugal
| | - Mariana Carvalho Dias
- Department of Neurology, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal
| | - Ghada A Mohamed
- Department of Neurology, Medical University of South Carolina (MUSC), Charleston, South Carolina, USA
| | - Thanh N Nguyen
- Department of Neurology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Raul G Nogueira
- Stroke Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Hassan Aboul-Nour
- Department of Neurology, Emory University Hospitals, Atlanta, Georgia, USA
| | - Horia Marin
- Department of Radiology, Henry Ford Health, Detroit, Michigan, USA
| | - Alex Bou Chebl
- Department of Neurology, Henry Ford Hospital, Detroit, Michigan, USA
| | | | - Alhamza R Al-Bayati
- Stroke Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Diogo C Haussen
- Department of Neurology and Radiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mohamad Abdalkader
- Department of Radiology, Boston Medical Center, Boston, Massachusetts, USA
| | - Johanna T Fifi
- Departments of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Santiago Ortega-Gutierrez
- Department of Neurology, Neurosurgery and Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Dileep R Yavagal
- Department of Neurology and Neurosurgery, University of Miami, Miami, Florida, USA
| | - Stephan A Mayer
- Department of Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | - Georgios Tsivgoulis
- Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National & Kapodistrian University of Athens, Athens, Greece
| | - Lia Lucas Neto
- Department of Neuroradiology, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal
- Institute of Anatomy, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Diana Aguiar de Sousa
- Institute of Anatomy, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
- Stroke Center, Lisbon Central University Hospital, Lisbon, Portugal
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Huang J, Jiao S, Chen Y, Lu J, Song Y, Zhang J, Zhang C, Liu C, Gong T, Wang D, Zhu J, Chen M. Efficacy of medical treatment and balloon angioplasty for severe intracranial atherosclerosis: a high-resolution MR vessel wall imaging. Eur Radiol 2023; 33:2478-2488. [PMID: 36418621 DOI: 10.1007/s00330-022-09218-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/27/2022] [Accepted: 10/05/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To investigate the efficacy of medical treatment and balloon angioplasty for intracranial atherosclerosis using high-resolution MR vessel wall imaging (HR-MRI). METHODS In this prospective study, patients with symptomatic severe stenosis from January 2018 to August 2021 were treated with medical treatment or balloon angioplasty. The patients underwent HR-MRI at baseline and at 3, 6, and 12 months. Plaque characteristics at follow-up were compared with those at baseline using paired sample T-test or Wilcoxon rank sum test. The difference in the recurrence of ischemic events between two groups was compared. RESULTS A total of 37 patients (26 males; mean age = 60.5 ± 11.6 years) were evaluated. Of 68 plaques, 42 (61.8%) were treated with medication only. At 12 months of medical treatment, maximum plaque length (p = 0.004), maximum wall thickness (p = 0.036), and plaque enhancement (p = 0.001) were significantly reduced than baseline. At 3 months after balloon angioplasty, luminal stenosis (p = 0.048) was significantly reduced compared to baseline. At 6 months after balloon angioplasty, maximum plaque length (p = 0.011), maximum wall thickness (p = 0.003), and luminal stenosis (p = 0.001) were significantly reduced than baseline. No difference was found in the recurrence of ischemic events between two groups (p = 0.458). CONCLUSION Intracranial atherosclerotic plaque shrank and tended to be stable at 12 months of medical treatment. Plaque burden was significantly reduced 6 months after balloon angioplasty. This may provide evidence for the application and selection of treatment strategies for intracranial atherosclerotic disease. KEY POINTS • Plaque burden and plaque enhancement were significantly reduced at 12 months of medical treatment compared to baseline. • Plaque burden was significantly reduced at 6 months after balloon angioplasty compared with baseline. • No significant difference in the recurrence rate of ischemic stroke between patients treated with medication and balloon angioplasty.
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Affiliation(s)
- Juan Huang
- Department of Radiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, NO. 1 Dahua Road, Dong Dan, Beijing, 100730, China
| | - Sheng Jiao
- Department of Radiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, NO. 1 Dahua Road, Dong Dan, Beijing, 100730, China
| | - Yuhui Chen
- Department of Neurology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jun Lu
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yan Song
- Department of Radiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, NO. 1 Dahua Road, Dong Dan, Beijing, 100730, China.
| | - Jintao Zhang
- Department of Radiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, NO. 1 Dahua Road, Dong Dan, Beijing, 100730, China
| | - Chen Zhang
- Department of Radiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, NO. 1 Dahua Road, Dong Dan, Beijing, 100730, China
| | - Cong Liu
- Department of Radiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, NO. 1 Dahua Road, Dong Dan, Beijing, 100730, China
| | - Tao Gong
- Department of Neurology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Daming Wang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jinxia Zhu
- MR Collaboration, Siemens Healthcare Ltd., Beijing, China
| | - Min Chen
- Department of Radiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, NO. 1 Dahua Road, Dong Dan, Beijing, 100730, China
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Evaluation of High Intracranial Plaque Prevalence in Type 2 Diabetes Using Vessel Wall Imaging on 7 T Magnetic Resonance Imaging. Brain Sci 2023; 13:brainsci13020217. [PMID: 36831760 PMCID: PMC9954742 DOI: 10.3390/brainsci13020217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/10/2023] [Accepted: 01/22/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND While type 2 diabetes (T2D) is a major risk for ischemic stroke, the associated vessel wall characteristics remain essentially unknown. This study aimed to clarify intracranial vascular changes on three-dimensional vessel wall imaging (3D-VWI) using fast spin echo by employing 7Tesla (7T) magnetic resonance imaging (MRI) in T2D patients without advanced atherosclerosis as compared to healthy controls. METHODS In 48 T2D patients and 35 healthy controls, the prevalence of cerebral small vessel diseases and intracranial plaques were evaluated by 3D-VWI with 7T MRI. RESULTS The prevalence rate of lacunar infarction was significantly higher in T2D than in controls (n = 8 in T2D vs. n = 0 in control, p = 0.011). The mean number of intracranial plaques in both anterior and posterior circulation of each subject was significantly larger in T2D than in controls (2.23 in T2D vs. 0.94 in control, p < 0.01). In T2D patients, gender was associated with the presence of intracranial plaques. CONCLUSION This is the first study to demonstrate the high prevalence of intracranial plaque in T2D patients with neither confirmed atherosclerotic disease nor symptoms by performing intracranial 3D-VWI employing 7TMRI. Investigation of intracranial VWI with 7T MRI is expected to provide novel insights allowing early intensive risk management for prevention of ischemic stroke in T2D patients.
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A Clinical Prediction Model for Patients with Acute Large Vessel Occlusion Due to Underlying Intracranial Atherosclerotic Stenosis. Clin Neuroradiol 2022; 33:519-528. [DOI: 10.1007/s00062-022-01241-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 11/09/2022] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Acute large vessel occlusion due to underlying intracranial atherosclerotic stenosis (ICAS-LVO) increases the difficulty of revascularization, resulting in frequent re-occlusion. The establishment of its pathogenesis before endovascular treatment (EVT) is beneficial for patients. We aimed at developing and validating a clinical prediction model for ICAS-LVO patients before EVT.
Methods
Patients with acute large vessel occlusion at Jining No. 1 People’s Hospital from January 2019 to September 2021 were retrospectively included as the training cohort. The 70 patients who met the inclusion and exclusion criteria were included in the validation cohort (October 2021 to May 2022). Demographics, onset form, medical history, digital subtraction angiography (DSA) imaging data, and laboratory test data were collected. Preprocedural parameters for the ICAS-LVO risk prediction model were established by stepwise logistic regression controlling for the confounding effects. Then, we constructed a nomogram model and evaluated its performance via the Hosmer-Lemeshow goodness-of-fit test, area under the ROC curve (AUC) analysis.
Results
The 231 acute LVO patients were included in the final analysis, 74 (32.3%) patients were ICAS-LVO. A preoperative diagnosis prediction model consisting of five predictors for ICAS-LVO, including fluctuating symptoms, NIHSS < 16, atrial fibrillation, tapered sign, and ASITN/SIR score ≥ 2. The model depicted an acceptable calibration (Hosmer-Lemeshow test, p = 0.451) and good discrimination (AUC, 0.941; 95% confidence interval, 0.910–0.971). The optimal cut-off value for the ICAS-LVO scale was 2 points, with 86.5% sensitivity, 91.1% specificity, and 90.5% accuracy. In the validation cohort, the discriminative ability was promising with an AUC value of 0.897, implying a good predictive performance.
Conclusion
The established ICAS-LVO scale, which is composed of five predictors: fluctuating symptoms, NIHSS < 16, atrial fibrillation, tapered sign, and ASITN/SIR score ≥ 2, has a good predictive value for ICAS-LVO in Chinese populations.
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Hu F, Lu F, Xiao H, Dong M, Xu Y. Relationship Between Hypertension and Basilar Atherosclerosis in Chinese Han Population: A High-Resolution Magnetic Resonance Imaging Study. Front Cardiovasc Med 2022; 9:830664. [PMID: 35571152 PMCID: PMC9094699 DOI: 10.3389/fcvm.2022.830664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/29/2022] [Indexed: 11/28/2022] Open
Abstract
Objective To investigate the relationship between hypertension and basilar atherosclerosis evaluated by high-resolution magnetic resonance imaging (HR-MRI) in the Chinese Han population. Methods High resolution-MRI vessel wall imaging was performed in selected 193 patients for various indications. Multivariable logistic regression models based on odds ratio (OR) with their associated 95% confidence interval (CI) were used to assess the relationship between hypertension and basilar artery (BA) plaque, moderate or severe stenosis of BA plaque, and vulnerable plaque. A linear regression model was used to assess the relationship between hypertension and BA plaque numbers. Results Patients with hypertension had a higher proportion of BA plaque and vulnerable plaque as well as more number of enhancements of BA plaque and serious plaque compared with normotensive patients (all values of p < 0.05). Multivariable logistic regression analysis indicated that patients with hypertension had an increased risk for and more number of enhancements of BA plaque (adjusted-OR: 4.32, 95% CI 1.89–9.88, p < 0.001; adjusted-β: 0.55, 95% CI 0.14–0.96, p = 0.009, respectively) and had a higher proportion of moderate or severe stenosis of BA plaque and vulnerable plaque (adjusted-OR: 3.08, 95% CI 0.77–12.32, p = 0.111; adjusted-OR: 4.52, 95% CI 1.50–13.64, p = 0.007, respectively) compared with the normotensive group. Moreover, there was a saturation effect of age on the prevalence of BA plaque and vulnerable plaque. Conclusion Hypertension was the independent risk factor of BA plaque and vulnerable plaque assessed by HR-MRI in the Chinese Han population.
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Affiliation(s)
- Feng Hu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Feng Lu
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Huiling Xiao
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Meixue Dong
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yan Xu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- *Correspondence: Yan Xu,
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Chow FC, Callen A, Arechiga V, Saloner D, Narvid J, Hsue PY. Intracranial vascular imaging detects arterial wall abnormalities in persons with treated HIV infection. AIDS 2022; 36:69-73. [PMID: 34482351 PMCID: PMC8665026 DOI: 10.1097/qad.0000000000003064] [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] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Although a substantial proportion of ischemic strokes in persons with HIV infection (PWH) is related to large artery disease, studies evaluating elevated cerebrovascular risk in PWH have focused primarily on microvascular disease. We compared the burden of intracranial large artery disease on vessel wall MRI (VW-MRI) in PWH and HIV-uninfected individuals. DESIGN Cross-sectional study. METHODS We recruited antiretroviral therapy-treated PWH with undetectable plasma viral load and HIV-uninfected individuals. All participants were at least 40 years of age and at moderate-to-high cardiovascular risk. We used Poisson and mixed effects logistic regression models to compare the number and associated characteristics of enhancing intracranial arteries on VW-MRI by HIV status. RESULTS Of 46 participants (mean age 59 years), 33 were PWH. PWH had nearly four-fold as many enhancing intracranial arteries on VW-MRI than HIV-uninfected individuals (rate ratio 3.94, 95% CI 1.57-9.88, P = 0.003). The majority of wall enhancement was eccentric (76%) and short-segment (93%), suggestive of intracranial atherosclerotic disease (ICAD). Sixty-nine percent of enhancing arteries were not associated with luminal narrowing on magnetic resonance angiography (MRA). None of these characteristics differed significantly by HIV status. CONCLUSION In persons at moderate-to-high cardiovascular risk, HIV infection, even when well controlled, may be associated with a greater burden of intracranial large artery disease and, specifically, of ICAD. Studies of the mechanisms underlying higher rates of ischemic stroke in PWH should include evaluation for intracranial large artery disease. VW-MRI provides added value as an adjunct to traditional luminal imaging when evaluating cerebrovascular risk in PWH.
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Affiliation(s)
- Felicia C Chow
- Department of Neurology, Weill Institute for Neurosciences
- Department of Medicine (Infectious Diseases), University of California, San Francisco, San Francisco
| | - Andrew Callen
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | | | | | - Priscilla Y Hsue
- Department of Medicine (Cardiology), University of California, San Francisco, San Francisco, California, USA
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Zhang DF, Wu XY, Zhang WD, Wang M, Yin X, Chen YC. The Relationship between Patterns of Remodeling and Degree of Enhancement in Patients with Atherosclerotic Middle Cerebral Artery Stenosis: A High-Resolution MRI Study. Neurol India 2021; 69:1663-1669. [PMID: 34979666 DOI: 10.4103/0028-3886.333443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
PURPOSE The aim of this research was to investigate the relationship between remodeling patterns and degree of enhancement in patients with atherosclerotic middle cerebral artery (MCA) stenosis using high-resolution magnetic resonance imaging (HR-MRI). MATERIALS AND METHODS From August 2015 to May 2016, 38 consecutive patients with unilateral MCA stenosis on time-of-flight (TOF) MR angiography were prospectively enrolled. The routine MR scan and cross-sectional images of the stenotic MCA vessel wall on HR-MRI were performed in all patients. Among them, 17 patients displayed positive remodeling (PR) and the other 21 patients displayed negative remodeling or non-remodeling (non-PR). The patients displaying hyperintense on diffusion-weighted imaging (DWI) in the territory of ipsilateral stenotic MCA were considered to have had acute stroke. Subsequently, the differences in the degree of enhancement and the number of acute stroke patients between the PR group and the non-PR group were compared. The Spearman rank correlation analysis of the enhancement degree (ED) and the remodeling index (RI) was calculated. Then, receiver operating curve (ROC) was used to evaluate diagnostic efficiency of RI and ED for acute infarction. RESULTS The PR group had more obvious enhancement plaques than the non-PR group (10 versus 3, P = 0.006). The PR group also had a larger number of acute stroke patients than the non-PR group (15 versus 4, P = 0.000). The spear-man rank correlation analysis showed that the degree of enhancement had a weak positive correlation with the remodeling index (r = 0.379, P = 0.019). The area under the curve (AUC) of RI and ED was higher than that of RI (0.924: 0.842). CONCLUSION The PR, obvious enhancement predicted vulnerable plaques that were more prone to causing acute stroke. RI and ED had valuable diagnostic efficiency for acute infarction.
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Affiliation(s)
- Dan-Feng Zhang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Xin-Ying Wu
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Wei-Dong Zhang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Mi Wang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Xindao Yin
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Yu-Chen Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
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Settecase F, Rayz VL. Advanced vascular imaging techniques. HANDBOOK OF CLINICAL NEUROLOGY 2021; 176:81-105. [DOI: 10.1016/b978-0-444-64034-5.00016-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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10
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Chuming H, Yifan H, Ke X, Chukai X, Weijie Z, Hui L, Guoyi P, Xiaoyong Z, Peifeng Z, Chuwei C. Association Between Occlusion Type and Etiology of Acute Intracranial Large Artery Occlusion. Front Neurol 2020; 11:582388. [PMID: 33193040 PMCID: PMC7642447 DOI: 10.3389/fneur.2020.582388] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/22/2020] [Indexed: 01/26/2023] Open
Abstract
Objective: To investigate the diagnostic efficiency of truncal-type occlusion and branching-site occlusion in determining the etiology of intracranial large artery occlusion related acute ischemic stroke (AIS). Methods: Patients with intracranial large artery occlusion related AIS who received stent retriever (SR) thrombectomy from November 2014 to June 2019 were included in the study. All patients underwent angiography before SR thrombectomy, which was used to evaluate the occlusion type. Differences in the distribution of occlusion types in intracranial atherosclerosis (ICAS) and embolism were assessed, and the diagnostic indicators, including the area under the ROC curve (AUC), sensitivity, and specificity were calculated. Results: Of the 115 AIS patients with intracranial large artery occlusion, 42 were classified as having ICAS, and 73 having an embolism. In the ICAS group, branching-site occlusion was responsible for 3 (7%) cases and truncal-type occlusion for 39 (93%) cases, while in the embolism group, branching-site occlusion was responsible for 66 (90%) cases and truncal-type occlusion for 7 (10%) cases; the difference was statistically significant (all P < 0.01). The AUC for ICAS predicted by truncal-type occlusion was 0.916, with a sensitivity of 92.86%, and specificity of 90.41%. Conclusion: Truncal-type occlusion showed a high predictability of ICAS. Determine the etiology of intracranial large artery occlusion related AIS before SR thrombectomy may be most helpful in setting up optimal endovascular treatment strategies.
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Affiliation(s)
| | - Hong Yifan
- Shantou Central Hospital, Shantou, China
| | - Xu Ke
- Shantou Central Hospital, Shantou, China
| | - Xu Chukai
- Shantou Central Hospital, Shantou, China
| | | | - Li Hui
- Shantou Central Hospital, Shantou, China
| | - Peng Guoyi
- Shantou Central Hospital, Shantou, China
| | | | | | - Cai Chuwei
- Shantou Central Hospital, Shantou, China
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Yi TY, Chen WH, Wu YM, Zhang MF, Zhan AL, Chen YH, Wu ZZ, Shi YC, Chen BL. Microcatheter "First-Pass Effect" Predicts Acute Intracranial Artery Atherosclerotic Disease-Related Occlusion. Neurosurgery 2020; 84:1296-1305. [PMID: 29790969 DOI: 10.1093/neuros/nyy183] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 04/13/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The differentiation between intracranial atherosclerotic stenosis (ICAS) and intracranial embolism as the immediate cause of acute ischemic stroke requiring endovascular therapy is important but challenging. In cases of ICAS, we often observe a phenomenon we call the microcatheter "first-pass effect," which is temporary blood flow through the occluded intracranial artery when the angiographic microcatheter is initially advanced through the site of total occlusion and immediately retrieved proximally. OBJECTIVE To evaluate whether this microcatheter first-pass effect can be used to differentiate ICAS from intracranial embolism. METHODS A total of 61 patients with acute ischemic stroke resulting from large intracranial artery occlusion and in whom recanalization was achieved by endovascular treatment were included in the study. The microcatheter first-pass effect was tested in these patients. The sensitivity, specificity, positive predictive values (PPV), and accuracy of the microcatheter first-pass effect for prediction of ICAS were assessed. RESULTS The microcatheter first-pass effect was more frequently observed in patients with ICAS than in those with intracranial embolism (90.9% vs 12.8%, P < .001). For identifying ICAS, sensitivity, specificity, PPV, and accuracy of the microcatheter first-pass effect were 90.9%, 87.2%, 80.0%, 88.5%, respectively. CONCLUSION The sensitivity and PPV of the microcatheter first-pass effect are high for prediction of ICAS in patients with acute symptoms.
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Affiliation(s)
- Ting-Yu Yi
- Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Wen-Huo Chen
- Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Yan-Min Wu
- Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Mei-Fang Zhang
- Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, China
| | - A-Lai Zhan
- Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Yue-Hong Chen
- Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Zong-Zhong Wu
- Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Yan-Chuan Shi
- Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Bai-Ling Chen
- Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, China
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Huang J, Jiao S, Zhao X, Zhang J, Zhang C, Chen M, Song Y. Characteristics of patients with enhancing intracranial atherosclerosis and association between plaque enhancement and recent cerebrovascular ischemic events: a high-resolution magnetic resonance imaging study. Acta Radiol 2019; 60:1301-1307. [PMID: 30650984 DOI: 10.1177/0284185118822645] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Juan Huang
- Peking University Fifth School of Clinical Medicine, Beijing, PR China
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing, PR China
| | - Sheng Jiao
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing, PR China
| | - Xihai Zhao
- Department of Biomedical Engineering, Tsinghua University, Beijing, PR China
| | - Jintao Zhang
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing, PR China
| | - Chen Zhang
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing, PR China
| | - Min Chen
- Peking University Fifth School of Clinical Medicine, Beijing, PR China
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing, PR China
| | - Yan Song
- Peking University Fifth School of Clinical Medicine, Beijing, PR China
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing, PR China
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13
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Zhang H, Sun X, Huang Q, Wang X, Yue Y, Ju M, Wang X, Ding J, Miao Z. Intracranial Atherosclerotic Disease-Related Acute Middle Cerebral Artery Occlusion Can Be Predicted by Diffusion-Weighted Imaging. Front Neurosci 2019; 13:903. [PMID: 31551677 PMCID: PMC6738444 DOI: 10.3389/fnins.2019.00903] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 08/13/2019] [Indexed: 01/12/2023] Open
Abstract
Background: The differentiation of large vessel occlusion caused by intracranial atherosclerotic stenosis (ICAS) or intracranial embolism significantly impacts the course of treatment (i.e., intravenous thrombolysis versus mechanical thrombectomy) for acute cerebral infarction. Currently, there is no objective evidence to indicate ICAS-related middle cerebral artery M1 segment occlusion before treatment. In cases of ICAS, it is often observed that the infarct core caused by ICAS-related M1 segment middle cerebral artery occlusion (MCAO) is located in deeper parts of the brain (basal ganglia or semiovoid region). Objective: To evaluate whether the location of the infarct core, identified using diffusion-weighted imaging (DWI), can be used to differentiate ICAS from intracranial embolism. Methods: Thirty-one consecutive patients diagnosed with acute cerebral infarction caused by middle cerebral artery M1 segment occlusion were retrospectively included based on angiographic findings to distinguish ICAS from embolic occlusion. Patients were divided into two groups based on the location of the infarct core on DWI: in the deep part of the brain (basal ganglia or semiovoid region) or more superficially (i.e., cortex). Results: In 16 patients, the infarct core was mainly in the deep part of the brain on DWI [14 of 16 patients in the ICAS group and only 2 in the non-ICAS group (93.3 vs. 6.7%, respectively; P < 0.001)]. The diagnostic sensitivity of DWI for ICAS was 93.3%, with a specificity of 87.5%, a Positive predictive value (PPV) of 87.5%, and an Negative predictive value (NPV) of 93.3%, the accuracy was 88.5%. Conclusion: Intracranial atherosclerotic disease-related acute MCAO can be predicted using DWI.
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Affiliation(s)
- Huijun Zhang
- Department of Neurology, Tong Ren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuan Sun
- Department of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Qiong Huang
- Department of Neurology, Tong Ren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiangming Wang
- Department of Neurology, Tong Ren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yunhua Yue
- Department of Neurology, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Mingfeng Ju
- Department of Neurology, Tong Ren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoping Wang
- Department of Neurology, Tong Ren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ji Ding
- Department of Neurology, Tong Ren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhongrong Miao
- Department of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
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Culprit intracranial plaque without substantial stenosis in acute ischemic stroke on vessel wall MRI: A systematic review. Atherosclerosis 2019; 287:112-121. [PMID: 31254918 DOI: 10.1016/j.atherosclerosis.2019.06.907] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 06/11/2019] [Accepted: 06/19/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS Intracranial atherosclerotic plaque is associated with ischemic strokes without substantial stenosis, and needs better characterization. We aim to investigate the clinical significance of intracranial plaque without substantial stenosis by high resolution vessel wall MRI (vwMRI) through a systematic review of existing studies. METHODS Studies investigating intracranial arterial atherosclerotic plaques without substantial stenosis in acute ischemic stroke patients using vwMRI were systematically identified by searching the PubMed and Medline database and article reference lists. Study characteristics were recorded, the methodological quality of eligible studies was assessed, relevant clinical data were extracted, and collective data was analyzed. RESULTS Twenty-one studies were identified as eligible. 463 patients were included without stenosis of the intracranial arteries, and 651 patients were included with stenosis <50%. The prevalence of intracranial plaque revealed by vwMRI among acute/subacute ischemic stroke patients with non-stenotic Magnetic Resonance Angiography (MRA) was 50.6% (95% confidence interval (CI), 46.1%-55.1%). The prevalence of <50% MRA stenotic culprit plaque among acute/subacute ischemic stroke patients with a clinical diagnosis of intracranial atherosclerosis was 51.2% (95% CI, 38.4%-64.0%). Plaques features, including wall enhancement, positive remodeling, intraplaque hemorrhage, plaque location and eccentricity, were associated with acute stroke, progressive motor deficits and unfavorable overall functional outcomes. CONCLUSIONS Intracranial high-risk plaque with zero or mild degree of stenosis is more prevalent than previously acknowledged, and is associated with ischemic stroke and unfavorable outcome. VwMRI can identify the high-risk plaque features, which may act as a promising tool to better risk stratify these patients.
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Significance of hyperintense arteries on Gd-enhanced 3D T1W black-blood imaging in acute stroke. Eur Radiol 2018; 29:1329-1337. [PMID: 30088068 DOI: 10.1007/s00330-018-5669-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/18/2018] [Accepted: 07/13/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To elucidate the pathogenesis of hyperintense arteries on Gd-enhanced 3D T1W BB FSE and their clinical significance in acute middle cerebral artery (MCA) stroke. METHODS We retrospectively reviewed 20 patients with MCA infarction. We measured the contrast-to-noise ratio between hyperintense artery and adjacent grey matter on T2-FLAIR and Gd-enhanced 3D T1W BB FSE and compared them by using Student's t test. The agreement of positive hyperintense artery between T2 FLAIR and Gd-enhanced 3D T1WI BB FSE was estimated with intraclass correlation coefficient. Our cohort was dichotomised into two groups depending on hyperintense artery scores, and clinical data were compared between two groups by using Student's t test and chi-square test. RESULTS The contrast between hyperintense artery and grey matter on Gd-enhanced 3D T1W BB FSE was significantly higher than that on T2-FLAIR (2.27 ± 1.65 versus 0.94 ± 0.86, p = 0.01). Overall, agreement of hyperintense arteries on T2-FLAIR and Gd-enhanced 3D T1W BB FSE was excellent (ρ = 0.76, p < 0.01). Patients with higher hyperintense artery scores had higher perfusion deficits that those with lower hyperintense artery scores (196.7 ± 41.4 vs 100.1 ± 130.1, p = 0.03). CONCLUSION Hyperintense arteries on Gd-enhanced 3D T1W BB FSE in acute MCA stroke may be associated with slow collateral flows. Their territories corresponded to those of FLAIR, but had a better contrast. The patients with hyperintense arteries in a wider territory showed larger perfusion deficit than those with hyperintense arteries in a narrower territory. KEY POINTS • Hyperintense arteries on Gd-enhanced 3D T1W BB FSE are slow collateral flows. • Hyperintense arteries on Gd-enhanced 3D T1W BB FSE are well matched with FLAIR hyperintense vessels. • Hyperintense arteries are associated with perfusion deficit in stroke patients.
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16
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Wu F, Ma Q, Song H, Guo X, Diniz MA, Song SS, Gonzalez NR, Bi X, Ji X, Li D, Yang Q, Fan Z. Differential Features of Culprit Intracranial Atherosclerotic Lesions: A Whole-Brain Vessel Wall Imaging Study in Patients With Acute Ischemic Stroke. J Am Heart Assoc 2018; 7:JAHA.118.009705. [PMID: 30033434 PMCID: PMC6201468 DOI: 10.1161/jaha.118.009705] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Intracranial atherosclerotic disease tends to affect multiple arterial segments. Using whole‐brain vessel wall imaging, we sought to study the differences in plaque features among various types of plaques in patients with a recent unilateral anterior circulation ischemic stroke. Methods and Results Sixty‐one patients with unilateral anterior circulation ischemic stroke were referred to undergo whole‐brain vessel wall imaging (before and after contrast) within 1 month of symptom onset for intracranial atherosclerotic disease evaluations. Each plaque was classified as a culprit, probably culprit, or nonculprit lesion, according to its likelihood of causing the stroke. The associations between plaque features (thickening pattern, plaque‐wall contrast ratio, high signal on T1‐weighted images, plaque contrast enhancement ratio, enhancement grade, and enhancement pattern) and culprit lesions were estimated using mixed multivariable logistic regression after adjustment for maximum wall thickness. In 52 patients without motion corruption in whole‐brain vessel wall imaging, a total of 178 intracranial plaques in the anterior circulation were identified, including 52 culprit lesions (29.2%), 51 probably culprit lesions (28.7%), and 75 nonculprit lesions (42.1%). High signal on T1‐weighted images (adjusted odds ratio, 9.1; 95% confidence interval, 1.9–44.1; P=0.006), grade 2 (enhancement ratio of plaque ≥ enhancement ratio of pituitary) contrast enhancement (adjusted odds ratio, 17.4; 95% confidence interval, 1.8–164.9; P=0.013), and type 2 (≥50% cross‐sectional wall involvement) enhancement pattern (adjusted odds ratio, 10.1; 95% confidence interval, 1.3–82.2; P=0.030) were independently associated with culprit lesions. Conclusions High signal on T1‐weighted images, grade 2 contrast enhancement, and type 2 enhancement pattern are associated with cerebrovascular ischemic events, which may provide valuable insights into risk stratification.
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Affiliation(s)
- Fang Wu
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qingfeng Ma
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Haiqing Song
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiuhai Guo
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Marcio A Diniz
- Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Shlee S Song
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Nestor R Gonzalez
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - Xunming Ji
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA.,Departments of Medicine and Bioengineering, University of California, Los Angeles, CA
| | - Qi Yang
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China .,Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Zhaoyang Fan
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA .,Departments of Medicine and Bioengineering, University of California, Los Angeles, CA
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17
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Zhang N, Zhang F, Deng Z, Yang Q, Diniz MA, Song SS, Schlick KH, Marcel Maya M, Gonzalez N, Li D, Zheng H, Liu X, Fan Z. 3D whole-brain vessel wall cardiovascular magnetic resonance imaging: a study on the reliability in the quantification of intracranial vessel dimensions. J Cardiovasc Magn Reson 2018; 20:39. [PMID: 29898736 PMCID: PMC6000985 DOI: 10.1186/s12968-018-0453-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 04/12/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND One of the potentially important applications of three-dimensional (3D) intracranial vessel wall (IVW) cardiovascular magnetic resonance (CMR) is to monitor disease progression and regression via quantitative measurement of IVW morphology during medical management or drug development. However, a prerequisite for this application is to validate that IVW morphologic measurements based on the modality are reliable. In this study we performed comprehensive reliability analysis for the recently proposed whole-brain IVW CMR technique. METHODS Thirty-four healthy subjects and 10 patients with known intracranial atherosclerotic disease underwent repeat whole-brain IVW CMR scans. In 19 of the 34 subjects, two-dimensional (2D) turbo spin-echo (TSE) scan was performed to serve as a reference for the assessment of vessel dimensions. Lumen and wall volume, normalized wall index, mean and maximum wall thickness were measured in both 3D and 2D IVW CMR images. Scan-rescan, intra-observer, and inter-observer reproducibility of 3D IVW CMR in the quantification of IVW or plaque dimensions were respectively assessed in volunteers and patients as well as for different healthy subjectsub-groups (i.e. < 50 and ≥ 50 years). The agreement in vessel wall and lumen measurements between the 3D technique and the 2D TSE method was also investigated. In addition, the sample size required for future longitudinal clinical studies was calculated. RESULTS The intra-class correlation coefficient (ICC) and Bland-Altman plots indicated excellent reproducibility and inter-method agreement for all morphologic measurements (All ICCs > 0.75). In addition, all ICCs of patients were equal to or higher than that of healthy subjects except maximum wall thickness. In volunteers, all ICCs of the age group of ≥50 years were equal to or higher than that of the age group of < 50 years. Normalized wall index and mean and maximum wall thickness were significantly larger in the age group of ≥50 years. To detect 5% - 20% difference between placebo and treatment groups, normalized wall index requires the smallest sample size while lumen volume requires the highest sample size. CONCLUSIONS Whole-brain 3D IVW CMR is a reliable imaging method for the quantification of intracranial vessel dimensions and could potentially be useful for monitoring plaque progression and regression.
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Affiliation(s)
- Na Zhang
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Ave., Shenzhen University Town, Shenzhen, 518055 China
- Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd., PACT 400, Los Angeles, CA 90048 USA
- Shenzhen College of Advanced Technology, University of Chinese Academy of Sciences, Shenzhen, China
| | - Fan Zhang
- Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd., PACT 400, Los Angeles, CA 90048 USA
| | - Zixin Deng
- Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd., PACT 400, Los Angeles, CA 90048 USA
- Department of Bioengineering, University of California, Los Angeles, CA USA
| | - Qi Yang
- Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd., PACT 400, Los Angeles, CA 90048 USA
| | - Marcio A. Diniz
- Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Shlee S. Song
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Konrad H. Schlick
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - M. Marcel Maya
- Department of Radiology, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Nestor Gonzalez
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Debiao Li
- Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd., PACT 400, Los Angeles, CA 90048 USA
- Department of Bioengineering, University of California, Los Angeles, CA USA
- Department of Medicine, University of California, Los Angeles, CA USA
| | - Hairong Zheng
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Ave., Shenzhen University Town, Shenzhen, 518055 China
- Shenzhen College of Advanced Technology, University of Chinese Academy of Sciences, Shenzhen, China
| | - Xin Liu
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Ave., Shenzhen University Town, Shenzhen, 518055 China
- Shenzhen College of Advanced Technology, University of Chinese Academy of Sciences, Shenzhen, China
| | - Zhaoyang Fan
- Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd., PACT 400, Los Angeles, CA 90048 USA
- Department of Medicine, University of California, Los Angeles, CA USA
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18
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Tan HW, Chen X, Maingard J, Barras CD, Logan C, Thijs V, Kok HK, Lee MJ, Chandra RV, Brooks M, Asadi H. Intracranial Vessel Wall Imaging with Magnetic Resonance Imaging: Current Techniques and Applications. World Neurosurg 2018; 112:186-198. [PMID: 29360586 DOI: 10.1016/j.wneu.2018.01.083] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 01/05/2018] [Accepted: 01/11/2018] [Indexed: 11/19/2022]
Abstract
Vessel wall magnetic resonance imaging (VW-MRI) is a modern imaging technique with expanding applications in the characterization of intracranial vessel wall pathology. VW-MRI provides added diagnostic capacity compared with conventional luminal imaging methods. This review explores the principles of VW-MRI and typical imaging features of various vessel wall pathologies, such as atherosclerosis, dissection, and vasculitis. Radiologists should be familiar with this important imaging technique, given its increasing use and future relevance to everyday practice.
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Affiliation(s)
- Haur Wey Tan
- Department of Radiology, Austin Hospital, Melbourne, Australia.
| | - Xiao Chen
- Department of Radiology, Austin Hospital, Melbourne, Australia
| | - Julian Maingard
- Department of Radiology, Austin Hospital, Melbourne, Australia; Department of Interventional Neuroradiology Service, Austin Hospital, Melbourne, Australia; Faculty of Health, School of Medicine, Deakin University, Waurn Ponds, Victoria, Australia
| | - Christen D Barras
- Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, London, United Kingdom; The South Australian Health and Medical Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | | | - Vincent Thijs
- Department of Neurology, Austin Health, Heidelberg, Victoria, Australia; Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
| | - Hong Kuan Kok
- Department of Interventional Radiology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Michael J Lee
- Department of Radiology, Beaumont Hospital, Dublin, Ireland; Interventional Radiology Service, Beaumont Hospital, Dublin, Ireland; Royal College of Surgeons Ireland, Dublin, Ireland
| | - Ronil V Chandra
- Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, Victoria, Australia; Department of Imaging, Monash University, Melbourne, Victoria, Australia
| | - Mark Brooks
- Department of Interventional Neuroradiology Service, Austin Hospital, Melbourne, Australia; Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia; Department of Radiology, Interventional Neuroradiology Service, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Hamed Asadi
- Department of Interventional Neuroradiology Service, Austin Hospital, Melbourne, Australia; Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia; Faculty of Health, School of Medicine, Deakin University, Waurn Ponds, Victoria, Australia
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High-resolution vessel wall MRI for the evaluation of intracranial atherosclerotic disease. Neuroradiology 2017; 59:1193-1202. [PMID: 28942481 DOI: 10.1007/s00234-017-1925-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 09/11/2017] [Indexed: 01/23/2023]
Abstract
High-resolution vessel wall MRI (vwMRI) of the intracranial arteries is an emerging diagnostic imaging technique with the goal of evaluating vascular pathology. vwMRI sequences have high spatial resolution and directly image the vessel wall by suppressing blood signal. With vwMRI, it is possible to identify distinct morphologic and enhancement patterns of atherosclerosis that can provide important information about stroke etiology and recurrence risk. We present a review of vwMRI research in relation to intracranial atherosclerosis, with a focus on the relationship between ischemic stroke and atherosclerotic plaque T1 post-contrast enhancement or plaque/vessel wall morphology. The goal of this review is to provide readers with the most current understanding of the reliability, incidence, and importance of specific vwMRI findings in intracranial atherosclerosis, to guide their interpretation of vwMRI research, and help inform clinical interpretation of vwMRI. We will also provide a translational perspective on the existing vwMRI literature and insight into future vwMRI research questions and objectives. With increased use of high field strength MRI, powerful gradients, and improved pulse sequences, vwMRI will become standard-of-care in the diagnosis and prognosis of patients with cerebrovascular disease, making a firm grasp of its strengths and weakness important for neuroimagers.
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20
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Yang WJ, Wong KS, Chen XY. Intracranial Atherosclerosis: From Microscopy to High-Resolution Magnetic Resonance Imaging. J Stroke 2017; 19:249-260. [PMID: 28877564 PMCID: PMC5647638 DOI: 10.5853/jos.2016.01956] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 02/26/2017] [Accepted: 03/31/2017] [Indexed: 12/22/2022] Open
Abstract
Intracranial atherosclerosis is one of the leading causes of ischemic stroke and occurs more commonly in patients of Asian, African or Hispanic origin than in Caucasians. Although the histopathology of intracranial atherosclerotic disease resembles extracranial atherosclerosis, there are some notable differences in the onset and severity of atherosclerosis. Current understanding of intracranial atherosclerotic disease has been advanced by the high-resolution magnetic resonance imaging (HRMRI), a novel emerging imaging technique that can directly visualize the vessel wall pathology. However, the pathological validation of HRMRI signal characteristics remains a key step to depict the plaque components and vulnerability in intracranial atherosclerotic lesions. The purpose of this review is to describe the histological features of intracranial atherosclerosis and to state current evidences regarding the validation of MR vessel wall imaging with histopathology.
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Affiliation(s)
- Wen-Jie Yang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Sha Tin, Hong Kong
| | - Ka-Sing Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Sha Tin, Hong Kong
| | - Xiang-Yan Chen
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Sha Tin, Hong Kong
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21
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Park JE, Jung SC, Lee SH, Jeon JY, Lee JY, Kim HS, Choi CG, Kim SJ, Lee DH, Kim SO, Kwon SU, Kang DW, Kim JS. Comparison of 3D magnetic resonance imaging and digital subtraction angiography for intracranial artery stenosis. Eur Radiol 2017; 27:4737-4746. [PMID: 28500366 DOI: 10.1007/s00330-017-4860-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 04/09/2017] [Accepted: 04/19/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare three-dimensional high-resolution magnetic resonance imaging (3D HR-MRI) and digital subtraction angiography (DSA) for diagnosing and evaluating stenosis in the entire circle of Willis. METHODS The study included 516 intracranial arteries from 43 patients with intracranial artery stenosis (ICAS) who underwent both 3D HR-MRI and DSA within 1 month. Two readers independently diagnosed atherosclerosis, dissection, moyamoya disease and vasculitis, rated their diagnostic confidence for each vessel and measured the luminal diameters. Reference standard was made from clinico-radiologic diagnosis. Diagnostic accuracy, diagnostic confidence, the degree of stenosis and luminal diameter were assessed and compared between both modalities. RESULTS For atherosclerosis, 3D HR-MRI showed better diagnostic accuracy (P = .03-.003), sensitivity (P = .006-.01) and positive predictive value (P ≤ .001-.006) compared to DSA. Overall, the readers were more confident of their diagnosis of ICAS when using 3D HR-MRI (reader 1, P ≤ .001-.007; reader 2, P ≤ .001-.015). 3D HR-MRI showed similar degree of stenosis (P > .05) and higher luminal diameter (P < .05) compared to DSA. CONCLUSIONS 3D HR-MRI might be useful to evaluate atherosclerosis, with better diagnostic confidence and comparable stenosis measurement compared to DSA in the entire circle of Willis. KEY POINTS • 3D HR-MRI showed better diagnostic accuracy for atherosclerosiscompared to DSA • 3D HR-MRI showed better overall diagnostic confidence for stenosiscompared to DSA • 3D HR-MRI and DSA showed similar degree of stenosis.
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Affiliation(s)
- Ji Eun Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Republic of Korea
| | - Seung Chai Jung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Republic of Korea.
| | - Sang Hun Lee
- Department of Neurology, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Ji Young Jeon
- Department of Radiology, Gil Medical Center, Gachon University, Incheon, Korea
| | - Ji Ye Lee
- Department of Radiology, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon, 420-767, Korea
| | - Ho Sung Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Republic of Korea
| | - Choong-Gon Choi
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Republic of Korea
| | - Sang Joon Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Republic of Korea
| | - Deok Hee Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Republic of Korea
| | - Seon-Ok Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun U Kwon
- Department of Neurology, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Dong-Wha Kang
- Department of Neurology, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Jong S Kim
- Department of Neurology, University of Ulsan College of Medicine, Ulsan, South Korea
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22
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Kilburg C, Scott McNally J, de Havenon A, Taussky P, Kalani MYS, Park MS. Advanced imaging in acute ischemic stroke. Neurosurg Focus 2017; 42:E10. [DOI: 10.3171/2017.1.focus16503] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The evaluation and management of acute ischemic stroke has primarily relied on the use of conventional CT and MRI techniques as well as lumen imaging sequences such as CT angiography (CTA) and MR angiography (MRA). Several newer or less-established imaging modalities, including vessel wall MRI, transcranial Doppler ultrasonography, and 4D CTA and MRA, are being developed to complement conventional CT and MRI techniques. Vessel wall MRI provides high-resolution analysis of both extracranial and intracranial vasculature to help identify previously occult lesions or characteristics of lesions that may portend a worse natural history. Transcranial Doppler ultrasonography can be used in the acute setting as a minimally invasive way of identifying large vessel occlusions or monitoring the response to stroke treatment. It can also be used to assist in the workup for cryptogenic stroke or to diagnose a patent foramen ovale. Four-dimensional CTA and MRA provide a less invasive alternative to digital subtraction angiography to determine the extent of the clot burden and the degree of collateral blood flow in large vessel occlusions. Along with technological advances, these new imaging modalities are improving the diagnosis, workup, and management of acute ischemic stroke— roles that will continue to expand in the future.
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23
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Zhu XJ, Wang W, Liu ZJ. High-resolution Magnetic Resonance Vessel Wall Imaging for Intracranial Arterial Stenosis. Chin Med J (Engl) 2017; 129:1363-70. [PMID: 27231176 PMCID: PMC4894049 DOI: 10.4103/0366-6999.182826] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To discuss the feasibility and clinical value of high-resolution magnetic resonance vessel wall imaging (HRMR VWI) for intracranial arterial stenosis. DATE SOURCES We retrieved information from PubMed database up to December 2015, using various search terms including vessel wall imaging (VWI), high-resolution magnetic resonance imaging, intracranial arterial stenosis, black blood, and intracranial atherosclerosis. STUDY SELECTION We reviewed peer-reviewed articles printed in English on imaging technique of VWI and characteristic findings of various intracranial vasculopathies on VWI. We organized this data to explain the value of VWI in clinical application. RESULTS VWI with black blood technique could provide high-quality images with submillimeter voxel size, and display both the vessel wall and lumen of intracranial artery simultaneously. Various intracranial vasculopathies (atherosclerotic or nonatherosclerotic) had differentiating features including pattern of wall thickening, enhancement, and vessel remodeling on VWI. This technique could be used for determining causes of stenosis, identification of stroke mechanism, risk-stratifying patients, and directing therapeutic management in clinical practice. In addition, a new morphological classification based on VWI could be established for predicting the efficacy of endovascular therapy. CONCLUSIONS This review highlights the value of HRMR VWI for discrimination of different intracranial vasculopathies and directing therapeutic management.
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Affiliation(s)
- Xian-Jin Zhu
- Department of Radiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Wu Wang
- Department of Radiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Zun-Jing Liu
- Department of Neurology, China-Japan Friendship Hospital, Beijing 100029, China
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24
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Jang J, Kim TW, Hwang EJ, Choi HS, Koo J, Shin YS, Jung SL, Ahn KJ, Kim BS. Assessment of Arterial Wall Enhancement for Differentiation of Parent Artery Disease from Small Artery Disease: Comparison between Histogram Analysis and Visual Analysis on 3-Dimensional Contrast-Enhanced T1-Weighted Turbo Spin Echo MR Images at 3T. Korean J Radiol 2017; 18:383-391. [PMID: 28246519 PMCID: PMC5313527 DOI: 10.3348/kjr.2017.18.2.383] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 09/01/2016] [Indexed: 01/23/2023] Open
Abstract
Objective The purpose of this study was to compare the histogram analysis and visual scores in 3T MRI assessment of middle cerebral arterial wall enhancement in patients with acute stroke, for the differentiation of parent artery disease (PAD) from small artery disease (SAD). Materials and Methods Among the 82 consecutive patients in a tertiary hospital for one year, 25 patients with acute infarcts in middle cerebral artery (MCA) territory were included in this study including 15 patients with PAD and 10 patients with SAD. Three-dimensional contrast-enhanced T1-weighted turbo spin echo MR images with black-blood preparation at 3T were analyzed both qualitatively and quantitatively. The degree of MCA stenosis, and visual and histogram assessments on MCA wall enhancement were evaluated. A statistical analysis was performed to compare diagnostic accuracy between qualitative and quantitative metrics. Results The degree of stenosis, visual enhancement score, geometric mean (GM), and the 90th percentile (90P) value from the histogram analysis were significantly higher in PAD than in SAD (p = 0.006 for stenosis, < 0.001 for others). The receiver operating characteristic curve area of GM and 90P were 1 (95% confidence interval [CI], 0.86–1.00). Conclusion A histogram analysis of a relevant arterial wall enhancement allows differentiation between PAD and SAD in patients with acute stroke within the MCA territory.
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Affiliation(s)
- Jinhee Jang
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Tae-Won Kim
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Eo-Jin Hwang
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Hyun Seok Choi
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Jaseong Koo
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Yong Sam Shin
- Department of Neurosurgery, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - So-Lyung Jung
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Kook-Jin Ahn
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Bum-Soo Kim
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
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25
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Yang Q, Deng Z, Bi X, Song SS, Schlick KH, Gonzalez NR, Li D, Fan Z. Whole-brain vessel wall MRI: A parameter tune-up solution to improve the scan efficiency of three-dimensional variable flip-angle turbo spin-echo. J Magn Reson Imaging 2017; 46:751-757. [PMID: 28106936 DOI: 10.1002/jmri.25611] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 12/08/2016] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To propose and evaluate a parameter tune-up solution to expedite a three-dimensional (3D) variable-flip-angle turbo spin-echo (TSE) sequence for whole-brain intracranial vessel wall (IVW) imaging. MATERIALS AND METHODS Elliptical k-space sampling and prolonged echo train length (ETL), were used to expedite a 3D variable-flip-angle TSE-based sequence. To compensate for the potential loss in vessel wall signal, optimal combination of prescribed T2 and ETL was experimentally investigated on 22 healthy volunteers at 3 Tesla. The optimized protocol (7-8 min) was then compared with a previous protocol (reference protocol, 11-12 min) in terms of signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), vessel wall sharpness, and wall delineation quality on a 4-point scale (0:poor; 3:excellent) in 10 healthy volunteers. A pilot study of five patients was performed and lesion delineation score was used to demonstrate the diagnostic quality. RESULTS A protocol with ETL = 52 and prescribed T2 = 170 ms was deemed an optimized one, which, compared with the reference protocol, provided significantly improved wall SNR (12.0 ± 1.3 versus 10.0 ± 1.1; P = 0.002), wall-lumen CNR (9.7 ± 1.2 versus 8.0 ± 0.9; P = 0.002), wall-CSF CNR (2.8 ± 1.0 versus 1.7 ± 1.0; P = 0.026), similar vessel wall sharpness at both inner (1.59 ± 0.18 versus 1.58 ± 0.14, P = 0.87) and outer (1.71 ± 0.25 versus 1.83 ± 0.30; P = 0.18) boundaries, and comparable vessel wall delineation score for individual segments (1.95-3; P > 0.06). In all patients, atherosclerotic plaques (10) or wall dissection (5) were identified with a delineation score of 3 or 2. CONCLUSION A parameter tune-up solution can accelerate 3D variable-flip-angle TSE acquisitions, particularly allowed for expedited whole-brain IVW imaging with preserved wall delineation quality. LEVEL OF EVIDENCE 2. Technical Efficacy: Stage 1 J. MAGN. RESON. IMAGING 2017;46:751-757.
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Affiliation(s)
- Qi Yang
- Department of Radiology, Xuanwu Hospital, Beijing, China.,Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Zixin Deng
- Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Bioengineering, University of California, Los Angeles, California, USA
| | - Xiaoming Bi
- MR R&D, Siemens Healthcare, Los Angeles, California, USA
| | - Shlee S Song
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Konrad H Schlick
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Nestor R Gonzalez
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Debiao Li
- Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Bioengineering, University of California, Los Angeles, California, USA
| | - Zhaoyang Fan
- Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
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26
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van den Wijngaard IR, Holswilder G, van Walderveen MAA, Algra A, Wermer MJH, Zaidat OO, Boiten J. Treatment and imaging of intracranial atherosclerotic stenosis: current perspectives and future directions. Brain Behav 2016; 6:e00536. [PMID: 27843693 PMCID: PMC5102638 DOI: 10.1002/brb3.536] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 05/08/2016] [Accepted: 06/08/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Intracranial atherosclerosis is a common cause of stroke worldwide. It results in ischemic stroke due to different mechanisms including artery-to-artery embolism, in situ thrombo-occlusion, occlusion of perforating arteries, and hemodynamic failure. In this review, we present an overview of current treatment and imaging modalities in intracranial atherosclerotic stenosis. METHODS PubMed was searched for relevant articles in English that evaluated the treatment and imaging of intracranial atherosclerotic stenosis (ICAS). RESULTS Aggressive medical management, consisting of dual antiplatelet therapy and intensive risk factor management, is important in patients with ICAS because of a substantial risk of recurrent stroke, approximately 20% in the first year, in patients on aspirin or warfarin alone. Recent trials have suggested that, aggressive medical therapy results in better outcome as compared with intracranial stenting. However, the question remains what the optimal treatment strategy would be in patients with recurrent strokes in the setting of failed aggressive medical therapy. Moreover, controversy exists whether a subgroup of patients with symptomatic ICAS could benefit from intracranial stenting if selection is based on radiological evidence of hemodynamic failure. With regard to imaging, transcranial Doppler ultrasound and magnetic resonance angiography are useful screening tests for exclusion of ICAS, but need confirmation by other imaging modalities when stenosis is suggested. Computed tomography angiography has a high positive and negative predictive value for detection of intracranial luminal stenosis of 50% or higher, but performs worse than digital subtraction angiography with regard to establishing the exact degree of luminal stenosis. Novel imaging techniques including high-resolution CT and MRI better identify plaque characteristics than conventional imaging methods. CONCLUSIONS Currently, aggressive medical management remains the standard of care for patients with ICAS. Further research is needed to identify high-risk subgroups and to develop more effective treatments for ICAS patients.
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Affiliation(s)
- Ido R. van den Wijngaard
- Department of RadiologyLeiden University Medical CenterLeidenthe Netherlands
- Department of NeurologyMedical Center Haaglandenthe Haguethe Netherlands
| | | | | | - Ale Algra
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenthe Netherlands
- Department of Neurology and NeurosurgeryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrechtthe Netherlands
| | | | - Osama O. Zaidat
- Department of NeurologyMedical College of Wisconsin/Froedtert HospitalMilwaukeeWIUSA
| | - Jelis Boiten
- Department of NeurologyMedical Center Haaglandenthe Haguethe Netherlands
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27
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Omodaka S, Endo H, Niizuma K, Fujimura M, Inoue T, Sato K, Sugiyama SI, Tominaga T. Quantitative Assessment of Circumferential Enhancement along the Wall of Cerebral Aneurysms Using MR Imaging. AJNR Am J Neuroradiol 2016; 37:1262-6. [PMID: 26939634 DOI: 10.3174/ajnr.a4722] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 01/03/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The incidence of wall enhancement of cerebral aneurysms on vessel wall MR imaging has been described as higher in ruptured intracranial aneurysms than in unruptured intracranial aneurysms, but the difference in the degree of enhancement between ruptured and unruptured aneurysms is unknown. We compared the degree of enhancement between ruptured and unruptured intracranial aneurysms by using quantitative MR imaging measures. MATERIALS AND METHODS We performed quantitative analyses of circumferential enhancement along the wall of cerebral aneurysms in 28 ruptured and 76 unruptured consecutive cases by using vessel wall MR imaging. A 3D-T1-weighted fast spin-echo sequence was obtained before and after contrast media injection, and the wall enhancement index was calculated. We then compared characteristics between ruptured and unruptured aneurysms. RESULTS The wall enhancement index was significantly higher in ruptured than in unruptured aneurysms (1.70 ± 1.06 versus 0.89 ± 0.88, respectively; P = .0001). The receiver operating characteristic curve analysis found that the most reliable cutoff value of the wall enhancement index to differentiate ruptured from unruptured aneurysms was 0.53 (sensitivity, 0.96; specificity, 0.47). The wall enhancement index remained significant in the multivariate logistic regression analysis (P < .0001). CONCLUSIONS Greater circumferential enhancement along the wall of cerebral aneurysms correlates with the ruptured state. A quantitative evaluation of circumferential enhancement by using vessel wall MR imaging could be useful in differentiating ruptured from unruptured intracranial aneurysms.
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Affiliation(s)
- S Omodaka
- From the Departments of Neurosurgery (S.O., H.E.)
| | - H Endo
- From the Departments of Neurosurgery (S.O., H.E.)
| | - K Niizuma
- Department of Neurosurgery (K.N., M.F., T.T.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - M Fujimura
- Department of Neurosurgery (K.N., M.F., T.T.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - T Inoue
- Department of Neurosurgery (T.I.), Sendai Medical Center, Sendai, Japan
| | - K Sato
- Neuroendovascular Therapy (K.S.)
| | - S-I Sugiyama
- Neuroanesthesia (S.-i.S.), Kohnan Hospital, Sendai, Japan
| | - T Tominaga
- Department of Neurosurgery (K.N., M.F., T.T.), Tohoku University Graduate School of Medicine, Sendai, Japan
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28
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de Havenon A, Chung L, Park M, Mossa-Basha M. Intracranial vessel wall MRI: a review of current indications and future applications. ACTA ACUST UNITED AC 2016. [DOI: 10.1186/s40809-016-0021-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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29
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Alexander MD, Yuan C, Rutman A, Tirschwell DL, Palagallo G, Gandhi D, Sekhar LN, Mossa-Basha M. High-resolution intracranial vessel wall imaging: imaging beyond the lumen. J Neurol Neurosurg Psychiatry 2016; 87:589-97. [PMID: 26746187 PMCID: PMC5504758 DOI: 10.1136/jnnp-2015-312020] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 11/23/2015] [Indexed: 01/21/2023]
Abstract
Accurate and timely diagnosis of intracranial vasculopathies is important due to significant risk of morbidity with delayed and/or incorrect diagnosis both from the disease process as well as inappropriate therapies. Conventional vascular imaging techniques for analysis of intracranial vascular disease provide limited information since they only identify changes to the vessel lumen. New advanced MR intracranial vessel wall imaging (IVW) techniques can allow direct characterisation of the vessel wall. These techniques can advance diagnostic accuracy and may potentially improve patient outcomes by better guided treatment decisions in comparison to previously available invasive and non-invasive techniques. While neuroradiological expertise is invaluable in accurate examination interpretation, clinician familiarity with the application and findings of the various vasculopathies on IVW can help guide diagnostic and therapeutic decision-making. This review article provides a brief overview of the technical aspects of IVW and discusses the IVW findings of various intracranial vasculopathies, differentiating characteristics and indications for when this technique can be beneficial in patient management.
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Affiliation(s)
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Aaron Rutman
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - David L Tirschwell
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Gerald Palagallo
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Dheeraj Gandhi
- Department of Radiology, Neurology and Neurosurgery, University of Maryland, Baltimore, Maryland, USA
| | - Laligam N Sekhar
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington, Seattle, Washington, USA
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30
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Natori T, Sasaki M, Miyoshi M, Ito K, Ohba H, Miyazawa H, Narumi S, Kabasawa H, Harada T, Terayama Y. Intracranial Plaque Characterization in Patients with Acute Ischemic Stroke Using Pre- and Post-Contrast Three-Dimensional Magnetic Resonance Vessel Wall Imaging. J Stroke Cerebrovasc Dis 2016; 25:1425-30. [PMID: 27021042 DOI: 10.1016/j.jstrokecerebrovasdis.2015.12.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 12/14/2015] [Accepted: 12/27/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Magnetic resonance vessel wall imaging (VWI) techniques have been developed to assess atherosclerotic plaques in intracranial arteries, which are a cardinal cause of ischemic stroke. However, the clinical roles of plaque-related vulnerability and inflammation remain unclear. Hence, we evaluated plaque characteristics using VWI of the proximal middle cerebral artery (M1) in patients with acute ischemic stroke. METHODS We prospectively examined 30 consecutive patients with acute noncardioembolic stroke in the M1 territory using pre-/postcontrast T1-weighted (T1W) three-dimensional (3D) VWI with a 3-Tesla scanner. The contrast ratio (CR) and contrast enhancement of the plaques were measured bilaterally at M1. RESULTS Plaques were identified in the bilateral M1s of all patients, and no substantial stenosis existed. The M1 plaque CRs ipsilateral to the infarct (46.7%-67.9%) were significantly higher than the plaque CRs on the contralateral side (34.3%-69.4%), particularly in patients with lacunar infarcts (P <.01). In contrast, the occurrence of plaque enhancement was not different between the ipsilateral (20.0%) and contralateral (16.7%) sides. Further, the CRs in the nonlacunar group were significantly higher than the CRs in the lacunar group (P <.05), whereas enhanced plaques tended to be more frequent in the nonlacunar group, but this difference was not significant (P = .09). CONCLUSIONS T1W 3D-VWI revealed that the signal intensity of M1 plaques was significantly higher in the affected side and in nonlacunar-type infarcts of patients with acute stroke, suggesting that unstable plaques in the M1 can cause stroke events presumably due to atherothrombotic mechanisms.
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Affiliation(s)
- Tatsunori Natori
- Department of Neurology and Gerontology, Iwate Medical University, Japan.
| | - Makoto Sasaki
- Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Japan
| | | | - Kohei Ito
- Department of Neurology and Gerontology, Iwate Medical University, Japan
| | - Hideki Ohba
- Department of Neurology and Gerontology, Iwate Medical University, Japan
| | - Haruna Miyazawa
- Department of Neurology and Gerontology, Iwate Medical University, Japan
| | - Shinsuke Narumi
- Department of Neurology and Gerontology, Iwate Medical University, Japan
| | | | - Taisuke Harada
- Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Japan
| | - Yasuo Terayama
- Department of Neurology and Gerontology, Iwate Medical University, Japan
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31
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Fan Z, Yang Q, Deng Z, Li Y, Bi X, Song S, Li D. Whole-brain intracranial vessel wall imaging at 3 Tesla using cerebrospinal fluid-attenuated T1-weighted 3D turbo spin echo. Magn Reson Med 2016; 77:1142-1150. [PMID: 26923198 DOI: 10.1002/mrm.26201] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 01/20/2016] [Accepted: 02/12/2016] [Indexed: 11/11/2022]
Abstract
PURPOSE Although three-dimensional (3D) turbo spin echo (TSE) with variable flip angles has proven to be useful for intracranial vessel wall imaging, it is associated with inadequate suppression of cerebrospinal fluid (CSF) signals and limited spatial coverage at 3 Tesla (T). This work aimed to modify the sequence and develop a protocol to achieve whole-brain, CSF-attenuated T1 -weighted vessel wall imaging. METHODS Nonselective excitation and a flip-down radiofrequency pulse module were incorporated into a commercial 3D TSE sequence. A protocol based on the sequence was designed to achieve T1 -weighted vessel wall imaging with whole-brain spatial coverage, enhanced CSF-signal suppression, and isotropic 0.5-mm resolution. Human volunteer and pilot patient studies were performed to qualitatively and quantitatively demonstrate the advantages of the sequence. RESULTS Compared with the original sequence, the modified sequence significantly improved the T1 -weighted image contrast score (2.07 ± 0.19 versus 3.00 ± 0.00, P = 0.011), vessel wall-to-CSF contrast ratio (0.14 ± 0.16 versus 0.52 ± 0.30, P = 0.007) and contrast-to-noise ratio (1.69 ± 2.18 versus 4.26 ± 2.30, P = 0.022). Significant improvement in vessel wall outer boundary sharpness was observed in several major arterial segments. CONCLUSIONS The new 3D TSE sequence allows for high-quality T1 -weighted intracranial vessel wall imaging at 3 T. It may potentially aid in depicting small arteries and revealing T1 -mediated high-signal wall abnormalities. Magn Reson Med 77:1142-1150, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Zhaoyang Fan
- Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Qi Yang
- Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Radiology, Xuanwu Hospital, Beijing, China
| | - Zixin Deng
- Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Bioengineering, University of California, Los Angeles, California, USA
| | - Yuxia Li
- Department of Neurology, Xuanwu Hospital, Beijing, China
| | - Xiaoming Bi
- MR R&D, Siemens Healthcare, Los Angeles, California, USA
| | - Shlee Song
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Debiao Li
- Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Bioengineering, University of California, Los Angeles, California, USA
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32
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Miller TR, Shivashankar R, Mossa-Basha M, Gandhi D. Reversible Cerebral Vasoconstriction Syndrome, Part 2: Diagnostic Work-Up, Imaging Evaluation, and Differential Diagnosis. AJNR Am J Neuroradiol 2015; 36:1580-8. [PMID: 25614476 DOI: 10.3174/ajnr.a4215] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The diagnostic evaluation of a patient with reversible cerebral vasoconstriction syndrome integrates clinical, laboratory, and radiologic findings. Imaging plays an important role by confirming the presence of cerebral vasoconstriction; monitoring potential complications such as ischemic stroke; and suggesting alternative diagnoses, including CNS vasculitis and aneurysmal subarachnoid hemorrhage. Noninvasive vascular imaging, including transcranial Doppler sonography and MR angiography, has played an increasingly important role in this regard, though conventional angiography remains the criterion standard for the evaluation of cerebral artery vasoconstriction. Newer imaging techniques, including high-resolution vessel wall imaging, may help in the future to better discriminate reversible cerebral vasoconstriction syndrome from primary angiitis of the CNS, an important clinical distinction.
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Affiliation(s)
- T R Miller
- From the Department of Diagnostic Radiology (T.R.M., R.S., D.G.), Section of Neuroradiology, University of Maryland Medical Center, Baltimore, Maryland
| | - R Shivashankar
- From the Department of Diagnostic Radiology (T.R.M., R.S., D.G.), Section of Neuroradiology, University of Maryland Medical Center, Baltimore, Maryland
| | - M Mossa-Basha
- Department of Diagnostic Radiology (M.M.-B.), Section of Neuroradiology, University of Washington, Seattle, Washington
| | - D Gandhi
- From the Department of Diagnostic Radiology (T.R.M., R.S., D.G.), Section of Neuroradiology, University of Maryland Medical Center, Baltimore, Maryland
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van der Kolk AG, Zwanenburg JJM, Denswil NP, Vink A, Spliet WGM, Daemen MJAP, Visser F, Klomp DWJ, Luijten PR, Hendrikse J. Imaging the intracranial atherosclerotic vessel wall using 7T MRI: initial comparison with histopathology. AJNR Am J Neuroradiol 2014; 36:694-701. [PMID: 25477359 DOI: 10.3174/ajnr.a4178] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 08/30/2014] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE Several studies have attempted to characterize intracranial atherosclerotic plaques by using MR imaging sequences. However, dedicated validation of these sequences with histology has not yet been performed. The current study assessed the ability of ultra-high-resolution 7T MR imaging sequences with different image contrast weightings to image plaque components, by using histology as criterion standard. MATERIALS AND METHODS Five specimens of the circle of Wills were imaged at 7T with 0.11 × 0.11 mm in-plane-resolution proton attenuation-, T1-, T2-, and T2*-weighted sequences (through-plane resolution, 0.11-1 mm). Tissue samples from 13 fiducial-marked locations (per specimen) on MR imaging underwent histologic processing and atherosclerotic plaque classification. Reconstructed MR images were matched with histologic sections at corresponding locations. RESULTS Forty-four samples were available for subsequent evaluation of agreement or disagreement between plaque components and image contrast differences. Of samples, 52.3% (n = 23) showed no image contrast heterogeneity; this group comprised solely no lesions or early lesions. Of samples, 25.0% (n = 11, mostly advanced lesions) showed good correlation between the spatial organization of MR imaging heterogeneities and plaque components. Areas of foamy macrophages were generally seen as proton attenuation-, T2-, and T2*- hypointense areas, while areas of increased collagen content showed more ambiguous signal intensities. Five samples showed image-contrast heterogeneity without corresponding plaque components on histology; 5 other samples showed contrast heterogeneity based on intima-media artifacts. CONCLUSIONS MR imaging at 7T has the image contrast capable of identifying both focal intracranial vessel wall thickening and distinguishing areas of different signal intensities spatially corresponding to plaque components within more advanced atherosclerotic plaques.
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Affiliation(s)
| | - J J M Zwanenburg
- Radiology (A.G.v.d.K., J.J.M.Z., F.V., D.W.J.K., P.R.L., J.H.) Image Sciences Institute (J.J.M.Z.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - N P Denswil
- Department of Pathology (N.P.D., M.J.A.P.D.), Academic Medical Center Amsterdam, Amsterdam, the Netherlands
| | - A Vink
- From the Departments of Pathology (A.V., W.G.M.S.)
| | - W G M Spliet
- From the Departments of Pathology (A.V., W.G.M.S.)
| | - M J A P Daemen
- Department of Pathology (N.P.D., M.J.A.P.D.), Academic Medical Center Amsterdam, Amsterdam, the Netherlands
| | - F Visser
- Radiology (A.G.v.d.K., J.J.M.Z., F.V., D.W.J.K., P.R.L., J.H.) Philips Healthcare (F.V.), Best, the Netherlands
| | - D W J Klomp
- Radiology (A.G.v.d.K., J.J.M.Z., F.V., D.W.J.K., P.R.L., J.H.)
| | - P R Luijten
- Radiology (A.G.v.d.K., J.J.M.Z., F.V., D.W.J.K., P.R.L., J.H.)
| | - J Hendrikse
- Radiology (A.G.v.d.K., J.J.M.Z., F.V., D.W.J.K., P.R.L., J.H.)
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Dieleman N, van der Kolk AG, Zwanenburg JJ, Harteveld AA, Biessels GJ, Luijten PR, Hendrikse J. Imaging Intracranial Vessel Wall Pathology With Magnetic Resonance Imaging. Circulation 2014; 130:192-201. [PMID: 25001624 DOI: 10.1161/circulationaha.113.006919] [Citation(s) in RCA: 129] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nikki Dieleman
- From the Department of Radiology (N.D., A.G.v.d.K., J.J.M.Z., A.A.H., P.R.L., J.H.), Image Sciences Institute (J.J.M.Z.), and Department of Neurology (G.J.B.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - Anja G. van der Kolk
- From the Department of Radiology (N.D., A.G.v.d.K., J.J.M.Z., A.A.H., P.R.L., J.H.), Image Sciences Institute (J.J.M.Z.), and Department of Neurology (G.J.B.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jaco J.M. Zwanenburg
- From the Department of Radiology (N.D., A.G.v.d.K., J.J.M.Z., A.A.H., P.R.L., J.H.), Image Sciences Institute (J.J.M.Z.), and Department of Neurology (G.J.B.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - Anita A. Harteveld
- From the Department of Radiology (N.D., A.G.v.d.K., J.J.M.Z., A.A.H., P.R.L., J.H.), Image Sciences Institute (J.J.M.Z.), and Department of Neurology (G.J.B.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - Geert J. Biessels
- From the Department of Radiology (N.D., A.G.v.d.K., J.J.M.Z., A.A.H., P.R.L., J.H.), Image Sciences Institute (J.J.M.Z.), and Department of Neurology (G.J.B.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - Peter R. Luijten
- From the Department of Radiology (N.D., A.G.v.d.K., J.J.M.Z., A.A.H., P.R.L., J.H.), Image Sciences Institute (J.J.M.Z.), and Department of Neurology (G.J.B.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jeroen Hendrikse
- From the Department of Radiology (N.D., A.G.v.d.K., J.J.M.Z., A.A.H., P.R.L., J.H.), Image Sciences Institute (J.J.M.Z.), and Department of Neurology (G.J.B.), University Medical Center Utrecht, Utrecht, the Netherlands
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