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Zhang H, Lu M, Liu S, Liu D, Liu X, Shen X, Han C, Sheng F, Cai J. Predictors of Stroke Outcomes in Conservatively Treated Patients With Moyamoya Disease: A Follow-up MRI Study. J Magn Reson Imaging 2024; 59:1456-1463. [PMID: 37357525 DOI: 10.1002/jmri.28880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/11/2023] [Accepted: 06/13/2023] [Indexed: 06/27/2023] Open
Abstract
BACKGROUND Little is known about the association between stroke and imaging and clinical features in conservatively treated patients with moyamoya disease (MMD). PURPOSE To investigate independent risk factors for stroke in conservatively treated patients with MMD during a long-term follow-up. STUDY TYPE Prospective study. SUBJECTS One hundred sixty conservatively managed patients with MMD (median age 46 years, 89 male). FIELD STRENGTH/SEQUENCE Time of flight, turbo inversion recovery magnitude T1WI, turbo spin echo (TSE) T2WI, echo-planar imaging DWI, T2-fluid attenuated inversion recovery, dynamic susceptibility contrast-magnetic resonance imaging, and pre- and post-contrast 3D TSE T1WI sequences at 3.0 Tesla. ASSESSMENT Patients were assessed at baseline and followed yearly. Ischemic and hemorrhagic stroke incidence rates were determined. Multiple demographic, clinical (modified Rankin score [mRS]), and cerebral imaging (cerebral blood volume [CBV] and concentric enhancement of arterial wall) factors at baseline were considered as potential predictors of stroke during the follow-up period. STATISTICAL TESTS Univariable and multivariable Cox proportional hazards models to calculate the hazard ratios (HRs) and corresponding 95% confidence interval (CI) for stroke. Cumulative risk of stroke was estimated by the Kaplan-Meier product-limit method. A P value <0.05 was considered statistically significant. RESULTS The median follow-up duration was 47 months. During the follow-up period, 18 (11.25%) patients experienced stroke events (13 [8.13%] ischemic, 5 [3.12%] hemorrhagic). Univariable analysis showed that 11 factors were significantly associated with stroke. After adjustment for clinical characteristics, multivariable analysis showed that mRS score ≥3 (HR, 1.99; 95% CI, 1.26-3.14), decreased CBV (HR, 5.31; 95% CI, 2.32-12.13), and concentric enhancement of the arterial wall (HR, 4.16; 95% CI, 1.55-11.15) were significantly associated with stroke. DATA CONCLUSION Decreased CBV, mRS score ≥ 3, and concentric enhancement of the arterial wall were significantly associated with increased incidence of stroke in conservatively treated MMD. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 4.
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Affiliation(s)
- Hongtao Zhang
- Department of Radiology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Mingming Lu
- Department of Radiology, Pingjin Hospital, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, China
| | - Shitong Liu
- Department of Radiology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Dongqing Liu
- Department of Radiology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xu Liu
- Department of Radiology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xuxuan Shen
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Cong Han
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Fugeng Sheng
- Department of Radiology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jianming Cai
- Department of Radiology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 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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Oestreich LKL, O'Sullivan MJ. Transdiagnostic In Vivo Magnetic Resonance Imaging Markers of Neuroinflammation. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2022; 7:638-658. [PMID: 35051668 DOI: 10.1016/j.bpsc.2022.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 05/13/2023]
Abstract
Accumulating evidence suggests that inflammation is not limited to archetypal inflammatory diseases such as multiple sclerosis, but instead represents an intrinsic feature of many psychiatric and neurological disorders not typically classified as neuroinflammatory. A growing body of research suggests that neuroinflammation can be observed in early and prodromal stages of these disorders and, under certain circumstances, may lead to tissue damage. Traditional methods to assess neuroinflammation include serum or cerebrospinal fluid markers and positron emission tomography. These methods require invasive procedures or radiation exposure and lack the exquisite spatial resolution of magnetic resonance imaging (MRI). There is, therefore, an increasing interest in noninvasive neuroimaging tools to evaluate neuroinflammation reliably and with high specificity. While MRI does not provide information at a cellular level, it facilitates the characterization of several biophysical tissue properties that are closely linked to neuroinflammatory processes. The purpose of this review is to evaluate the potential of MRI as a noninvasive, accessible, and cost-effective technology to image neuroinflammation across neurological and psychiatric disorders. We provide an overview of current and developing MRI methods used to study different aspects of neuroinflammation and weigh their strengths and shortcomings. Novel MRI contrast agents are increasingly able to target inflammatory processes directly, therefore offering a high degree of specificity, particularly if used in conjunction with multitissue, biophysical diffusion MRI compartment models. The capability of these methods to characterize several aspects of the neuroinflammatory milieu will likely push MRI to the forefront of neuroimaging modalities used to characterize neuroinflammation transdiagnostically.
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Affiliation(s)
- Lena K L Oestreich
- Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia; Centre for Advanced Imaging, The University of Queensland, Brisbane, Queensland, Australia.
| | - Michael J O'Sullivan
- Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia; Institute of Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia; Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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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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Lu M, Zhang H, Liu D, Liu X, Zhang L, Peng P, Yuan F, Liu S, Sheng F, Liu Y, He Y, Zhao X, Zhang Q, Fu H, Han C, Cai J. Association of intracranial vessel wall enhancement and cerebral hemorrhage in moyamoya disease: a high-resolution magnetic resonance imaging study. J Neurol 2021; 268:4768-4777. [PMID: 33956201 DOI: 10.1007/s00415-021-10587-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/25/2021] [Accepted: 04/27/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND PURPOSE This study aimed to investigate the enhancement characteristics of vessel wall in patients with moyamoya disease (MMD) using 3D high-resolution magnetic resonance (MR) imaging and their relationship with initial and recurrent intracranial hemorrhage. METHODS Consecutive patients with MMD were retrospectively analyzed and classified as intracranial hemorrhagic and non-hemorrhagic groups according to the CT or MR images. The clinical features and vessel wall characteristics were compared between the two groups. Logistic regression was performed to relate the vessel wall characteristics to the initial hemorrhage in MMD patients. Patients in hemorrhagic group were followed up after surgery to evaluate the relationship between vessel wall characteristics and recurrent hemorrhage. RESULTS A total of 507 MMD patients including 79 hemorrhagic and 428 non-hemorrhagic MMD patients were recruited in the study. We found that hemorrhagic group had more patients with vessel wall enhancements (40.5% vs. 25.7%, p = 0.009) and more eccentric enhanced lesions (17.7% vs. 6.5%, p = 0.001) compared to those in non-hemorrhage group and vessel wall enhancements were independently associated with ipsilateral initial hemorrhage after adjusted for clinical factors (OR = 1.99, CI 1.20-3.28, p = 0.007). Furthermore, three recurrent intracranial hemorrhagic episodes in the present study were all observed in MMD patients with vessel wall enhancement during the long-term follow-up after surgery. CONCLUSIONS Wall enhancement of intracranial vessels was significantly associated with intracranial hemorrhage in MMD patients. Our findings suggest that vessel wall enhancement may serve as a marker of intracranial hemorrhage.
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Affiliation(s)
- Mingming Lu
- Department of Radiology, Pingjin Hospital, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, China.,State Key Laboratory of Kidney Disease, Beijing Key Laboratory of Aging and Geriatrics, Institute of Geriatrics, The Second Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Hongtao Zhang
- Department of Radiology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Dongqing Liu
- Department of Radiology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Xu Liu
- Department of Radiology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Lichen Zhang
- Department of Radiology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Peng Peng
- Department of Radiology, Pingjin Hospital, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, China
| | - Fei Yuan
- Department of Radiology, Pingjin Hospital, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, China
| | - Shitong Liu
- Department of Radiology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Fugeng Sheng
- Department of Radiology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Yuan Liu
- Department of Radiology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Yao He
- State Key Laboratory of Kidney Disease, Beijing Key Laboratory of Aging and Geriatrics, Institute of Geriatrics, The Second Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xihai Zhao
- Department of Biomedical Engineering, Center for Biomedical Imaging Research, Tsinghua University School of Medicine, Beijing, China
| | - Qian Zhang
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, 100853, China
| | - Heguan Fu
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, 100853, China
| | - Cong Han
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, 100853, China.
| | - Jianming Cai
- Department of Radiology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.
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Acute ischemic stroke versus transient ischemic attack: Differential plaque morphological features in symptomatic intracranial atherosclerotic lesions. Atherosclerosis 2021; 319:72-78. [PMID: 33486353 DOI: 10.1016/j.atherosclerosis.2021.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/18/2020] [Accepted: 01/06/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND AIMS Intracranial atherosclerotic disease (ICAD) is a major etiologic cause for acute ischemic stroke (AIS) and transient ischemic attack (TIA). The study was designed to investigate if differential morphological features exist in symptomatic atherosclerotic lesions between AIS and TIA patients. METHODS The culprit plaques from 45 AIS patients and 42 TIA patients were analyzed for the degree of stenosis, vessel wall irregularity, normalized wall index (NWI), remodeling index, plaque-wall contrast ratio (CR), high signal intensity on T1-weighted images, plaque enhancement ratio and enhancement grade. These plaque features along with clinical characteristics were compared between AIS and TIA groups as well as between their stenosis degree-matched subgroups. RESULTS Overall, grade 2 enhancement (OR 3.85, 95%CI 1.42-10.46, p = 0.006) and hyperlipidemia (OR 3.04, 95%CI 1.13-8.22, p = 0.025) were independent indicators for AIS, whereas high NWI (OR 1.47, 95%CI 0.76-2.86, p = 0.004) was associated with TIA. In the comparison between the subgroups with moderate (30%-69%) stenosis, high plaque-wall CR (OR 5.38, 95%CI 1.39-20.75, p = 0.008) was associated with AIS, whereas high NWI (OR 2.50, 95%CI 0.61-10.00, p = 0.006) was associated with TIA. CONCLUSIONS Our study reveals differential morphological features in symptomatic ICAD lesions between AIS and TIA patients. Probing these features with MR vessel wall imaging may provide insights into the prognosis of patients with ICAD.
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Suzuki T, Natori T, Sasaki M, Miyazawa H, Narumi S, Ito K, Kamada A, Yoshida M, Tsuda K, Yoshioka K, Terayama Y. Evaluating recanalization of relevant lenticulostriate arteries in acute ischemic stroke using high-resolution MRA at 7T. Int J Stroke 2020; 16:1039-1046. [PMID: 31955704 DOI: 10.1177/1747493019897868] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Occluded major intracranial arteries can spontaneously recanalize in patients with acute ischemic stroke mainly due to embolic mechanisms. However, it remains unknown whether recanalization can occur in perforating arteries, such as lenticulostriate arteries. Therefore, in the present study, we assessed changes suggesting recanalization of the lenticulostriate arteries in patients with acute ischemic stroke of the lenticulostriate artery territory using high-resolution magnetic resonance angiography (HR-MRA) at 7T. METHODS We prospectively examined 39 consecutive patients with acute infarcts confined within the lenticulostriate artery territory. Using a 7T scanner during the acute period and one month thereafter, we evaluated imaging findings indicating the recanalization of the relevant lenticulostriate arteries, following which we examined differences in other imaging findings and clinical characteristics between patients with/without recanalization. RESULTS HR-MRA findings suggestive of recanalization (i.e. patent lenticulostriate arteries within acute infarct lesions with/without hemorrhagic changes) were observed in 8 (25%) of 32 patients who were eligible for analyses. These findings were detected in three and five patients on the baseline and follow-up images, respectively. The lengths of relevant lenticulostriate arteries on the follow-up MRA were significantly larger in patients with recanalization than in those without (P = 0.01). However, there were no significant differences in the infarct volume or clinical outcomes between the recanalization and non-recanalization groups. CONCLUSION HR-MRA at 7T revealed that recanalization of the relevant lenticulostriate arteries can occur in patients with acute ischemic stroke confined to the lenticulostriate artery territory.
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Affiliation(s)
- Takafumi Suzuki
- Department of Neurology and Gerontology, Iwate Medical University, Morioka, Japan
| | - Tatsunori Natori
- Department of Neurology and Gerontology, Iwate Medical University, Morioka, Japan
| | - Makoto Sasaki
- Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Morioka, Japan
| | - Haruna Miyazawa
- Department of Neurology and Gerontology, Iwate Medical University, Morioka, Japan
| | - Shinsuke Narumi
- Department of Neurology and Gerontology, Iwate Medical University, Morioka, Japan
| | - Kohei Ito
- Department of Neurology and Gerontology, Iwate Medical University, Morioka, Japan
| | - Asami Kamada
- Department of Neurology and Gerontology, Iwate Medical University, Morioka, Japan
| | - Makiko Yoshida
- Department of Neurology and Gerontology, Iwate Medical University, Morioka, Japan
| | - Keisuke Tsuda
- Department of Neurology and Gerontology, Iwate Medical University, Morioka, Japan
| | | | - Yasuo Terayama
- Department of Neurology and Gerontology, Iwate Medical University, Morioka, Japan
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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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Natori T, Narumi S, Suzuki T, Sato M, Tsuda K, Kamada A, Yoshida M, Oi K, Suzuki Y, Terayama Y. An Anatomical Variation in the Cervical Carotid Artery of a Young Stroke Patient. Intern Med 2019; 58:123-126. [PMID: 30146606 PMCID: PMC6367095 DOI: 10.2169/internalmedicine.1526-18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
The cervical carotid artery has been reported to show anatomical variations. We report the case of a young stroke patient with a small right-parietal-lobe infarction whose cervical carotid artery showed anatomical variation. The right internal carotid artery (ICA) originated at the C2 level of the external carotid artery with protrusion at the right carotid bifurcation. The vessel wall of the protrusion showed a high signal intensity on T1-weighted magnetic resonance carotid plaque imaging. The protrusion, considered a remnant of the ICA, possibly caused the stroke due to the formation of thrombi as a result of changes in blood flow and viscosity.
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Affiliation(s)
- Tatsunori Natori
- Department of Neurology and Gerontology, Institute for Biomedical Sciences, Iwate Medical University, Japan
| | - Shinsuke Narumi
- Department of Neurology and Gerontology, Institute for Biomedical Sciences, Iwate Medical University, Japan
| | - Takafumi Suzuki
- Department of Neurology and Gerontology, Institute for Biomedical Sciences, Iwate Medical University, Japan
| | - Mitsunobu Sato
- Department of Neurology and Gerontology, Institute for Biomedical Sciences, Iwate Medical University, Japan
| | - Keisuke Tsuda
- Department of Neurology and Gerontology, Institute for Biomedical Sciences, Iwate Medical University, Japan
| | - Asami Kamada
- Department of Neurology and Gerontology, Institute for Biomedical Sciences, Iwate Medical University, Japan
| | - Makiko Yoshida
- Department of Neurology and Gerontology, Institute for Biomedical Sciences, Iwate Medical University, Japan
| | - Kiyotaka Oi
- Department of Neurology and Gerontology, Institute for Biomedical Sciences, Iwate Medical University, Japan
| | - Yoshio Suzuki
- Department of Neurology and Gerontology, Institute for Biomedical Sciences, Iwate Medical University, Japan
| | - Yasuo Terayama
- Department of Neurology and Gerontology, Institute for Biomedical Sciences, Iwate Medical University, Japan
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Miyazawa H, Natori T, Kameda H, Sasaki M, Ohba H, Narumi S, Ito K, Sato M, Suzuki T, Tsuda K, Yoshioka K, Terayama Y. Detecting lenticulostriate artery lesions in patients with acute ischemic stroke using high-resolution MRA at 7 T. Int J Stroke 2018; 14:290-297. [PMID: 30299228 DOI: 10.1177/1747493018806163] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Recent advances in high-resolution (HR) magnetic resonance angiography (MRA) using ultrahigh-field systems enable direct visualization of the lenticulostriate arteries (LSAs), which had been hardly achieved by conventional MRA. Hence, by using HR-MRA at 7 T, we attempted to assess occlusive changes in the LSAs in patients with LSA territorial infarcts. METHODS We prospectively examined 34 consecutive patients with acute ischemic stroke in the LSA territory using a 7 T scanner. We measured the lengths of the relevant LSAs on HR-MRA and the diameters/volume of the infarcts and compared these between the patients with/without occlusive changes in the LSAs. RESULTS On HR-MRA, occlusion of the LSAs was observed in 19 (59%) of 32 patients who were eligible for the analyses. The curved/straight lengths of the LSAs in the patients with LSA occlusion (23.1-31.1/17.8-24.3 mm) were significantly shorter than in those without apparent LSA occlusion (25.8-39.5/24.0-30.4 mm) ( P = 0.027/0.003). The anteroposterior/superoinferior diameters of the infarcts were significantly larger in the occluded-LSA group (14.5-21.4/14.9-22.2 mm) than in the intact-LSA group (10.9-16.8/10.8-16.2 mm) ( P = 0.041/0.011). In addition, the curved lengths of the relevant LSAs showed significant correlations with the superoinferior diameters of the infarcts ( r = 0.38, P = 0.034). CONCLUSION Occlusive changes in the LSAs were frequently found in patients with acute ischemic stroke within the LSA territory when using HR-MRA at 7 T and were substantially related to superoinferior extension of the infarcts.
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Affiliation(s)
- Haruna Miyazawa
- 1 Department of Neurology and Gerontology Iwate Medical University, Japan
| | - Tatsunori Natori
- 1 Department of Neurology and Gerontology Iwate Medical University, Japan
| | - Hiroyuki Kameda
- 2 Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Japan
| | - Makoto Sasaki
- 2 Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Japan
| | - Hideki Ohba
- 1 Department of Neurology and Gerontology Iwate Medical University, Japan
| | - Shinsuke Narumi
- 1 Department of Neurology and Gerontology Iwate Medical University, Japan
| | - Kohei Ito
- 1 Department of Neurology and Gerontology Iwate Medical University, Japan
| | - Mitsunobu Sato
- 1 Department of Neurology and Gerontology Iwate Medical University, Japan
| | - Takafumi Suzuki
- 1 Department of Neurology and Gerontology Iwate Medical University, Japan
| | - Keisuke Tsuda
- 1 Department of Neurology and Gerontology Iwate Medical University, Japan
| | | | - Yasuo Terayama
- 1 Department of Neurology and Gerontology Iwate Medical University, Japan
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Wang M, Wu F, Yang Y, Miao H, Fan Z, Ji X, Li D, Guo X, Yang Q. Quantitative assessment of symptomatic intracranial atherosclerosis and lenticulostriate arteries in recent stroke patients using whole-brain high-resolution cardiovascular magnetic resonance imaging. J Cardiovasc Magn Reson 2018; 20:35. [PMID: 29880054 PMCID: PMC5992765 DOI: 10.1186/s12968-018-0465-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 05/24/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND It has been shown that intracranial atherosclerotic stenosis (ICAS) has heterogeneous features in terms of plaque instability and vascular remodeling. Therefore, quantitative information on the changes of intracranial atherosclerosis and lenticulostriate arteries (LSAs) may potentially improve understanding of the pathophysiological mechanisms underlying stroke and may guide the treatment and work-up strategies. Our present study aimed to use a novel whole-brain high-resolution cardiovascular magnetic resonance imaging (WB-HRCMR) to assess both ICAS plaques and LSAs in recent stroke patients. METHODS Twenty-nine symptomatic and 23 asymptomatic ICAS patients were enrolled in this study from Jan 2015 through Sep 2017 and all patients underwent WB-HRCMR. Intracranial atherosclerotic plaque burden, plaque enhancement volume, plaque enhancement index, as well as the number and length of LSAs were evaluated in two groups. Enhancement index was calculated as follows: ([Signal intensity (SI)plaque/SInormal wall on post-contrast imaging] - [SIplaque/SInormal wall on matched pre-contrast imaging])/(SIplaque / SInormal wall on matched pre-contrast imaging). Logistic regression analysis was used to investigate the independent high risk plaque and LSAs features associated with stroke. RESULTS Symptomatic ICAS patients exhibited larger enhancement plaque volume (20.70 ± 3.07 mm3 vs. 6.71 ± 1.87 mm3 P = 0.001) and higher enhancement index (0.44 ± 0.08 vs. 0.09 ± 0.06 P = 0.001) compared with the asymptomatic ICAS. The average length of LSAs in symptomatic ICAS (20.95 ± 0.87 mm) was shorter than in asymptomatic ICAS (24.04 ± 0.95 mm) (P = 0.02). Regression analysis showed that the enhancement index (100.43, 95% CI - 4.02-2510.96; P = 0.005) and the average length of LSAs (0.80, 95% CI - 0.65-0.99; P = 0.036) were independent factors for predicting of stroke. CONCLUSION WB-HRCMR enabled the comprehensive quantitative evaluation of intracranial atherosclerotic lesions and perforating arteries. Symptomatic ICAS had distinct plaque characteristics and shorter LSA length compared with asymptomatic ICAS.
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Affiliation(s)
- Mengnan Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053 China
| | - Fang Wu
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053 China
| | - Yujiao Yang
- Department of Neurology, Sanbo Brain Hospital, Capital Medical University, Beijing, 100093 China
| | - Huijuan Miao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053 China
| | - Zhaoyang Fan
- Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, CA 90048 USA
| | - Xunming Ji
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053 China
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, CA 90048 USA
| | - Xiuhai Guo
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053 China
| | - Qi Yang
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053 China
- Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, CA 90048 USA
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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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