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Sun B, Wang L, Li X, Zhang J, Zhang J, Tian J, Mossa-Basha M, Xu J, Zhou Y, Zhao H, Zhu C. Delayed Enhancement of Intracranial Atherosclerotic Plaque Can Better Differentiate Culprit Lesions: A Multiphase Contrast-Enhanced Vessel Wall MRI Study. AJNR Am J Neuroradiol 2024; 45:262-270. [PMID: 38388686 DOI: 10.3174/ajnr.a8132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 12/05/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND AND PURPOSE Intracranial plaque enhancement (IPE) identified by contrast-enhanced vessel wall MR imaging (VW-MR imaging) is an emerging marker of plaque instability related to stroke risk, but there was no standardized timing for postcontrast acquisition. We aim to explore the optimal postcontrast timing by using multiphase contrast-enhanced VW-MR imaging and to test its performance in differentiating culprit and nonculprit lesions. MATERIALS AND METHODS Patients with acute ischemic stroke due to intracranial plaque were prospectively recruited to undergo VW-MR imaging with 1 precontrast phase and 4 consecutive postcontrast phases (9 minutes and 13 seconds for each phase). The signal intensity (SI) values of the CSF and intracranial plaque were measured on 1 precontrast and 4 postcontrast phases to determine the intracranial plaque enhancement index (PEI). The dynamic changes of the PEI were compared between culprit and nonculprit plaques on the postcontrast acquisitions. RESULTS Thirty patients with acute stroke (aged 59 ± 10 years, 18 [60%] men) with 113 intracranial plaques were included. The average PEI of all intracranial plaques significantly increased (up to 14%) over the 4 phases. There was significantly increased PEI over the 4 phases for culprit plaques (an average increase of 23%), but this was not observed for nonculprit plaques. For differentiating culprit and nonculprit plaques, we observed that the performance of IPE in the second postcontrast phase (cutoff = 0.83, AUC = 0.829 [0.746-0.893]) exhibited superior accuracy when compared with PEI in the first postcontrast phase (cutoff = 0.48; AUC = 0.768 [0.680-0.843]) (P = .022). CONCLUSIONS A 9-minute delay of postcontrast acquisition can maximize plaque enhancement and better differentiate between culprit and nonculprit plaques. In addition, culprit and nonculprit plaques have different enhancement temporal patterns, which should be evaluated in future studies.
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Affiliation(s)
- Beibei Sun
- From the Department of Radiology, Ren Ji Hospital (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai China
- College of Health Science and Technology (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Radiology (M.M., C.Z.), University of Washington, Seattle, Washington
| | - Lingling Wang
- From the Department of Radiology, Ren Ji Hospital (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai China
- College of Health Science and Technology (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao Li
- From the Department of Radiology, Ren Ji Hospital (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai China
- College of Health Science and Technology (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jin Zhang
- From the Department of Radiology, Ren Ji Hospital (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai China
- College of Health Science and Technology (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianjian Zhang
- From the Department of Radiology, Ren Ji Hospital (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai China
- College of Health Science and Technology (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiaqi Tian
- From the Department of Radiology, Ren Ji Hospital (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai China
- College of Health Science and Technology (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mahmud Mossa-Basha
- Department of Radiology (M.M., C.Z.), University of Washington, Seattle, Washington
| | - Jianrong Xu
- From the Department of Radiology, Ren Ji Hospital (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai China
- College of Health Science and Technology (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Zhou
- From the Department of Radiology, Ren Ji Hospital (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai China
- College of Health Science and Technology (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huilin Zhao
- From the Department of Radiology, Ren Ji Hospital (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai China
- College of Health Science and Technology (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chengcheng Zhu
- Department of Radiology (M.M., C.Z.), University of Washington, Seattle, Washington
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Zuo M, Chen W, Zhou Z. Multimodal Neuroimaging Reveals and Guides Treatment of a Middle Cerebral Artery Web. JAMA Neurol 2024; 81:79-80. [PMID: 37955912 DOI: 10.1001/jamaneurol.2023.4216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
This case report describes how neuroimaging was used to determine treatment for episodic sudden-onset weakness and numbness in the left limbs.
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Affiliation(s)
- Meng Zuo
- Department of Neurology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Wei Chen
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Zhenhua Zhou
- Department of Neurology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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Wu G, Zhu C, Wang H, Fu D, Lu X, Cao C, Zhang X, Zhu J, Huang L, Mossa-Basha M, Xia S. Co-existing intracranial and extracranial carotid atherosclerosis predicts large-artery atherosclerosis stroke recurrence: a single-center prospective study utilizing combined head-and-neck vessel wall imaging. Eur Radiol 2023; 33:6970-6980. [PMID: 37081300 PMCID: PMC10527495 DOI: 10.1007/s00330-023-09654-5] [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: 09/04/2022] [Revised: 01/15/2023] [Accepted: 03/09/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVES Intracranial and extracranial plaque features on high-resolution vessel wall imaging (HR-VWI) are associated with large-artery atherosclerosis (LAA) stroke recurrence. However, most studies have focused on a single vascular bed, and the prognostic value of combined intracranial and extracranial plaque features has yet to be studied. This study aimed to investigate the roles of plaque features, plaque number, and co-existing atherosclerosis in predicting stroke recurrence, utilizing combined head-and-neck HR-VWI. METHODS From September 2016 to March 2020, participants with acute LAA ischemic strokes were prospectively enrolled and underwent combined head-and-neck HR-VWI. The participants were followed for stroke recurrence for at least 12 months or until a subsequent event occurred. The imaging features at baseline, including conventional and histogram plaque features, plaque number, and co-existing atherosclerosis, were evaluated. Univariable Cox regression analysis and the least absolute shrinkage and selection operator (lasso) method were used for variable screening. Multivariable Cox regression analyses were used to determine the independent risk factors of stroke recurrence. RESULTS A total of 97 participants (59 ± 12 years, 63 men) were followed for a median of 30.9 months, and 21 participants experienced recurrent strokes. Multivariable Cox analysis identified co-existing intracranial high signal on T1-weighted fat-suppressed images (HST1) and extracranial carotid atherosclerosis (HR, 6.12; 95% CI, 2.52-14.82; p = 0.001) as an independent imaging predictor of stroke recurrence. CONCLUSION Co-existing intracranial HST1 and extracranial carotid atherosclerosis independently predicted LAA stroke recurrence. Combined head-and-neck HR-VWI is a promising technique for atherosclerosis imaging. CLINICAL RELEVANCE STATEMENT This prospective study using combined head-and-neck HR-VWI highlighted the necessity of both intracranial culprit plaque evaluation and multi-vascular bed assessment, adding value to the prediction of stroke recurrence. KEY POINTS • This study highlighted the necessity of both intracranial culprit plaque evaluation and multi-vascular bed assessment, adding value to the prediction of stroke recurrence. • This prospective study using combined head-and-neck HR-VWI found co-existing intracranial HST1 and extracranial carotid atherosclerosis to be independent predictors of stroke recurrence.
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Affiliation(s)
- Gemuer Wu
- Department of Radiology, Tianjin First Central Hospital, School of Medicine, Nankai University, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China
- Department of Radiology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010050, China
| | - Chengcheng Zhu
- Department of Radiology, University of Washington, 325 9Th Ave, Seattle, WA, 98104, USA
| | - Huiying Wang
- The School of Medicine, Nankai University, 94 Weijin Road, Tianjin, 300071, China
| | - Dingwei Fu
- Department of Radiology, The Second Affiliated Hospital of Wannan Medical College, 10 Kangfu Road, Jinghu District, Wuhu, 241000, China
| | - Xiudi Lu
- Department of Radiology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300381, China
| | - Chen Cao
- Department of Radiology, Tianjin Huanhu Hospital, Tianjin, 300350, China
| | | | - Jinxia Zhu
- MR Collaboration, Siemens Healthineers Ltd., Beijing, China
| | - Lixiang Huang
- Department of Radiology, Tianjin First Central Hospital, School of Medicine, Nankai University, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington, 325 9Th Ave, Seattle, WA, 98104, USA
| | - Shuang Xia
- Department of Radiology, Tianjin First Central Hospital, School of Medicine, Nankai University, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China.
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Visualisation of lenticulostriate arteries using contrast-enhanced time-of-flight magnetic resonance angiography at 7 Tesla. Sci Rep 2022; 12:20306. [PMID: 36434036 PMCID: PMC9700841 DOI: 10.1038/s41598-022-24832-z] [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: 08/29/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022] Open
Abstract
7 Tesla-field-strength (7 T) Magnetic Resonance Imaging allows the small perforating arteries in the brain to be visualised, and this modality may allow visualisation of the arterial pathology in cerebral small vessel disease. Most studies have used standard Time-of-Flight (ToF) Magnetic Resonance Angiography (MRA). Whether the use of contrast enhancement improves perforating artery visualisation at 7 T remains unclear. In a prospective study, we compared standard ToF MRA with contrast-enhanced (CE) ToF MRA at 7 T for the visualisation of the lenticulostriate arteries (LSAs). Ten patients with symptomatic lacunar stroke were recruited (mean age, SD, 64 ± 9.9 years). Visualisation was assessed using a visual rating scale administered by two independent expert readers and length of the LSAs visible. Visualisation of the LSAs was improved with CE ToF MRA. The mean Visibility and Sharpness Score was higher for CE ToF MRA over standard ToF MRA (2.55 ± 0.64 vs. 1.75 ± 0.68; P = 0.0008). The mean length of LSA visualised was significantly longer with CE ToF MRA compared to standard ToF MRA (24.4 ± 4.5 vs. 21.9 ± 4.0 mm; P = 0.01). CE ToF MRA offers improved visualisation of the LSAs over standard ToF MRA. The addition of contrast may improve the ability to visualise cerebral small vessel disease arterial pathology.
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7T MRI for Intracranial Vessel Wall Lesions and Its Associated Neurological Disorders: A Systematic Review. Brain Sci 2022; 12:brainsci12050528. [PMID: 35624915 PMCID: PMC9139315 DOI: 10.3390/brainsci12050528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/16/2022] [Accepted: 04/20/2022] [Indexed: 11/24/2022] Open
Abstract
Intracranial vessel wall lesions are involved in a variety of neurological diseases. The advanced technique 7T MRI provides greater efficacy in the diagnosis of the pathology changes in the vessel wall and helps to identify potential subtle lesions. The purpose of this literature review was to systematically describe and evaluate the existing literature focusing on the use of 7T MRI in the detection and characterization of intracranial vessel wall lesions and their associated neurological disorders, to highlight the current knowledge gaps, and to formulate a framework to guide future applications and investigations. We systematically reviewed the existing articles up to July 2021, seeking the studies that assessed intracranial vessel wall lesions and their associated neurological disorders using 7T MRI. The literature search provided 12 studies that met the inclusion criteria. The most common intracranial vessel wall lesions were changes related to intracranial atherosclerosis (n = 8) and aneurysms (n = 4), such as intracranial atherosclerosis burden and aneurysm wall enhancement. The associated neurological disorders included aneurysms, ischemic stroke or TIA, small vessel disease, cognitive decline, and extracranial atherosclerosis. No paper studied the use of 7T MRI for investigating vessel wall conditions such as moyamoya disease, small vessel disease, or neurological disorders related to central nervous vasculitis. In conclusion, the novel 7T MRI enables the identification of a wider spectrum of subtle changes and associations. Future research on cerebral vascular diseases other than intracranial atherosclerosis and aneurysms may also benefit from 7T MRI.
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Xiao J, Song SS, Schlick KH, Xia S, Jiang T, Han T, Jackson RJ, Diniz MA, Dumitrascu OM, Maya MM, Lyden PD, Li D, Yang Q, Fan Z. Disparate trends of atherosclerotic plaque evolution in stroke patients under 18-month follow-up: a 3D whole-brain magnetic resonance vessel wall imaging study. Neuroradiol J 2022; 35:42-52. [PMID: 34159814 PMCID: PMC8826292 DOI: 10.1177/19714009211026920] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The trend of atherosclerotic plaque feature evolution is unclear in stroke patients with and without recurrence. We aimed to use three-dimensional whole-brain magnetic resonance vessel wall imaging to quantify the morphological changes of causative lesions during medical therapy in patients with symptomatic intracranial atherosclerotic disease. METHODS Patients with acute ischemic stroke attributed to intracranial atherosclerotic disease were retrospectively enrolled if they underwent both baseline and follow-up magnetic resonance vessel wall imaging. The morphological features of the causative plaque, including plaque volume, peak normalized wall index, maximum wall thickness, degree of stenosis, pre-contrast plaque-wall contrast ratio, and post-contrast plaque enhancement ratio, were quantified and compared between the non-recurrent and recurrent groups (defined as the recurrence of a vascular event within 18 months of stroke). RESULTS Twenty-nine patients were included in the final analysis. No significant differences were found in plaque features in the baseline scan between the non-recurrent (n = 22) and recurrent groups (n = 7). The changes in maximum wall thickness (-13.32% vs. 8.93%, P = 0.026), plaque-wall contrast ratio (-0.82% vs. 3.42%, P = 0.005) and plaque enhancement ratio (-11.03% vs. 9.75%, P = 0.019) were significantly different between the non-recurrent and recurrent groups. Univariable logistic regression showed that the increase in plaque-wall contrast ratio (odds ratio 3.22, 95% confidence interval 1.55-9.98, P = 0.003) was related to stroke recurrence. CONCLUSION Morphological changes of plaque features on magnetic resonance vessel wall imaging demonstrated distinct trends in symptomatic intracranial atherosclerotic disease patients with and without stroke recurrence.
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Affiliation(s)
- Jiayu Xiao
- Biomedical Imaging Research
Institute, Cedars-Sinai Medical Center, USA
| | - Shlee S Song
- Department of Neurology,
Cedars-Sinai Medical Center, USA
| | | | - Shuang Xia
- Department of Radiology, Tianjin
First Central Hospital, China
| | - Tao Jiang
- Department of Radiology, Beijing
Chaoyang Hospital, China
| | - Tong Han
- Department of Radiology, Tianjin
Huanhu Hospital, China
| | | | - Marcio A Diniz
- Biostatistics and Bioinformatics
Research Center, Cedars-Sinai Medical Center, USA
| | | | - Marcel M Maya
- Department of Imaging, Cedars-Sinai
Medical Center, USA
| | - Patrick D Lyden
- Department of Physiology and
Neuroscience, Zilkha Neurogenetic Institute, University of Southern California,
USA
| | - Debiao Li
- Biomedical Imaging Research
Institute, Cedars-Sinai Medical Center, USA,Department of Bioengineering,
University of California, Los Angeles, USA
| | - Qi Yang
- Department of Radiology, Beijing
Chaoyang Hospital, China
| | - Zhaoyang Fan
- Biomedical Imaging Research
Institute, Cedars-Sinai Medical Center, USA,Departments of Radiology and
Radiation Oncology, University of Southern California, USA,Zhaoyang Fan, 2250 Alcazar Street, Room
104, Los Angeles, CA, USA.
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Wu G, Wang H, Zhao C, Cao C, Chai C, Huang L, Guo Y, Gong Z, Tirschwell D, Zhu C, Xia S. Large Culprit Plaque and More Intracranial Plaques Are Associated with Recurrent Stroke: A Case-Control Study Using Vessel Wall Imaging. AJNR Am J Neuroradiol 2022; 43:207-215. [PMID: 35058299 PMCID: PMC8985671 DOI: 10.3174/ajnr.a7402] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/02/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND PURPOSE Intracranial atherosclerotic plaque features are potential factors associated with recurrent stroke, but previous studies only focused on a single lesion, and few studies investigated them with perfusion impairment. This study aimed to investigate the association among whole-brain plaque features, perfusion deficit, and stroke recurrence. MATERIALS AND METHODS Patients with ischemic stroke due to intracranial atherosclerosis were retrospectively collected and categorized into first-time and recurrent-stroke groups. Patients underwent high-resolution vessel wall imaging and DSC-PWI. Intracranial plaque number, culprit plaque features (such as plaque volume/burden, degree of stenosis, enhancement ratio), and perfusion deficit variables were recorded. Logistic regression analyses were performed to determine the independent factors associated with recurrent stroke. RESULTS One hundred seventy-five patients (mean age, 59 [SD, 12] years; 115 men) were included. Compared with the first-time stroke group (n = 100), the recurrent-stroke group (n = 75) had a larger culprit volume (P = .006) and showed more intracranial plaques (P < .001) and more enhanced plaques (P = .003). After we adjusted for other factors, culprit plaque volume (OR, 1.16 per 10-mm3 increase; 95% CI, 1.03-1.30; P = .015) and total plaque number (OR, 1.31; 95% CI, 1.13-1.52; P < .001) were independently associated with recurrent stroke. Combining these factors increased the area under the curve to 0.71. CONCLUSIONS Large culprit plaque and more intracranial plaques were independently associated with recurrent stroke. Performing whole-brain vessel wall imaging may help identify patients with a higher risk of recurrent stroke.
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Affiliation(s)
- G. Wu
- From The School of Medicine (G.W., H.W.), Nankai University, Tianjin, China
| | - H. Wang
- From The School of Medicine (G.W., H.W.), Nankai University, Tianjin, China
| | - C. Zhao
- Department of Radiology (C. Zhao), First Central Clinical College, Tianjin Medical University, Tianjin, China
| | - C. Cao
- Department of Radiology (C. Cao), Tianjin Huanhu Hospital, Tianjin, China
| | - C. Chai
- Department of Radiology (C. Chai, L.H., Y.G., S.X.)
| | - L. Huang
- Department of Radiology (C. Chai, L.H., Y.G., S.X.)
| | - Y. Guo
- Department of Radiology (C. Chai, L.H., Y.G., S.X.)
| | - Z. Gong
- Neurology (Z.G.), Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
| | | | - C. Zhu
- Radiology (C. Zhu), University of Washington, Seattle, Washington
| | - S. Xia
- Department of Radiology (C. Chai, L.H., Y.G., S.X.)
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Guo Y, Canton G, Chen L, Sun J, Geleri DB, Balu N, Xu D, Mossa-Basha M, Hatsukami TS, Yuan C. Multi-Planar, Multi-Contrast and Multi-Time Point Analysis Tool (MOCHA) for Intracranial Vessel Wall Characterization. J Magn Reson Imaging 2022; 56:944-955. [PMID: 35099091 DOI: 10.1002/jmri.28087] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/16/2022] [Accepted: 01/18/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Three-dimensional (3D) intracranial vessel wall (IVW) magnetic resonance imaging can reliably image intracranial atherosclerotic disease (ICAD). However, an integrated, streamlined, and optimized workflow for IVW analysis to provide qualitative and quantitative measurements is lacking. PURPOSE To propose and evaluate an image analysis pipeline (MOCHA) that can register multicontrast and multitime point 3D IVW for multiplanar review and quantitative plaque characterization. STUDY TYPE Retrospective. POPULATION A total of 11 subjects with ICAD (68 ± 10 years old, 6 males). FIELD STRENGTH/SEQUENCE A 3.0 T, 3D time-of-flight gradient echo sequence and T1- and proton density-weighted fast spin echo sequences. ASSESSMENT Each participant underwent two IVW sessions within 2 weeks. Scan and rescan IVW images were preprocessed using MOCHA. The presence of atherosclerotic lesions was identified in different intracranial arterial segments by two readers (GC and JS, 12 years of vascular MR imaging experience each) following an established review protocol to reach consensus on each of the reviews. For all locations with identified plaques, plaque length, lumen and vessel wall areas, maximum and mean wall thickness values, normalized wall index and contrast enhancement ratio were measured. STATISTICAL TESTS Percent agreement and Cohen's κ were used to test scan-rescan reproducibility of detecting plaques using MOCHA. Intraclass correlation coefficient (ICC) and Bland-Altman analysis were used to evaluate scan-rescan reproducibility for plaque morphologic and enhancement measurements. RESULTS In 150 paired intracranial vessel segments, the overall agreement in plaque detection was 92.7% (κ = 0.822). The ICCs (all ICCs > 0.90) and Bland-Altman plots (no bias observed) indicated excellent scan-rescan reproducibility for all morphologic and enhancement measurements. DATA CONCLUSION Findings from this study demonstrate that MOCHA provides high scan-rescan reproducibility for identification and quantification of atherosclerosis along multiple intracranial arterial segments and highlight its potential use in characterizing plaque composition and monitoring plaque development. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Yin Guo
- Department of Bioengineering, University of Washington, Seattle, Washington, 98109, USA
| | - Gador Canton
- Department of Radiology, University of Washington, Seattle, Washington, 98109, USA
| | - Li Chen
- Department of Electrical and Computer Engineering, University of Washington, Seattle, Washington, 98109, USA
| | - Jie Sun
- Department of Radiology, University of Washington, Seattle, Washington, 98109, USA
| | - Duygu Baylam Geleri
- Department of Radiology, University of Washington, Seattle, Washington, 98109, USA
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, Washington, 98109, USA
| | - Dongxiang Xu
- Department of Radiology, University of Washington, Seattle, Washington, 98109, USA
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington, Seattle, Washington, 98109, USA
| | - Thomas S Hatsukami
- Department of Surgery, University of Washington, Seattle, Washington, 98109, USA
| | - Chun Yuan
- Department of Bioengineering, University of Washington, Seattle, Washington, 98109, USA.,Department of Radiology, University of Washington, Seattle, Washington, 98109, USA
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9
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Lindenholz A, de Bresser J, van der Kolk AG, van der Worp HB, Witkamp TD, Hendrikse J, van der Schaaf IC. Intracranial Atherosclerotic Burden and Cerebral Parenchymal Changes at 7T MRI in Patients With Transient Ischemic Attack or Ischemic Stroke. Front Neurol 2021; 12:637556. [PMID: 34025551 PMCID: PMC8134532 DOI: 10.3389/fneur.2021.637556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/22/2021] [Indexed: 12/05/2022] Open
Abstract
The relevance of intracranial vessel wall lesions detected with MRI is not fully established. In this study (trial identification number: NTR2119; www.trialregister.nl), 7T MRI was used to investigate if a higher vessel wall lesion burden is associated with more cerebral parenchymal changes in patients with ischemic stroke or transient ischemic attack (TIA). MR images of 82 patients were assessed for the number of vessel wall lesions of the large intracranial arteries and for cerebral parenchymal changes, including the presence and number of cortical, small subcortical, and deep gray matter infarcts; lacunes of presumed vascular origin; cortical microinfarcts; and periventricular and deep white matter hyperintensities (WMHs). Regression analyses showed that a higher vessel wall lesion burden was associated with the presence of small subcortical infarcts, lacunes of presumed vascular origin, and deep gray matter infarcts (relative risk 1.18; 95% CI, 1.03–1.35) and presence of moderate-to-severe periventricular WMHs (1.21; 95% CI, 1.03–1.42), which are all manifestations of small vessel disease (SVD). The burden of enhancing vessel wall lesions was associated with the number of cortical microinfarcts only (1.48; 95% CI, 1.04–2.11). These results suggest an interrelationship between large vessel wall lesion burden and cerebral parenchymal manifestations often linked to SVD or, alternatively, that vascular changes occur in both large and small intracranial arteries simultaneously.
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Affiliation(s)
- Arjen Lindenholz
- Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Jeroen de Bresser
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Anja G van der Kolk
- Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands.,Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - H Bart van der Worp
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, Netherlands
| | - Theodoor D Witkamp
- Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands
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10
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Kong Q, Wu Y, Weng D, An J, Zhuo Y, Zhang Z. Optimized Inner-Volume 3D TSE for High-Resolution Vessel Wall Imaging of Intracranial Perforating Arteries at 7T. Front Neurosci 2021; 15:620172. [PMID: 33716650 PMCID: PMC7947629 DOI: 10.3389/fnins.2021.620172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/14/2021] [Indexed: 11/28/2022] Open
Abstract
The impairment of microvessels can lead to neurologic diseases such as stroke and vascular dementia. The imaging of lumen and vessel wall of perforating arteries requires an extremely high resolution due to their small caliber size. Current imaging techniques have the difficulty in observing the wall of perforating arteries. In this study, we developed a 3D inner-volume (IV) TSE (SPACE) sequence with optimized 2D spatially selective excitation (SSE) RF pulses. The optimized SSE RF pulses were designed through a series of optimization including iterative RF pulse design, trajectory optimization, and phase convention of Carr-Purcell-Meiboom-Gill (CPMG) condition to meet the perforating arteries imaging demands. High resolution of isotropic 0.30 mm within 10 min was achieved for the black- blood images of lenticulostriate artery (LSA). The LSA lumen and vessel wall were imaged by the IV-SPACE sequence simultaneously. Images obtained by the optimized RF pulse has fewer aliasing artifacts from outside of ROI than the traditional pulse. The IV-SPACE images showed clearer delineation of vessel wall and lumen of LSA than conventional SPACE images. IV-SPACE might be a promising method for detecting microvasculopathies of cerebral vascular diseases.
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Affiliation(s)
- Qingle Kong
- State Key Laboratory of Brain and Cognitive Science, Beijing MR Center for Brain Research, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
- MR Collaboration, Siemens Healthcare Ltd, Beijing, China
| | - Yue Wu
- State Key Laboratory of Brain and Cognitive Science, Beijing MR Center for Brain Research, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
- Innovation Center for Excellence in Brain Science, Chinese Academy of Sciences, Beijing, China
| | - Dehe Weng
- Siemens Shenzhen Magnetic Resonance Ltd, Shenzhen, China
| | - Jing An
- Siemens Shenzhen Magnetic Resonance Ltd, Shenzhen, China
| | - Yan Zhuo
- State Key Laboratory of Brain and Cognitive Science, Beijing MR Center for Brain Research, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
- Innovation Center for Excellence in Brain Science, Chinese Academy of Sciences, Beijing, China
| | - Zihao Zhang
- State Key Laboratory of Brain and Cognitive Science, Beijing MR Center for Brain Research, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
- Innovation Center for Excellence in Brain Science, Chinese Academy of Sciences, Beijing, China
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11
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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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12
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A High Resolution MRI Study of the Relationship Between Plaque Enhancement and Perforator Stroke after Stenting for Symptomatic Vertebrobasilar Artery Stenosis. J Stroke Cerebrovasc Dis 2020; 30:105558. [PMID: 33348247 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 12/11/2020] [Accepted: 12/13/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND AND PURPOSE Perforator stroke is one of the most common complications of vertebrobasilar arterial stenting. We investigated whether perforator stroke after vertebrobasilar arterial stenting is associated with plaque enhancement in patients with severe vertebrobasilar artery stenosis. METHODS We studied patients with symptomatic vertebrobasilar arterial stenosis who underwent stenting from January 2017 to July 2020. Patients who underwent high resolution magnetic resonance imaging were recruited among them. Demographic data, risk factors of atherosclerosis, procedure details, and characteristics of imaging were extracted from electronic health records and imaging data. Plaque features were investigated by high resolution magnetic resonance imaging. RESULTS 136 patients were enrolled in this study, 39 of whom fulfilled the inclusion criteria. 18 patients (46.2%) had obvious plaque enhancement among the 39 patients, and 21 (53.8%) had plaque non-enhancement. 21 patients (53.8%) had diffuse distribution, and 22 patients (56.4%) had irregular plaques surface. Patients were divided into plaque enhanced and plaque non-enhanced groups according to the degree of plaque enhancement. Clinical characteristics and other plaque features were similar between two groups. Procedure-related perforator stroke was identified in 4 patients (10.3%). Patients with plaque enhancement were more likely to have perforator stroke after stenting compared with those with plaque non-enhancement (22.2% versus 0%, P = 0.037). CONCLUSIONS Plaque enhancement in high resolution magnetic resonance imaging may be associated with perforator stroke after vertebrobasilar artery stenting.
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13
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van Hespen KM, Zwanenburg JJM, Hendrikse J, Kuijf HJ. Subvoxel vessel wall thickness measurements of the intracranial arteries using a convolutional neural network. Med Image Anal 2020; 67:101818. [PMID: 33049576 DOI: 10.1016/j.media.2020.101818] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 07/10/2020] [Accepted: 08/25/2020] [Indexed: 11/29/2022]
Abstract
Vessel wall thickening of the intracranial arteries has been associated with cerebrovascular disease and atherosclerotic plaque development. Visualization of the vessel wall has been enabled by recent advancements in vessel wall MRI. However, quantifying early wall thickening from these MR images is difficult and prone to severe overestimation, because the voxel size of clinically used acquisitions exceeds the wall thickness of the intracranial arteries. In this study, we aimed for accurate and precise subvoxel vessel wall thickness measurements. A convolutional neural network was trained on MR images of 34 ex vivo circle of Willis specimens, acquired with a clinically used protocol (isotropic acquired voxel size: 0.8 mm). Ground truth measurements were performed on images acquired with an ultra-high-resolution protocol (isotropic acquired voxel size: 0.11 mm) and were used for evaluation. Additionally, we determined the robustness of our method by applying Monte Carlo dropout and test time augmentation. Lastly, we applied our method on in vivo images of three intracranial aneurysms to measure their wall thickness. Our method shows resolvability of different vessel wall thicknesses, well below the acquired voxel size. The method described may facilitate quantitative measurements on MRI data for a wider range of clinical applications.
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Affiliation(s)
- Kees M van Hespen
- Center for Image Sciences, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584CX, the Netherlands.
| | - Jaco J M Zwanenburg
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584CX, the Netherlands
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584CX, the Netherlands
| | - Hugo J Kuijf
- Image Sciences Institute, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584CX, the Netherlands
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14
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Park CJ, Cha J, Ahn SS, Choi HS, Kim YD, Nam HS, Heo JH, Lee SK. Contrast-Enhanced High-Resolution Intracranial Vessel Wall MRI with Compressed Sensing: Comparison with Conventional T1 Volumetric Isotropic Turbo Spin Echo Acquisition Sequence. Korean J Radiol 2020; 21:1334-1344. [PMID: 32767865 PMCID: PMC7689147 DOI: 10.3348/kjr.2020.0128] [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: 02/16/2020] [Revised: 04/08/2020] [Accepted: 04/25/2020] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE Compressed sensing (CS) has gained wide interest since it accelerates MRI acquisition. We aimed to compare the 3D post-contrast T1-weighted volumetric isotropic turbo spin echo acquisition (VISTA) with CS (VISTA-CS) and without CS (VISTA-nonCS) in intracranial vessel wall MRIs (VW-MRI). MATERIALS AND METHODS From April 2017 to July 2018, 72 patients who underwent VW-MRI, including both VISTA-CS and VISTA-nonCS, were retrospectively enrolled. Wall and lumen volumes, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were measured from normal and lesion sites. Two neuroradiologists independently evaluated overall image quality and degree of normal and lesion wall delineation with a four-point scale (scores ≥ 3 defined as acceptable). RESULTS Scan coverage was increased in VISTA-CS to cover both anterior and posterior circulations with a slightly shorter scan time compared to VISTA-nonCS (approximately 7 minutes vs. 8 minutes). Wall and lumen volumes were not significantly different with VISTA-CS or VISTA-nonCS (interclass correlation coefficient = 0.964-0.997). SNR was or trended towards significantly higher values in VISTA-CS than in VISTA-nonCS. At normal sites, CNR was not significantly different between two sequences (p = 0.907), whereas VISTA-CS provided lower CNR in lesion sites compared with VISTA-nonCS (p = 0.003). Subjective wall delineation was superior with VISTA-nonCS than with VISTA-CS (p = 0.019), although overall image quality did not differ (p = 0.297). The proportions of images with acceptable quality were not significantly different between VISTA-CS (83.3-97.8%) and VISTA-nonCS (75-100%). CONCLUSION CS may be useful for intracranial VW-MRI as it allows for larger scan coverage with slightly shorter scan time without compromising image quality.
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Affiliation(s)
- Chae Jung Park
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jihoon Cha
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.
| | - Sung Soo Ahn
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Seok Choi
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hoe Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Koo Lee
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
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15
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Edjlali M, Qiao Y, Boulouis G, Menjot N, Saba L, Wasserman BA, Romero JM. Vessel wall MR imaging for the detection of intracranial inflammatory vasculopathies. Cardiovasc Diagn Ther 2020; 10:1108-1119. [PMID: 32968663 DOI: 10.21037/cdt-20-324] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Intracranial vasculopathies are routinely investigated by lumen-based modalities such as magnetic resonance angiography (MRA), computed tomography angiography (CTA), and digital subtraction angiography (DSA). These techniques are useful to analyze the vessel lumen, allowing to detect vessel stenosis or occlusion. However, the primum movins of the disease, i.e., an abnormal thickening of the vessel wall, remains within the arterial wall. The vasculopathy can moreover be present without always narrowing the lumen or modifying its regularity. Hence, there is a need to detect directly and analyze vessel wall abnormalities. Development of 3D high-resolution black blood sequences for intracranial vessel wall MR imaging (VW-MRI) enabled routine clinical applications not only vasculitis, but also of intracranial atherosclerotic disease (ICAD), intracranial dissections, reversible intracranial dissections, reversible cerebral vasoconstriction syndrome (RCVS), Moyamoya disease, and intracranial aneurysms. This high-resolution intracranial VW- MRI approach is increasingly used on a clinical basis at many centers to solve diagnostic problems, especially in patients with ischemic stroke or intracranial hemorrhage. An expert consensus Guideline from the American Society of Neuroradiology provides recommendations for clinical implementation of intracranial vessel wall MRI. There are several technical aspects needed to be considered when implementing VW-MRI in intracranial vessels, including flow suppression, both in blood and cerebrospinal fluid (CSF), spatial resolution and signal-to-noise ratio (SNR). In this article, we review the technical aspects of VW-MRI, and recommend applications for vascular diseases including non-occlusive intracranial vasculopathies, Moyamoya disease, and identifying culprit plaques. We also give a focus on the utility of VW-MRI for determining stroke etiology in adults and in children and young adults.
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Affiliation(s)
- Myriam Edjlali
- Department of Neuroradiology, Université Paris-Descartes-Sorbonne-Paris-Cité, IMABRAIN-INSERM-UMR1266, DHU-Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Ye Qiao
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Gregoire Boulouis
- Department of Neuroradiology, Université Paris-Descartes-Sorbonne-Paris-Cité, IMABRAIN-INSERM-UMR1266, DHU-Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Nicolas Menjot
- Département de Neuroradiologie, Hôpital Gui de Chauliac, Centre Hospitalier Régional Universitaire de Montpellier, Montpellier, France.,Institut d'Imagerie Fonctionnelle Humaine (I2FH), Hôpital Gui de Chauliac, Centre Hospitalier Régional Universitaire de Montpellier, Montpellier, France.,Département d'imagerie médicale; Centre Hospitalier Universitaire Caremeau, Nîmes, France.,Laboratoire Charles Coulomb, CNRS UMR 5221, Université de Montpellier, Montpellier, France
| | - Luca Saba
- Department of Radiology, University of Cagliari, Cagliari, Italy
| | - Bruce Alan Wasserman
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Javier M Romero
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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16
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Song JW, Moon BF, Burke MP, Kamesh Iyer S, Elliott MA, Shou H, Messé SR, Kasner SE, Loevner LA, Schnall MD, Kirsch JE, Witschey WR, Fan Z. MR Intracranial Vessel Wall Imaging: A Systematic Review. J Neuroimaging 2020; 30:428-442. [PMID: 32391979 DOI: 10.1111/jon.12719] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/22/2020] [Accepted: 04/10/2020] [Indexed: 12/22/2022] Open
Abstract
The purpose of this systematic review is to identify trends and extent of variability in intracranial vessel wall MR imaging (VWI) techniques and protocols. Although variability in selection of protocol design and pulse sequence type is known, data on what and how protocols vary are unknown. Three databases were searched to identify publications using intracranial VWI. Publications were screened by predetermined inclusion/exclusion criteria. Technical development publications were scored for completeness of reporting using a modified Nature Reporting Summary Guideline to assess reproducibility. From 2,431 articles, 122 met the inclusion criteria. Trends over the last 23 years (1995-2018) show increased use of 3-Tesla MR (P < .001) and 3D volumetric T1-weighted acquisitions (P < .001). Most (65%) clinical VWI publications report achieving a noninterpolated in-plane spatial resolution of ≤.55 mm. In the last decade, an increasing number of technical development (n = 20) and 7 Tesla (n = 12) publications have been published, focused on pulse sequence development, improving cerebrospinal fluid suppression, scan efficiency, and imaging ex vivo specimen for histologic validation. Mean Reporting Summary Score for the technical development publications was high (.87, range: .63-1.0) indicating strong scientific technical reproducibility. Innovative work continues to emerge to address implementation challenges. Gradual adoption into the research and scientific community was suggested by a shift in the name in the literature from "high-resolution MR" to "vessel wall imaging," specifying diagnostic intent. Insight into current practices and identifying the extent of technical variability in the literature will help to direct future clinical and technical efforts to address needs for implementation.
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Affiliation(s)
- Jae W Song
- Department of Radiology, University of Pennsylvania, Philadelphia, PA
| | - Brianna F Moon
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA
| | - Morgan P Burke
- Department of Radiology, University of Pennsylvania, Philadelphia, PA
| | | | - Mark A Elliott
- Department of Radiology, University of Pennsylvania, Philadelphia, PA
| | - Haochang Shou
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Steven R Messé
- Department of Neurology, Hospital of University of Pennsylvania, Philadelphia, PA
| | - Scott E Kasner
- Department of Neurology, Hospital of University of Pennsylvania, Philadelphia, PA.,Department of Emergency Medicine, Hospital of University of Pennsylvania, Philadelphia, PA
| | - Laurie A Loevner
- Department of Radiology, University of Pennsylvania, Philadelphia, PA.,Department of Otolaryngology, Hospital of University of Pennsylvania, Philadelphia, PA
| | | | - John E Kirsch
- Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA
| | - Walter R Witschey
- Department of Radiology, University of Pennsylvania, Philadelphia, PA
| | - Zhaoyang Fan
- Department of Biomedical Sciences, Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA
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17
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Song X, Zhao X, Liebeskind DS, Wang L, Xu W, Xu Y, Hou D, Zheng Z, Wu J. Incremental value of plaque enhancement in predicting stroke recurrence in symptomatic intracranial atherosclerosis. Neuroradiology 2020; 62:1123-1131. [DOI: 10.1007/s00234-020-02418-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 03/26/2020] [Indexed: 10/24/2022]
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18
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Lindenholz A, van der Kolk AG, van der Schaaf IC, van der Worp HB, Harteveld AA, Dieleman N, Bots ML, Hendrikse J. Intracranial Atherosclerosis Assessed with 7-T MRI: Evaluation of Patients with Ischemic Stroke or Transient Ischemic Attack. Radiology 2020; 295:162-170. [DOI: 10.1148/radiol.2020190643] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Arjen Lindenholz
- From the Department of Radiology (A.L., A.G.v.d.K., I.C.v.d.S., A.A.H., N.D., J.H.), Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (H.B.v.d.W.), and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, Utrecht University, Postbox 85500, 3508 GA Utrecht, the Netherlands
| | - Anja G. van der Kolk
- From the Department of Radiology (A.L., A.G.v.d.K., I.C.v.d.S., A.A.H., N.D., J.H.), Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (H.B.v.d.W.), and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, Utrecht University, Postbox 85500, 3508 GA Utrecht, the Netherlands
| | - Irene C. van der Schaaf
- From the Department of Radiology (A.L., A.G.v.d.K., I.C.v.d.S., A.A.H., N.D., J.H.), Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (H.B.v.d.W.), and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, Utrecht University, Postbox 85500, 3508 GA Utrecht, the Netherlands
| | - H. Bart van der Worp
- From the Department of Radiology (A.L., A.G.v.d.K., I.C.v.d.S., A.A.H., N.D., J.H.), Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (H.B.v.d.W.), and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, Utrecht University, Postbox 85500, 3508 GA Utrecht, the Netherlands
| | - Anita A. Harteveld
- From the Department of Radiology (A.L., A.G.v.d.K., I.C.v.d.S., A.A.H., N.D., J.H.), Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (H.B.v.d.W.), and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, Utrecht University, Postbox 85500, 3508 GA Utrecht, the Netherlands
| | - Nikki Dieleman
- From the Department of Radiology (A.L., A.G.v.d.K., I.C.v.d.S., A.A.H., N.D., J.H.), Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (H.B.v.d.W.), and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, Utrecht University, Postbox 85500, 3508 GA Utrecht, the Netherlands
| | - Michiel L. Bots
- From the Department of Radiology (A.L., A.G.v.d.K., I.C.v.d.S., A.A.H., N.D., J.H.), Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (H.B.v.d.W.), and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, Utrecht University, Postbox 85500, 3508 GA Utrecht, the Netherlands
| | - Jeroen Hendrikse
- From the Department of Radiology (A.L., A.G.v.d.K., I.C.v.d.S., A.A.H., N.D., J.H.), Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (H.B.v.d.W.), and Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, Utrecht University, Postbox 85500, 3508 GA Utrecht, the Netherlands
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19
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Lindenholz A, van der Schaaf IC, van der Kolk AG, van der Worp HB, Harteveld AA, Kappelle LJ, Hendrikse J. MRI Vessel Wall Imaging after Intra-Arterial Treatment for Acute Ischemic Stroke. AJNR Am J Neuroradiol 2020; 41:624-631. [PMID: 32139427 DOI: 10.3174/ajnr.a6460] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 01/28/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE Vessel wall imaging is increasingly performed in the diagnostic work-up of patients with ischemic stroke. The aim of this study was to compare vessel wall enhancement after intra-arterial thrombosuction with that in patients not treated with thrombosuction. MATERIALS AND METHODS From 2009 to 2017, forty-nine patients with an ischemic stroke underwent 7T MR imaging within 3 months after symptom onset as part of a prospective intracranial vessel wall imaging study. Fourteen of these patients underwent intra-arterial treatment using thrombosuction (intra-arterial treatment group). In the intra-arterial treatment group, vessel walls were evaluated for major vessel wall changes. All patients underwent pre- and postcontrast vessel wall imaging to assess enhancing foci of the vessel wall using coregistered subtraction images. A Wilcoxon signed rank test was performed to test for differences. RESULTS In the intra-arterial treatment group, 11 of 14 patients (79%) showed vessel wall enhancement compared with 17 of 35 patients without intra-arterial treatment (49%). In the intra-arterial treatment group, more enhancing foci were detected on the ipsilateral side (n = 18.5) compared with the contralateral side (n = 3, P = .005). Enhancement was more often concentric on the ipsilateral side (n = 8) compared with contralateral side (n = 0, P = .01). No differences were found in the group without intra-arterial treatment between the number and configuration of ipsilateral and contralateral enhancing foci. CONCLUSIONS Patients with intra-arterial treatment by means of thrombosuction showed more (concentric) enhancing foci of the vessel wall ipsilateral compared with contralateral to the treated artery than the patients without intra-arterial treatment, suggesting reactive changes of the vessel wall. This finding should be taken into account when assessing vessel wall MR images in patients with stroke.
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Affiliation(s)
- A Lindenholz
- From the Departments of Radiology (A.L., I.C.v.d.S., A.G.v.d.K., A.A.H., J.H.)
| | - I C van der Schaaf
- From the Departments of Radiology (A.L., I.C.v.d.S., A.G.v.d.K., A.A.H., J.H.)
| | - A G van der Kolk
- From the Departments of Radiology (A.L., I.C.v.d.S., A.G.v.d.K., A.A.H., J.H.)
| | - H B van der Worp
- Neurology and Neurosurgery (H.B.v.d.W., L.J.K.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - A A Harteveld
- From the Departments of Radiology (A.L., I.C.v.d.S., A.G.v.d.K., A.A.H., J.H.)
| | - L J Kappelle
- Neurology and Neurosurgery (H.B.v.d.W., L.J.K.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - J Hendrikse
- From the Departments of Radiology (A.L., I.C.v.d.S., A.G.v.d.K., A.A.H., J.H.)
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20
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Millesi M, Knosp E, Mach G, Hainfellner JA, Ricken G, Trattnig S, Gruber A. Focal irregularities in 7-Tesla MRI of unruptured intracranial aneurysms as an indicator for areas of altered blood-flow parameters. Neurosurg Focus 2019; 47:E7. [PMID: 31786557 DOI: 10.3171/2019.9.focus19489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/09/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In the last several decades, various factors have been studied for a better evaluation of the risk of rupture in incidentally discovered intracranial aneurysms (IAs). With advanced MRI, attempts were made to delineate the wall of IAs to identify weak areas prone to rupture. However, the field strength of the MRI investigations was insufficient for reasonable image resolution in many of these studies. Therefore, the aim of this study was to analyze findings of IAs in ultra-high field MRI at 7 Tesla (7 T). METHODS Patients with incidentally found IAs of at least 5 mm in diameter were included in this study and underwent MRI investigations at 7 T. At this field strength a hyperintense intravascular signal can be observed on nonenhanced images with a brighter "rim effect" along the vessel wall. Properties of this rim effect were evaluated and compared with computational fluid dynamics (CFD) analyses. RESULTS Overall, 23 aneurysms showed sufficient image quality for further evaluation. In 22 aneurysms focal irregularities were identified within this rim effect. Areas of such irregularities showed significantly higher values in wall shear stress and vorticity compared to areas with a clearly visible rim effect (p = 0.043 in both). CONCLUSIONS A hyperintense rim effect along the vessel wall was observed in most cases. Focal irregularities within this rim effect showed higher values of the mean wall shear stress and vorticity when compared by CFD analyses. Therefore, these findings indicate alterations in blood flow in IAs within these areas.
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Affiliation(s)
- Matthias Millesi
- 1Department of Neurosurgery.,3Cerebrovascular Research Group Vienna
| | | | | | | | | | - Siegfried Trattnig
- 5High Field MR Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna; and
| | - Andreas Gruber
- 1Department of Neurosurgery.,2Department of Neurosurgery, Johannes Kepler University Linz, Austria.,3Cerebrovascular Research Group Vienna
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21
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Kern KC, Liebeskind DS. Vessel Wall Imaging of Cerebrovascular Disorders. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:65. [DOI: 10.1007/s11936-019-0782-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Cogswell PM, Lants SK, Davis LT, Donahue MJ. Vessel wall and lumen characteristics with age in healthy participants using 3T intracranial vessel wall magnetic resonance imaging. J Magn Reson Imaging 2019; 50:1452-1460. [PMID: 30994958 PMCID: PMC6800748 DOI: 10.1002/jmri.26750] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 04/02/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Intracranial vessel wall imaging (VWI) at a clinical field strength of 3T has become more widely available. However, how vessel measurements change with age and sex, over an age range spanning a typical lifespan, are needed. PURPOSE/HYPOTHESIS To assess for identifiable changes in arterial wall thickness, outer vessel wall diameter, and lumen diameter with age cross-sectionally in healthy controls without cerebrovascular disease risk factors at the spatial resolution afforded by currently recommended 3T VWI approaches. STUDY TYPE Prospective. POPULATION/SUBJECTS Healthy subjects (n = 82; age = 8-79 years). FIELD STRENGTH/SEQUENCE 3T intracranial VWI, angiography, and T1 -weighted anatomical imaging. ASSESSMENT Two readers measured lumen and outer wall diameters of the supraclinoid internal carotid artery (ICA) and distal basilar artery. Wall thickness and intraclass correlation coefficients (ICCs) were calculated. STATISTICAL TESTS Separate linear regressions were performed to understand the relationship between wall measurements (lumen diameter, outer vessel wall diameter, and wall thickness) and age, gender, side (left or right); significance: two-sided P < 0.05. RESULTS Readers showed excellent agreement for lumen and outer wall diameters (ICC 0.83-094). Linear regression of supraclinoid ICA wall measurements showed a statistically significant increase in wall thickness (P = 0.00051) and outer vessel wall diameter (P = 0.030) with age. ICA lumen and outer vessel wall diameters were statistically greater in males vs. females (lumen diameter 3.69 ± 0.41 vs. 3.54 ± 0.35 mm, P = 0.026; outer wall diameter 5.78 ± 0.52 vs. 5.56 ± 0.44 mm, P = 0.0089) with a trend toward increase in wall thickness (1.05 ± 0.12 vs. 1.01 ± 0.10 mm, P = 0.055). No significant difference was found in basilar artery wall thickness (P = 0.45, P = 0.72), lumen diameter (P = 0.15, P = 0.42), or outer vessel wall diameter (P = 0.34, P = 0.41) with age or gender, respectively. DATA CONCLUSION Intracranial vessel wall measurements were shown to be consistent between readers. At the available spatial resolution of 3T intracranial VWI sequences, supraclinoid ICA vessel wall thickness and outer vessel wall diameter appear to mildly increase with age. There was no detectable change in basilar artery vessel wall characteristics with age. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019;50:1452-1460.
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Affiliation(s)
| | - Sarah K. Lants
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - L. Taylor Davis
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Manus J. Donahue
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
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Wu J, Xin J, Yang X, Sun J, Xu D, Zheng N, Yuan C. Deep morphology aided diagnosis network for segmentation of carotid artery vessel wall and diagnosis of carotid atherosclerosis on black-blood vessel wall MRI. Med Phys 2019; 46:5544-5561. [PMID: 31356693 DOI: 10.1002/mp.13739] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/14/2019] [Accepted: 07/11/2019] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Early detection of carotid atherosclerosis on the vessel wall (VW) magnetic resonance imaging (MRI) (VW-MRI) images can prevent the progression of cardiovascular disease. However, the manual inspection process of the VW-MRI images is cumbersome and has low reproducibility. Therefore in this paper, by using the convolutional neural networks (CNNs), we develop a deep morphology aided diagnosis (DeepMAD) network for automated segmentation of the VW of carotid artery and for automated diagnosis of the carotid atherosclerosis with the black-blood (BB) VW-MRI (i.e., the T1-weighted MRI) in a slice-by-slice manner. METHODS The proposed DeepMAD network consists of a segmentation subnetwork and a diagnosis subnetwork for performing the segmentation and diagnosis tasks on the BB-VW-MRI images, where the manual labeled lumen area, the manual labeled outer wall area and the manual labeled lesion Types based on the modified American Heart Association (AHA) criteria are used as the ground-truth. Specifically, a deep U-shape CNN with a weighted fusion layer is designed as the segmentation subnetwork, where the lumen area and the outer wall area can be simultaneously segmented under the supervision of the triple Dice loss to provide the vessel wall map as morphological information. Then, the image stream from the BB-VWMRI image and the morphology stream from the obtained vessel wall map are extracted from two deep CNNs and combined to obtain the diagnosis results of atherosclerosis in the diagnosis subnetwork. In addition, the triple input set is formed by three carotid regions of interest (ROIs) from three consecutive slices of the MRI sequence and input to the DeepMAD network, where the first and last slices used as additional adjacent slices to provide 2.5D spatial information along the carotid artery centerline for the intermediate slice, which is the target slice for segmentation and diagnosis in the study. RESULTS Compared to other existing methods, the DeepMAD network can achieve promising segmentation performances (0.9594 Dice for the lumen and 0.9657 Dice for the outer wall) and better diagnosis Accuracy of the carotid atherosclerosis (0.9503 AUC and 0.8916 Accuracy) in the test dataset (including invisible subjects) from same source as the training dataset. In addition, the trained DeepMAD model can be successfully transferred to another test dataset for segmentation and diagnosis tasks with remarkable performance (0.9475 Dice for the lumen and 0.9542 Dice for the outer wall, 0. 9227 AUC and 0.8679 Accuracy for diagnosis). CONCLUSIONS Even without the intervention of reviewers required for previous works, the proposed DeepMAD network automatically segments the lumen and the outer wall together and diagnoses the carotid atherosclerosis with high performances. The DeepMAD network can be used in clinical trials to help radiologists get rid of tedious reading tasks, such as screening review to separate the normal carotid from the atherosclerotic arteries and outlining the vessel wall contours.
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Affiliation(s)
- Jiayi Wu
- Institute of Artificial Intelligence and Robotics, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Jingmin Xin
- Institute of Artificial Intelligence and Robotics, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Xiaofeng Yang
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Jie Sun
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Dongxiang Xu
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Nanning Zheng
- Institute of Artificial Intelligence and Robotics, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, WA, USA
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Truong M, Markenroth Bloch K, Andersen M, Andsberg G, Töger J, Wassélius J. Subacute vessel wall imaging at 7-T MRI in post-thrombectomy stroke patients. Neuroradiology 2019; 61:1145-1153. [PMID: 31240344 PMCID: PMC6754352 DOI: 10.1007/s00234-019-02242-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 06/04/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Reports from 3-T vessel wall MRI imaging have shown contrast enhancement following thrombectomy for acute stroke, suggesting potential intimal damage. Comparisons have shown higher SNR and more lesions detected by vessel wall imaging when using 7 T compared with 3 T. The aim of this study was to investigate the vessel walls after stent retriever thrombectomy using high-resolution vessel wall imaging at 7 T. METHODS Seven patients with acute stroke caused by occlusion of the distal internal carotid artery (T-occlusion), or proximal medial cerebral artery, and treated by stent retriever thrombectomy with complete recanalization were included and examined by 7-T MRI within 2 days. The MRI protocol included a high-resolution black blood sequence with prospective motion correction (iMOCO), acquired before and after contrast injection. Flow measurements were performed in the treated and untreated M1 segments. RESULTS All subjects completed the MRI examination. Image quality was independently rated as excellent by two neuroradiologists for all cases, and the level of motion artifacts did not impair diagnostic quality, despite severe motion in some cases. Contrast enhancement correlated with the deployment location of the stent retrievers. Flow data showed complete restoration of flow after treatment. CONCLUSION Vessel wall imaging with prospective motion correction can be performed in patients following thrombectomy with excellent imaging quality at 7 T. We show that vessel wall contrast enhancement is the normal post-operative state and corresponds to the deployment location of the stent retriever.
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Affiliation(s)
- My Truong
- Medical Imaging Department, Neuroradiology, Skåne University Hospital, 22185, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | | | | | - Gunnar Andsberg
- Department of Neurology, Skåne University Hospital, Lund, Sweden
| | - Johannes Töger
- Diagnostic Radiology, Department of Clinical Sciences, Skåne University Hospital Lund, Lund University, Lund, Sweden
| | - Johan Wassélius
- Medical Imaging Department, Neuroradiology, Skåne University Hospital, 22185, Lund, Sweden.
- Department of Clinical Sciences, Lund University, Lund, Sweden.
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Characterization of lenticulostriate arteries with high resolution black-blood T1-weighted turbo spin echo with variable flip angles at 3 and 7 Tesla. Neuroimage 2019; 199:184-193. [PMID: 31158475 DOI: 10.1016/j.neuroimage.2019.05.065] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/30/2019] [Accepted: 05/25/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The lenticulostriate arteries (LSAs) with small diameters of a few hundred microns take origin directly from the high flow middle cerebral artery (MCA), making them especially susceptible to damage (e.g. by hypertension). This study aims to present high resolution (isotropic ∼0.5 mm), black blood MRI for the visualization and characterization of LSAs at both 3 T and 7 T. MATERIALS AND METHODS T1-weighted 3D turbo spin-echo with variable flip angles (T1w TSE-VFA) sequences were optimized for the visualization of LSAs by performing extended phase graph (EPG) simulations. Twenty healthy volunteers (15 under 35 years old, 5 over 60 years old) were imaged with the T1w TSE-VFA sequences at both 3 T and 7 T. Contrast-to-noise ratio (CNR) was quantified, and LSAs were manually segmented using ITK-SNAP. Automated Reeb graph shape analysis was performed to extract features including vessel length and tortuosity. All quantitative metrics were compared between the two field strengths and two age groups using ANOVA. RESULTS LSAs can be clearly delineated using optimized 3D T1w TSE-VFA at 3 T and 7 T, and a greater number of LSA branches can be detected compared to those by time-of-flight MR angiography (TOF MRA) at 7 T. The CNR of LSAs was comparable between 7 T and 3 T. T1w TSE-VFA showed significantly higher CNR than TOF MRA at the stem portion of the LSAs branching off the medial middle cerebral artery. The mean vessel length and tortuosity were greater on TOF MRA compared to TSE-VFA. The number of detected LSAs by both TSE-VFA and TOF MRA was significantly reduced in aged subjects, while the mean vessel length measured on 7 T TSE-VFA showed significant difference between the two age groups. CONCLUSION The high-resolution black-blood 3D T1w TSE-VFA sequence offers a new method for the visualization and quantification of LSAs at both 3 T and 7 T, which may be applied for a number of pathological conditions related to the damage of LSAs.
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Arenillas JF, Dieleman N, Bos D. Intracranial arterial wall imaging: Techniques, clinical applicability, and future perspectives. Int J Stroke 2019; 14:564-573. [DOI: 10.1177/1747493019840942] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose To review the current state of the art and future development of intracranial vessel wall imaging. Methods Recent literature review and expert opinion about intracranial arterial wall imaging. Results Intracranial large artery diseases represent an important cause of stroke and vascular cognitive impairment worldwide. Our traditional understanding of intracranial large artery diseases is based on the observation of luminal narrowing or occlusion with angiographic or ultrasound techniques. Recently, novel imaging techniques have made the intracranial artery wall accessible for noninvasive visualization. The main advantage of vessel-wall imaging as compared to conventional imaging techniques for visualization of intracranial arteries is the ability to detect vessel wall changes even before they get to cause any significant luminal stenosis. This diagnostic capacity is provoking a revolutionary change in the way we see the intracranial circulation. In this article, we will review the current state of magnetic resonance imaging and computed tomography-based intracranial arterial wall imaging, focusing on technical considerations and their clinical applicability. Moreover, we will provide the readers with our vision on the future development of vessel-wall imaging techniques. Conclusion Intracranial arterial wall imaging methods are gaining increasing potential to impact the diagnosis and treatment of patients with cerebrovascular diseases.
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Affiliation(s)
- Juan F Arenillas
- Department of Neurology, University Clinical Hospital of Valladolid, Valladolid, Spain
- Neurovascular Research Laboratory i3, Instituto de Biología y Genética Molecular, Universidad de Valladolid – Consejo Superior de Investigaciones Científicas, Valladolid, Spain
| | - Nikki Dieleman
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Daniel Bos
- Department of Radiology and Nuclear Medicine, Erasmus MC – University Medical Center Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Bang OY, Kim BM, Seo WK, Jeon P. Endovascular Therapy for Acute Ischemic Stroke of Intracranial Atherosclerotic Origin-Neuroimaging Perspectives. Front Neurol 2019; 10:269. [PMID: 30949124 PMCID: PMC6435574 DOI: 10.3389/fneur.2019.00269] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 02/28/2019] [Indexed: 12/18/2022] Open
Abstract
Large vessel occlusion (LVO) due to intracranial atherosclerosis (ICAS) is a common cause of acute ischemic stroke (AIS) in Asians. Endovascular therapy (EVT) has been established as the mainstay of treatment in patients with AIS and LVO. However, only a few patients of Asian descent with ICAS-related LVO (ICAS-LVO) were included in recent randomized controlled trials of EVT for AIS. Therefore, the findings of these trials cannot be directly applied to Asian patients with ICAS-LVO. In embolic LVO due to thrombus from the heart or a more proximal vessel, rapid, and complete recanalization can be achieved in more than 70-80% of patients, and it is important to exclude patients with large cores. In contrast, patients with ICAS-LVO usually have favorable hemodynamic profiles (good collateral status, small core, and less severe perfusion deficit), but poor response to EVT (more rescue treatments and longer procedure times are required for successful recanalization due to higher rates of reocclusion). Patients with ICAS-LVO may have different anatomic (plaque, angioarchitecture), hemodynamic (collateral status), and pathophysiologic (thrombus composition) features on neuroimaging compared to patients with embolic LVO. In this review, we discuss these neuroimaging features, their clinical implications with respect to determination of EVT responses, and the need for development of specific EVT devices and procedures for patients with ICAS-LVO.
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Affiliation(s)
- Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Byung Moon Kim
- Department of Radiology, Severance Hospital Stroke Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Pyoung Jeon
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Kwee RM, Qiao Y, Liu L, Zeiler SR, Wasserman BA. Temporal course and implications of intracranial atherosclerotic plaque enhancement on high-resolution vessel wall MRI. Neuroradiology 2019; 61:651-657. [PMID: 30834465 DOI: 10.1007/s00234-019-02190-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 02/18/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Little is known about the natural history of intracranial atherosclerotic plaque enhancement and its clinical implications. Our objective was to investigate the value of follow-up high-resolution contrast-enhanced vessel wall MRI (VWMRI) for classifying culprit plaques in patients with intracranial atherosclerotic disease (ICAD). METHODS Fourteen patients with symptomatic ICAD (50% females; median age 48 years) underwent serial 3T VWMRI. Fifty-five plaques were identified and graded based on the likelihood of having caused the ischemic event (non-culprit, indeterminate, culprit) and degree of enhancement (0, 1, 2) at baseline and follow-up (median follow-up, 140 days). For accuracy analysis, plaque enhancement at baseline and stable or increasing plaque enhancement at follow-up was tested to identify a culprit plaque, and areas under the receiver operating characteristic curves (AUCs) were compared. RESULTS In 37/55 (67.3%) plaques, enhancement grade remained unchanged. Lack of enhancement was only seen in non-culprit plaques at baseline, and none developed enhancement over time. Enhancement never changed more than one grade. Thirty-seven percent (10/27) of non-culprit plaques that enhanced decreased in enhancement grade at follow-up, but no culprit plaques decreased in enhancement. AUC of baseline and follow-up plaque enhancement combined was significantly larger than AUC of baseline plaque enhancement alone to identify culprit plaques (0.733 vs. 0.567, p = 0.0001). CONCLUSION Contrast enhancement of ICAD can persist months after the ischemic event. Lack of enhancement at baseline or a decrease in enhancement at follow-up suggests that the plaque is not culprit. Persistent enhancement from baseline to follow-up improves accuracy in identifying culprit plaques.
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Affiliation(s)
- Robert M Kwee
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 367 East Park Building, 600 N Wolfe St, Baltimore, MD, 21287, USA.,Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/Geleen, The Netherlands
| | - Ye Qiao
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 367 East Park Building, 600 N Wolfe St, Baltimore, MD, 21287, USA
| | - Li Liu
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 367 East Park Building, 600 N Wolfe St, Baltimore, MD, 21287, USA
| | - Steven R Zeiler
- Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Bruce A Wasserman
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 367 East Park Building, 600 N Wolfe St, Baltimore, MD, 21287, USA.
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Wu F, Zhang Q, Dong K, Duan J, Yang X, Wu Y, Zhang L, Li D, Fan Z, Yang Q. Whole-brain magnetic resonance imaging of plaque burden and lenticulostriate arteries in patients with different types of stroke. Ther Adv Neurol Disord 2019; 12:1756286419833295. [PMID: 30833987 PMCID: PMC6393832 DOI: 10.1177/1756286419833295] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 12/11/2018] [Indexed: 12/21/2022] Open
Abstract
Background Large-vessel atherosclerotic disease is an important pathogenesis of deep-perforator infarction (DPI). However, altered vessel walls of intracranial large arteries and distribution of small arteries in DPI are unclear because of the limited resolution of current imaging techniques. In this study the intracranial plaque burden and lenticulostriate artery (LSA) distribution in patients with recent DPI and non-DPI using whole-brain vessel-wall imaging (WB-VWI) were investigated. Methods A total of 44 patients with recent DPI (23 patients) or non-DPI (21 patients) due to intracranial atherosclerotic disease were prospectively enrolled. WB-VWI was performed in all the patients using a three-dimensional T1-weighted vessel-wall magnetic resonance technique. Hemispheres with DPI and non-DPI were considered as the DPI group and non-DPI group, respectively. Hemispheres without a history of stroke were the control group. The intracranial plaque burden was compared between the DPI and non-DPI groups. The number and length of visualized LSA branches among DPI, non-DPI, and control groups were also evaluated. Results A total of 77 hemispheres were analyzed (23 in the DPI group, 21 in the non-DPI group, and 33 in the control group). Plaque burden was lower (p = 0.047) in the DPI group (82.0 ± 45.9 mm3) compared with the non-DPI group (130.9 ± 90.3 mm3). There was a significant reduction (p = 0.002) in length of visualized LSA branches in the DPI group (74.1 ± 21.7 mm) compared with the control group (104.6 ± 33.3 mm). Conclusions WB-VWI enables the combination of vessel-wall and LSA imaging in one image setting, which can provide information about plaque burden and LSA distribution.
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Affiliation(s)
- Fang Wu
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qian Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Kai Dong
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jiangang Duan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiaoxu Yang
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ye Wu
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ling Zhang
- Department of Radiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA, and Departments of Medicine and Bioengineering, University of California, Los Angeles, CA, USA
| | - Zhaoyang Fan
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA, and Departments of Medicine and Bioengineering, University of California, Los Angeles, CA, USA
| | - Qi Yang
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
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Shi F, Yang Q, Guo X, Qureshi TA, Tian Z, Miao H, Dey D, Li D, Fan Z. Intracranial Vessel Wall Segmentation Using Convolutional Neural Networks. IEEE Trans Biomed Eng 2019; 66:2840-2847. [PMID: 30716027 DOI: 10.1109/tbme.2019.2896972] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To develop an automated vessel wall segmentation method using convolutional neural networks to facilitate the quantification on magnetic resonance (MR) vessel wall images of patients with intracranial atherosclerotic disease (ICAD). METHODS Vessel wall images of 56 subjects were acquired with our recently developed whole-brain three-dimensional (3-D) MR vessel wall imaging (VWI) technique. An intracranial vessel analysis (IVA) framework was presented to extract, straighten, and resample the interested vessel segment into 2-D slices. A U-net-like fully convolutional networks (FCN) method was proposed for automated vessel wall segmentation by hierarchical extraction of low- and high-order convolutional features. RESULTS The network was trained and validated on 1160 slices and tested on 545 slices. The proposed segmentation method demonstrated satisfactory agreement with manual segmentations with Dice coefficient of 0.89 for the lumen and 0.77 for the vessel wall. The method was further applied to a clinical study of additional 12 symptomatic and 12 asymptomatic patients with >50% ICAD stenosis at the middle cerebral artery (MCA). Normalized wall index at the focal MCA ICAD lesions was found significantly larger in symptomatic patients compared to asymptomatic patients. CONCLUSION We have presented an automated vessel wall segmentation method based on FCN as well as the IVA framework for 3-D intracranial MR VWI. SIGNIFICANCE This approach would make large-scale quantitative plaque analysis more realistic and promote the adoption of MR VWI in ICAD management.
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Alexander MD, de Havenon A, Kim SE, Parker DL, McNally JS. Assessment of quantitative methods for enhancement measurement on vessel wall magnetic resonance imaging evaluation of intracranial atherosclerosis. Neuroradiology 2019; 61:643-650. [PMID: 30675639 DOI: 10.1007/s00234-019-02167-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 01/11/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Quantitative measures of vessel wall magnetic resonance imaging (vwMRI) for the evaluation of intracranial atherosclerotic disease (ICAD) offers standardization not available with previously used qualitative approaches that may be difficult to replicate. METHODS vwMRI studies performed to evaluate ICAD that had caused a stroke were analyzed. Two blinded reviewers qualitatively rated culprit lesions for the presence of enhancement on T1 delay alternating with nutation for tailored excitation (DANTE) SPACE images. At least 3 months later, quantitative analysis was performed of the same images, comparing lesion enhancement to reference structures. Cohen's kappa and intraclass correlation coefficients were calculated to assess agreement. Ratios of enhancement of lesions to references were compared to qualitative ratings. RESULTS Studies from 54 patients met inclusion criteria. A mean of 49 (90.7%) lesions were qualitatively rated as enhancing, with good inter-rater agreement (κ = 0.783). Among reference structure candidates, low infundibulum demonstrated the highest inter-rater agreement on pre- and post-contrast imaging. The ratio of percentage increase in plaque signal following contrast to the same measure in low infundibulum demonstrated the highest agreement with qualitative assessment, with highest agreement seen with a ratio of 0.8 set as a threshold (κ = 0.675). CONCLUSION Quantitative metrics can yield objective data to better standardize techniques and acceptance of vwMRI evaluation of ICAD. The low infundibulum had the highest inter-rater agreement on both pre- and post-contrast images and is best suited as a normally enhancing reference structure. Such quantitative techniques should be implemented in future research of vwMRI for the evaluation of ICAD.
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Affiliation(s)
- Matthew D Alexander
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA. .,Department of Neurosurgery, University of Utah, 30 North 1900 East, Room 1A071, Salt Lake City, UT, 84132, USA.
| | - Adam de Havenon
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Seong-Eun Kim
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Dennis L Parker
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Joseph S McNally
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
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Accelerated multi-contrast high isotropic resolution 3D intracranial vessel wall MRI using a tailored k-space undersampling and partially parallel reconstruction strategy. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2019; 32:343-357. [PMID: 30607664 PMCID: PMC6525120 DOI: 10.1007/s10334-018-0730-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 11/28/2018] [Accepted: 12/11/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To develop a 3D multi-contrast IVW protocol with 0.5-mm isotropic resolution and a scan time of 5 min per sequence. MATERIALS AND METHODS Pre-contrast T1w VISTA, DANTE prepared PDw VISTA, SNAP, and post-contrast T1w VISTA were accelerated using cartesian undersampling with target ordering method (CUSTOM) and self-supporting tailored k-space estimation for parallel imaging reconstruction (STEP). CUSTOM + STEP IVW was compared to full-sample IVW, SENSE-accelerated IVW, and CUSTOM + zero-filled Fourier reconstruction in normal volunteers and subjects with intracranial atherosclerotic disease (ICAD). Image quality, vessel delineation, CSF suppression, and blood suppression were compared. RESULTS CUSTOM + STEP vessel wall delineation was comparable to full-sample IVW and better than SENSE IVW for vessel wall delineation on T1w VISTA and luminal contrast on SNAP. Average image quality and wall depiction were significantly improved using STEP reconstruction compared with zero-filled Fourier reconstruction, with no significant difference in CSF or blood suppression. CONCLUSIONS CUSTOM + STEP allowed multi-contrast 3D 0.5-mm isotropic IVW within 30 min. Although some quantitative and qualitative scores for CUSTOM - STEP were lower than fully sampled IVW, CUSTOM + STEP provided comparable vessel wall delineation as full-sample IVW and was superior to SENSE. CUSTOM + STEP IVW was well tolerated by patients and showed good delineation of ICAD plaque.
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Han Y, Qiao H, Chen S, Jing J, Pan Y, Li D, Liu Y, Meng X, Wang Y, Zhao X. Intracranial artery stenosis magnetic resonance imaging aetiology and progression study: Rationale and design. Brain Behav 2018; 8:e01154. [PMID: 30456898 PMCID: PMC6305940 DOI: 10.1002/brb3.1154] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 10/01/2018] [Accepted: 10/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It has been shown that intracranial artery stenosis (ICAS) plays a key role in Chinese ischemic stroke or transient ischemic attack (TIA) patients. Many vascular diseases can lead to ICAS, such as atherosclerosis, dissection, vasculitis, moyamoya disease, and reversible cerebral vasoconstriction syndrome (RCVS). In addition, progression of intracranial atherosclerotic disease (ICAD) will increase the risk of ischemic cerebrovascular events. The ICASMAP study primarily aims to determine the etiology and disease distribution of ICAS using noninvasive magnetic resonance (MR) imaging and evaluate the rate for progression of ICAD in symptomatic population. METHODS The ICASMAP study is a prospective, observational, and multicenter study by recruiting 300 subjects (18-80 years old) with recent stroke or TIA (within 2 weeks after onset of symptoms) in China. All the subjects will undergo MR imaging examination including brain and intracranial artery MR imaging at baseline. In addition, the clinical risk factors will be collected and blood biomarkers will be tested. A subgroup of more than 200 subjects who were diagnosed with ICAD according to baseline MR imaging will be followed up for 2 years. During the follow-up study, MR imaging examination will be performed at 12 and 24 months. The primary end point is presence of progression of intracranial artery atherosclerotic plaques. CONCLUSIONS The ICASMAP study investigates the etiology of ICAS and progression of ICAD in Chinese stroke patients and may help to improve the precise diagnosis and intervention of ICAS and stroke prevention.
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Affiliation(s)
- Yongjun Han
- Center for Brain Disorders Research, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China.,Department of Biomedical Engineering, Center for Biomedical Imaging Research, Tsinghua University School of Medicine, Beijing, China
| | - Huiyu Qiao
- Department of Biomedical Engineering, Center for Biomedical Imaging Research, Tsinghua University School of Medicine, Beijing, China
| | - Shuo Chen
- Department of Biomedical Engineering, Center for Biomedical Imaging Research, Tsinghua University School of Medicine, Beijing, China
| | - Jing Jing
- Department of Neurology, Beijing Tiantan hospital, Capital Medical University, Beijing, China
| | - Yuesong Pan
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Dongye Li
- Center for Brain Disorders Research, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China.,Department of Biomedical Engineering, Center for Biomedical Imaging Research, Tsinghua University School of Medicine, Beijing, China
| | - Yang Liu
- Department of Radiology, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan hospital, Capital Medical University, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan hospital, Capital Medical University, Beijing, China
| | - Xihai Zhao
- Department of Biomedical Engineering, Center for Biomedical Imaging Research, Tsinghua University School of Medicine, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
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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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Cogswell PM, Siero JC, Lants SK, Waddle S, Davis LT, Gilbert G, Hendrikse J, Donahue MJ. Variable impact of CSF flow suppression on quantitative 3.0T intracranial vessel wall measurements. J Magn Reson Imaging 2018; 48:1120-1128. [PMID: 29603829 PMCID: PMC6167215 DOI: 10.1002/jmri.26028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/13/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Flow suppression techniques have been developed for intracranial (IC) vessel wall imaging (VWI) and optimized using simulations; however, simulation results may not translate in vivo. PURPOSE To evaluate experimentally how IC vessel wall and lumen measurements change in identical subjects when evaluated using the most commonly available blood and cerebrospinal fluid (CSF) flow suppression modules and VWI sequences. STUDY TYPE Prospective. POPULATION/SUBJECTS Healthy adults (n = 13; age = 37 ± 15 years) were enrolled. FIELD STRENGTH/SEQUENCE A 3.0T 3D T1 /proton density (PD)-weighted turbo-spin-echo (TSE) acquisition with post-readout anti-driven equilibrium module, with and without Delay-Alternating-with-Nutation-for-Tailored-Excitation (DANTE) was applied. DANTE flip angle (8-12°) and TSE refocusing angle (sweep = 40-120° or 50-120°) were varied. ASSESSMENT Basilar artery and internal carotid artery (ICA) wall thicknesses, CSF signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and signal ratio (SR) were assessed. Measurements were made by two readers (radiology resident and board-certified neuroradiologist). STATISTICAL TESTS A Wilcoxon signed-rank test was applied with corrected two-sided P < 0.05 required for significance (critical P = 0.008, 0.005, and 0.05 for SNR/CNR, SR, and wall thickness, respectively). RESULTS A TSE pulse sweep = 40-120° and sweep = 50-120° provided similar (P = 0.55) CSF suppression. Addition of the DANTE preparation reduced CSF SNR from 17.4 to 6.7, thereby providing significant (P < 0.008) improvement in CSF suppression. The DANTE preparation also resulted in a significant (P < 0.008) reduction in vessel wall SNR, but variable vessel wall to CSF CNR improvement (P = 0.87). There was a trend for a difference in blood SNR with vs. without DANTE (P = 0.05). The outer vessel wall diameter and wall thickness values were lower (P < 0.05) with (basilar artery 4.45 mm, 0.81 mm, respectively) vs. without (basilar artery 4.88 mm, 0.97 mm, respectively) DANTE 8°. DATA CONCLUSION IC VWI with TSE sweep = 40-120° and with DANTE flip angle = 8° provides the best CSF suppression and CNR of the approaches evaluated. However, improvements are heterogeneous, likely owing to intersubject vessel pulsatility and CSF flow variations, which can lead to variable flow suppression efficacy in these velocity-dependent modules. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;48:1120-1128.
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Affiliation(s)
- Petrice M. Cogswell
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jeroen C.W. Siero
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Spinoza Center for Neuroimaging, Amsterdam, The Netherlands
| | - Sarah K. Lants
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Spencer Waddle
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - L. Taylor Davis
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Guillaume Gilbert
- MR Clinical Science, Philips Healthcare Canada, Markham, Ontario, Canada
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Manus J. Donahue
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
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36
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Donahue MJ, Achten E, Cogswell PM, De Leeuw FE, Derdeyn CP, Dijkhuizen RM, Fan AP, Ghaznawi R, Heit JJ, Ikram MA, Jezzard P, Jordan LC, Jouvent E, Knutsson L, Leigh R, Liebeskind DS, Lin W, Okell TW, Qureshi AI, Stagg CJ, van Osch MJP, van Zijl PCM, Watchmaker JM, Wintermark M, Wu O, Zaharchuk G, Zhou J, Hendrikse J. Consensus statement on current and emerging methods for the diagnosis and evaluation of cerebrovascular disease. J Cereb Blood Flow Metab 2018; 38:1391-1417. [PMID: 28816594 PMCID: PMC6125970 DOI: 10.1177/0271678x17721830] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 05/26/2017] [Accepted: 06/10/2017] [Indexed: 01/04/2023]
Abstract
Cerebrovascular disease (CVD) remains a leading cause of death and the leading cause of adult disability in most developed countries. This work summarizes state-of-the-art, and possible future, diagnostic and evaluation approaches in multiple stages of CVD, including (i) visualization of sub-clinical disease processes, (ii) acute stroke theranostics, and (iii) characterization of post-stroke recovery mechanisms. Underlying pathophysiology as it relates to large vessel steno-occlusive disease and the impact of this macrovascular disease on tissue-level viability, hemodynamics (cerebral blood flow, cerebral blood volume, and mean transit time), and metabolism (cerebral metabolic rate of oxygen consumption and pH) are also discussed in the context of emerging neuroimaging protocols with sensitivity to these factors. The overall purpose is to highlight advancements in stroke care and diagnostics and to provide a general overview of emerging research topics that have potential for reducing morbidity in multiple areas of CVD.
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Affiliation(s)
- Manus J Donahue
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Physics and Astronomy, Vanderbilt University, Nashville, TN, USA
| | - Eric Achten
- Department of Radiology and Nuclear Medicine, Universiteit Gent, Gent, Belgium
| | - Petrice M Cogswell
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Frank-Erik De Leeuw
- Radboud University, Nijmegen Medical Center, Donders Institute Brain Cognition & Behaviour, Center for Neuroscience, Department of Neurology, Nijmegen, The Netherlands
| | - Colin P Derdeyn
- Department of Radiology and Neurology, University of Iowa, Iowa City, IA, USA
| | - Rick M Dijkhuizen
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Audrey P Fan
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Rashid Ghaznawi
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jeremy J Heit
- Department of Radiology, Neuroimaging and Neurointervention Division, Stanford University, CA, USA
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
- Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
| | - Peter Jezzard
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Lori C Jordan
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eric Jouvent
- Department of Neurology, AP-HP, Lariboisière Hospital, Paris, France
| | - Linda Knutsson
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
| | - Richard Leigh
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | | | - Weili Lin
- Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Thomas W Okell
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Adnan I Qureshi
- Department of Neurology, Zeenat Qureshi Stroke Institute, St. Cloud, MN, USA
| | - Charlotte J Stagg
- Oxford Centre for Human Brain Activity, University of Oxford, Oxford, UK
| | | | - Peter CM van Zijl
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Jennifer M Watchmaker
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Max Wintermark
- Department of Radiology, Neuroimaging and Neurointervention Division, Stanford University, CA, USA
| | - Ona Wu
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
- Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Greg Zaharchuk
- Department of Radiology, Neuroimaging and Neurointervention Division, Stanford University, CA, USA
| | - Jinyuan Zhou
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
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37
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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: 58] [Impact Index Per Article: 9.7] [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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38
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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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Matsushige T, Kraemer M, Sato T, Berlit P, Forsting M, Ladd ME, Jabbarli R, Sure U, Khan N, Schlamann M, Wrede KH. Visualization and Classification of Deeply Seated Collateral Networks in Moyamoya Angiopathy with 7T MRI. AJNR Am J Neuroradiol 2018; 39:1248-1254. [PMID: 29880473 DOI: 10.3174/ajnr.a5700] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 03/07/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Collateral networks in Moyamoya angiopathy have a complex angioarchitecture difficult to comprehend on conventional examinations. This study aimed to evaluate morphologic patterns and the delineation of deeply seated collateral networks using ultra-high-field MRA in comparison with conventional DSA. MATERIALS AND METHODS Fifteen white patients with Moyamoya angiopathy were investigated in this prospective trial. Sequences acquired at 7T were TOF-MRA with 0.22 × 0.22 × 0.41 mm3 resolution and MPRAGE with 0.7 × 0.7 × 0.7 mm3 resolution. Four raters evaluated the presence of deeply seated collateral networks and image quality in a consensus reading of DSA, TOF-MRA, and MPRAGE using a 5-point scale in axial source images and maximum intensity projections. Delineation of deeply seated collateral networks by different imaging modalities was compared by means of the McNemar test, whereas image quality was compared using the Wilcoxon signed-rank test. RESULTS The relevant deeply seated collateral networks were classified into 2 categories and 6 pathways. A total of 100 collateral networks were detected on DSA; 106, on TOF-MRA; and 73, on MPRAGE. Delineation of deeply seated collateral networks was comparable between TOF-MRA and DSA (P = .25); however, both were better than MPRAGE (P < .001). CONCLUSIONS This study demonstrates excellent delineation of 6 distinct deeply seated collateral network pathways in Moyamoya angiopathy in white adults using 7T TOF-MRA, comparable to DSA.
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Affiliation(s)
- T Matsushige
- From the Department of Neurosurgery (T.M., T.S., R.J., U.S., K.H.W.), University Hospital Essen, University Duisburg-Essen, Essen, Germany.,Department of Neurosurgery (T.M.), Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.,Erwin L. Hahn Institute for Magnetic Resonance Imaging (T.M., T.S., M.E.L., K.H.W.), University Duisburg-Essen, Essen, Germany
| | - M Kraemer
- Department of Neurology (M.K., P.B.), Alfried Krupp Hospital, Essen, Germany.,Department of Neurology (M.K.), University Hospital Duesseldorf, Duesseldorf, Germany
| | - T Sato
- From the Department of Neurosurgery (T.M., T.S., R.J., U.S., K.H.W.), University Hospital Essen, University Duisburg-Essen, Essen, Germany.,Erwin L. Hahn Institute for Magnetic Resonance Imaging (T.M., T.S., M.E.L., K.H.W.), University Duisburg-Essen, Essen, Germany.,Department of Neurosurgery (T.S.), Fukushima Medical University, Fukushima, Japan
| | - P Berlit
- Department of Neurology (M.K., P.B.), Alfried Krupp Hospital, Essen, Germany
| | - M Forsting
- Department of Diagnostic and Interventional Radiology and Neuroradiology (M.F., M.S.), University Hospital Essen, Essen, Germany
| | - M E Ladd
- Erwin L. Hahn Institute for Magnetic Resonance Imaging (T.M., T.S., M.E.L., K.H.W.), University Duisburg-Essen, Essen, Germany.,Medical Physics in Radiology (M.E.L.), German Cancer Research Center, Heidelberg, Germany.,Faculty of Physics and Astronomy and Faculty of Medicine (M.E.L.), University of Heidelberg, Heidelberg, Germany
| | - R Jabbarli
- From the Department of Neurosurgery (T.M., T.S., R.J., U.S., K.H.W.), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - U Sure
- From the Department of Neurosurgery (T.M., T.S., R.J., U.S., K.H.W.), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - N Khan
- Moyamoya Center, Division of Pediatric Neurosurgery (N.K.), Department of Surgery, University Children's Hospital Zurich, Zurich, Switzerland
| | - M Schlamann
- Department of Diagnostic and Interventional Radiology and Neuroradiology (M.F., M.S.), University Hospital Essen, Essen, Germany.,Department of Neuroradiology (M.S.), University Hospital Cologne, Cologne, Germany
| | - K H Wrede
- From the Department of Neurosurgery (T.M., T.S., R.J., U.S., K.H.W.), University Hospital Essen, University Duisburg-Essen, Essen, Germany .,Erwin L. Hahn Institute for Magnetic Resonance Imaging (T.M., T.S., M.E.L., K.H.W.), University Duisburg-Essen, Essen, Germany
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40
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Bang OY, Toyoda K, Arenillas JF, Liu L, Kim JS. Intracranial Large Artery Disease of Non-Atherosclerotic Origin: Recent Progress and Clinical Implications. J Stroke 2018; 20:208-217. [PMID: 29886713 PMCID: PMC6007295 DOI: 10.5853/jos.2018.00150] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 02/15/2018] [Accepted: 03/18/2018] [Indexed: 12/18/2022] Open
Abstract
Intracranial large artery disease (ILAD) is the major cause of stroke worldwide. With the application of recently introduced diagnostic techniques, the prevalence of non-atherosclerotic ILAD is expected to increase. Herein, we reviewed recent reports and summarized progress in the diagnosis and clinical impact of differentiation between ILAD of atherosclerotic and non-atherosclerotic origin. Our review of the literature suggests that more careful consideration of non-atherosclerotic causes and the application of appropriate diagnostic techniques in patients with ILAD may not only provide better results in the treatment of patients, but it may also lead to more successful clinical trials for the treatment of intracranial atherosclerosis.
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Affiliation(s)
- Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Juan F Arenillas
- Department of Neurology, University Clinical Hospital of Valladolid, Valladolid, Spain
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jong S Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Shi Z, Zhu C, Degnan AJ, Tian X, Li J, Chen L, Zhang X, Peng W, Chen C, Lu J, Jiang T, Saloner D, Liu Q. Identification of high-risk plaque features in intracranial atherosclerosis: initial experience using a radiomic approach. Eur Radiol 2018; 28:3912-3921. [PMID: 29633002 PMCID: PMC6081255 DOI: 10.1007/s00330-018-5395-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 02/15/2018] [Accepted: 02/20/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To evaluate a quantitative radiomic approach based on high-resolution magnetic resonance imaging (HR-MRI) to differentiate acute/sub-acute symptomatic basilar artery plaque from asymptomatic plaque. METHODS Ninety-six patients with basilar artery stenosis underwent HR-MRI between January 2014 and December 2016. Patients were scanned with T1- and T2-weighted imaging, as well as T1 imaging following gadolinium-contrast injection (CE-T1). The stenosis value, plaque area/burden, lumen area, minimal luminal area (MLA), intraplaque haemorrhage (IPH), contrast enhancement ratio and 94 quantitative radiomic features were extracted and compared between acute/sub-acute and asymptomatic patients. Multi-variate logistic analysis and a random forest model were used to evaluate the diagnostic performance. RESULTS IPH, MLA and enhancement ratio were independently associated with acute/subacute symptoms. Radiomic features in T1 and CE-T1 images were associated with acute/subacute symptoms, but the features from T2 images were not. The combined IPH, MLA and enhancement ratio had an area under the curve (AUC) of 0.833 for identifying acute/sub-acute symptomatic plaques, and the combined T1 and CE-T1 radiomic approach had a significantly higher AUC of 0.936 (p = 0.01). Combining all features achieved an AUC of 0.974 and accuracy of 90.5%. CONCLUSIONS Radiomic analysis of plaque texture on HR-MRI accurately distinguished between acutely symptomatic and asymptomatic basilar plaques. KEY POINTS • High-resolution magnetic resonance imaging can assess basilar artery atherosclerotic plaque. • Radiomic features in T1 and CE-T1 images are associated with acute symptoms. • Radiomic analysis can accurately distinguish between acute symptomatic and asymptomatic plaque. • The highest accuracy may be achieved by combining radiomic and conventional features.
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Affiliation(s)
- Zhang Shi
- Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China
| | - Chengcheng Zhu
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, USA
| | - Andrew J Degnan
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Xia Tian
- Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China
| | - Jing Li
- Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China
| | - Luguang Chen
- Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China
| | - Xuefeng Zhang
- Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China
| | - Wenjia Peng
- Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China
| | - Chao Chen
- Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China
| | - Jianping Lu
- Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China
| | - Tao Jiang
- Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China
| | - David Saloner
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, USA
| | - Qi Liu
- Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China.
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De Cocker LJ, Lindenholz A, Zwanenburg JJ, van der Kolk AG, Zwartbol M, Luijten PR, Hendrikse J. Clinical vascular imaging in the brain at 7T. Neuroimage 2018; 168:452-458. [PMID: 27867089 PMCID: PMC5862656 DOI: 10.1016/j.neuroimage.2016.11.044] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 09/30/2016] [Accepted: 11/16/2016] [Indexed: 01/23/2023] Open
Abstract
Stroke and related cerebrovascular diseases are a major cause of mortality and disability. Even at standard-field-strengths (1.5T), MRI is by far the most sensitive imaging technique to detect acute brain infarctions and to characterize incidental cerebrovascular lesions, such as white matter hyperintensities, lacunes and microbleeds. Arterial time-of-flight (TOF) MR angiography (MRA) can depict luminal narrowing or occlusion of the major brain feeding arteries, and this without the need for contrast administration. Compared to 1.5T MRA, the use of high-field strength (3T) and even more so ultra-high-field strengths (7T), enables the visualization of the lumen of much smaller intracranial vessels, while adding a contrast agent to TOF MRA at 7T may enable the visualization of even more distal arteries in addition to veins and venules. Moreover, with 3T and 7T, the arterial vessel walls beyond the circle of Willis become visible with high-resolution vessel wall imaging. In addition, with 7T MRI, the brain parenchyma can now be visualized on a submillimeter scale. As a result, high-resolution imaging studies of the brain and its blood supply at 7T have generated new concepts of different cerebrovascular diseases. In the current article, we will discuss emerging clinical applications and future directions of vascular imaging in the brain at 7T MRI.
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Affiliation(s)
- Laurens Jl De Cocker
- Department of Radiology, University Medical Center Utrecht, The Netherlands; Department of Radiology, Kliniek Sint-Jan, Brussels, Belgium.
| | - Arjen Lindenholz
- Department of Radiology, University Medical Center Utrecht, The Netherlands
| | - Jaco Jm Zwanenburg
- Department of Radiology, University Medical Center Utrecht, The Netherlands
| | | | - Maarten Zwartbol
- Department of Radiology, University Medical Center Utrecht, The Netherlands
| | - Peter R Luijten
- Department of Radiology, University Medical Center Utrecht, The Netherlands
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht, The Netherlands
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43
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How to choose the right MR sequence for your research question at 7 T and above? Neuroimage 2018; 168:119-140. [DOI: 10.1016/j.neuroimage.2017.04.044] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 04/18/2017] [Accepted: 04/19/2017] [Indexed: 12/29/2022] Open
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Ide S, Kakeda S, Miyata M, Iwata S, Ohkubo N, Nakayamada S, Futatsuya K, Watanabe K, Moriya J, Fujino Y, Tanaka Y, Korogi Y. Intracranial vessel wall lesions in patients with systematic lupus erythematosus. J Magn Reson Imaging 2018; 48:1237-1246. [DOI: 10.1002/jmri.25966] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 01/22/2018] [Indexed: 11/10/2022] Open
Affiliation(s)
- Satoru Ide
- University of Occupational and Environmental Health School of Medicine, Department of Radiology; Yahatanishi-ku Kitakyushu-shi Fukuoka Japan
| | - Shingo Kakeda
- University of Occupational and Environmental Health School of Medicine, Department of Radiology; Yahatanishi-ku Kitakyushu-shi Fukuoka Japan
| | - Mari Miyata
- University of Occupational and Environmental Health School of Medicine, Department of Radiology; Yahatanishi-ku Kitakyushu-shi Fukuoka Japan
| | - Shigeru Iwata
- University of Occupational and Environmental Health School of Medicine, First Department of Internal Medicine; Yahatanishi-ku Kitakyushu-shi Fukuoka Japan
| | - Naoaki Ohkubo
- University of Occupational and Environmental Health School of Medicine, First Department of Internal Medicine; Yahatanishi-ku Kitakyushu-shi Fukuoka Japan
| | - Shingo Nakayamada
- University of Occupational and Environmental Health School of Medicine, First Department of Internal Medicine; Yahatanishi-ku Kitakyushu-shi Fukuoka Japan
| | - Koichiro Futatsuya
- University of Occupational and Environmental Health School of Medicine, Department of Radiology; Yahatanishi-ku Kitakyushu-shi Fukuoka Japan
| | - Keita Watanabe
- University of Occupational and Environmental Health School of Medicine, Department of Radiology; Yahatanishi-ku Kitakyushu-shi Fukuoka Japan
| | - Junji Moriya
- University of Occupational and Environmental Health School of Medicine, Department of Radiology; Yahatanishi-ku Kitakyushu-shi Fukuoka Japan
| | - Yoshihisa Fujino
- University of Occupational and Environmental Health School of Medicine, Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences; Yahatanishi-ku Kitakyushu-shi Fukuoka Japan
| | - Yoshiya Tanaka
- University of Occupational and Environmental Health School of Medicine, First Department of Internal Medicine; Yahatanishi-ku Kitakyushu-shi Fukuoka Japan
| | - Yukunori Korogi
- University of Occupational and Environmental Health School of Medicine, Department of Radiology; Yahatanishi-ku Kitakyushu-shi Fukuoka Japan
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Lindenholz A, van der Kolk AG, Zwanenburg JJM, Hendrikse J. The Use and Pitfalls of Intracranial Vessel Wall Imaging: How We Do It. Radiology 2018; 286:12-28. [DOI: 10.1148/radiol.2017162096] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Arjen Lindenholz
- From the Department of Radiology, Imaging Division, University Medical Center Utrecht, Heidelberglaan 100, 3508GA Utrecht, the Netherlands
| | - Anja G. van der Kolk
- From the Department of Radiology, Imaging Division, University Medical Center Utrecht, Heidelberglaan 100, 3508GA Utrecht, the Netherlands
| | - Jaco J. M. Zwanenburg
- From the Department of Radiology, Imaging Division, University Medical Center Utrecht, Heidelberglaan 100, 3508GA Utrecht, the Netherlands
| | - Jeroen Hendrikse
- From the Department of Radiology, Imaging Division, University Medical Center Utrecht, Heidelberglaan 100, 3508GA Utrecht, the Netherlands
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Gras V, Mauconduit F, Vignaud A, Amadon A, Le Bihan D, Stöcker T, Boulant N. Design of universal parallel-transmit refocusing k T -point pulses and application to 3D T 2 -weighted imaging at 7T. Magn Reson Med 2017; 80:53-65. [PMID: 29193250 DOI: 10.1002/mrm.27001] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 10/02/2017] [Accepted: 10/16/2017] [Indexed: 12/18/2022]
Abstract
PURPOSE T2 -weighted sequences are particularly sensitive to the radiofrequency (RF) field inhomogeneity problem at ultra-high-field because of the errors accumulated by the imperfections of the train of refocusing pulses. As parallel transmission (pTx) has proved particularly useful to counteract RF heterogeneities, universal pulses were recently demonstrated to save precious time and computational efforts by skipping B1 calibration and online RF pulse tailoring. Here, we report a universal RF pulse design for non-selective refocusing pulses to mitigate the RF inhomogeneity problem at 7T in turbo spin-echo sequences with variable flip angles. METHOD Average Hamiltonian theory was used to synthetize a single non-selective refocusing pulse with pTx while optimizing its scaling properties in the presence of static field offsets. The design was performed under explicit power and specific absorption rate constraints on a database of 10 subjects using a 8Tx-32Rx commercial coil at 7T. To validate the proposed design, the RF pulses were tested in simulation and applied in vivo on 5 additional test subjects. RESULTS The root-mean-square rotation angle error (RA-NRMSE) evaluation and experimental data demonstrated great improvement with the proposed universal pulses (RA-NRMSE ∼8%) compared to the standard circularly polarized mode of excitation (RA-NRMSE ∼26%). CONCLUSION This work further completes the spectrum of 3D universal pulses to mitigate RF field inhomogeneity throughout all 3D MRI sequences without any pTx calibration. The approach returns a single pulse that can be scaled to match the desired flip angle train, thereby increasing the modularity of the proposed plug and play approach. Magn Reson Med 80:53-65, 2018. © 2017 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Vincent Gras
- CEA, DRF, Joliot, NeuroSpin, Unirs, CEA Saclay, Gif sur Yvette, France
| | | | - Alexandre Vignaud
- CEA, DRF, Joliot, NeuroSpin, Unirs, CEA Saclay, Gif sur Yvette, France
| | - Alexis Amadon
- CEA, DRF, Joliot, NeuroSpin, Unirs, CEA Saclay, Gif sur Yvette, France
| | - Denis Le Bihan
- CEA, DRF, Joliot, NeuroSpin, Unirs, CEA Saclay, Gif sur Yvette, France
| | - Tony Stöcker
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Nicolas Boulant
- CEA, DRF, Joliot, NeuroSpin, Unirs, CEA Saclay, Gif sur Yvette, France
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47
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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: 88] [Impact Index Per Article: 12.6] [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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48
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Neuroradiologic Characteristics of Primary Angiitis of the Central Nervous System According to the Affected Vessel Size. Clin Neuroradiol 2017; 29:37-44. [PMID: 28875326 DOI: 10.1007/s00062-017-0622-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 08/16/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Magnetic resonance imaging (MRI) has an important impact in diagnosing primary angiitis of the central nervous system (PACNS). However, neuroradiologic findings may vary immensely, making an easy and definite diagnosis challenging. METHODS In this retrospective, single center study, we analyzed neuroradiologic findings of patients with PACNS diagnosed at our hospital between 2009 and 2014. Furthermore, we classified patients according to the affected vessel size and compared imaging characteristics between the subgroups. RESULTS Thirty-three patients were included (mean age 43 [±15.3] years, 17 females) in this study. Patients with positive angiographic findings were classified as either medium or large vessel PACNS and presented more ischemic lesions (p < 0.001) and vessel wall enhancement (p = 0.017) compared to patients with small vessel PACNS. No significant differences were detected for the distribution of contrast-enhancing lesions (parenchymal or leptomeningeal), hemorrhages, or lesions with mass effect. Twenty-five patients underwent brain biopsy. Patients with medium or large vessel PACNS were less likely to have positive biopsy results. DISCUSSION It is essential to differentiate between small and medium/large vessel PACNS since results in MRI, digital subtraction angiography and brain biopsy may differ immensely. Since image quality of MR scanners improves gradually and brain biopsy may often be nonspecific or negative, our results emphasize the importance of MRI/MRA in the diagnosis process of PACNS.
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49
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Coolen BF, Calcagno C, van Ooij P, Fayad ZA, Strijkers GJ, Nederveen AJ. Vessel wall characterization using quantitative MRI: what's in a number? MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2017; 31:201-222. [PMID: 28808823 PMCID: PMC5813061 DOI: 10.1007/s10334-017-0644-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 07/04/2017] [Accepted: 07/18/2017] [Indexed: 12/15/2022]
Abstract
The past decade has witnessed the rapid development of new MRI technology for vessel wall imaging. Today, with advances in MRI hardware and pulse sequences, quantitative MRI of the vessel wall represents a real alternative to conventional qualitative imaging, which is hindered by significant intra- and inter-observer variability. Quantitative MRI can measure several important morphological and functional characteristics of the vessel wall. This review provides a detailed introduction to novel quantitative MRI methods for measuring vessel wall dimensions, plaque composition and permeability, endothelial shear stress and wall stiffness. Together, these methods show the versatility of non-invasive quantitative MRI for probing vascular disease at several stages. These quantitative MRI biomarkers can play an important role in the context of both treatment response monitoring and risk prediction. Given the rapid developments in scan acceleration techniques and novel image reconstruction, we foresee the possibility of integrating the acquisition of multiple quantitative vessel wall parameters within a single scan session.
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Affiliation(s)
- Bram F Coolen
- Department of Biomedical Engineering and Physics, Academic Medical Center, PO BOX 22660, 1100 DD, Amsterdam, The Netherlands. .,Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands.
| | - Claudia Calcagno
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Pim van Ooij
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Zahi A Fayad
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gustav J Strijkers
- Department of Biomedical Engineering and Physics, Academic Medical Center, PO BOX 22660, 1100 DD, Amsterdam, The Netherlands
| | - Aart J Nederveen
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
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50
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Jiang Y, Peng W, Tian B, Zhu C, Chen L, Wang X, Liu Q, Wang Y, Xiang Z, Degnan AJ, Teng Z, Saloner D, Lu J. Identification and Quantitative Assessment of Different Components of Intracranial Atherosclerotic Plaque by Ex Vivo 3T High-Resolution Multicontrast MRI. AJNR Am J Neuroradiol 2017; 38:1716-1722. [PMID: 28684455 DOI: 10.3174/ajnr.a5266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 04/23/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND PURPOSE High-resolution 3T MR imaging can visualize intracranial atherosclerotic plaque. However, histologic validation is still lacking. This study aimed to evaluate the ability of 3T MR imaging to identify and quantitatively assess intracranial atherosclerotic plaque components ex vivo with histologic validation. MATERIALS AND METHODS Fifty-three intracranial arterial specimens with atherosclerotic plaques from 20 cadavers were imaged by 3T MR imaging with T1, T2, and proton-density-weighted FSE and STIR sequences. The signal characteristics and areas of fibrous cap, lipid core, calcification, fibrous tissue, and healthy vessel wall were recorded on MR images and compared with histology. Fibrous cap thickness and maximum wall thickness were also quantified. The percentage of areas of the main plaque components, the ratio of fibrous cap thickness to maximum wall thickness, and plaque burden were calculated and compared. RESULTS The signal intensity of the lipid core was significantly lower than that of the fibrous cap on T2-weighted, proton-density, and STIR sequences (P < .01) and was comparable on T1-weighted sequences (P = 1.00). Optimal contrast between the lipid core and fibrous cap was found on T2-weighted images. Plaque component mean percentages were comparable between MR imaging and histology: fibrous component (81.86% ± 10.59% versus 81.87% ± 11.59%, P = .999), lipid core (19.51% ± 10.76% versus 19.86% ± 11.56%, P = .863), and fibrous cap (31.10% ± 11.28% versus 30.83% ± 8.51%, P = .463). However, MR imaging overestimated mean calcification (9.68% ± 5.21% versus 8.83% ± 5.67%, P = .030) and plaque burden (65.18% ± 9.01% versus 52.71% ± 14.58%, P < .001). CONCLUSIONS Ex vivo 3T MR imaging can accurately identify and quantitatively assess intracranial atherosclerotic plaque components, providing a direct reference for in vivo intracranial plaque imaging.
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Affiliation(s)
- Y Jiang
- From the Department of Radiology (Y.J.), Wuhan General Hospital of the People's Liberation Army, Wuhan, China.,Departments of Radiology (Y.J., W.P., B.T., L.C., X.W., Q.L., J.L.)
| | - W Peng
- Departments of Radiology (Y.J., W.P., B.T., L.C., X.W., Q.L., J.L.)
| | - B Tian
- Departments of Radiology (Y.J., W.P., B.T., L.C., X.W., Q.L., J.L.)
| | - C Zhu
- Department of Radiology and Biomedical Imaging (C.Z., D.S.), University of California, San Francisco, San Francisco, California
| | - L Chen
- Departments of Radiology (Y.J., W.P., B.T., L.C., X.W., Q.L., J.L.)
| | - X Wang
- Departments of Radiology (Y.J., W.P., B.T., L.C., X.W., Q.L., J.L.)
| | - Q Liu
- Departments of Radiology (Y.J., W.P., B.T., L.C., X.W., Q.L., J.L.)
| | - Y Wang
- Pathology (Y.W., Z.X.), Changhai Hospital, Shanghai, China
| | - Z Xiang
- Pathology (Y.W., Z.X.), Changhai Hospital, Shanghai, China
| | - A J Degnan
- Department of Radiology (A.J.D.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Z Teng
- Department of Radiology (Z.T.), University of Cambridge, Cambridge, UK
| | - D Saloner
- Department of Radiology and Biomedical Imaging (C.Z., D.S.), University of California, San Francisco, San Francisco, California
| | - J Lu
- Departments of Radiology (Y.J., W.P., B.T., L.C., X.W., Q.L., J.L.)
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