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Seo M, Jung W, Jeong G, Yang S, Shin I, Lee JY, Ahn KJ, Kim BS, Jang J. Deep learning improves quality of intracranial vessel wall MRI for better characterization of potentially culprit plaques. Sci Rep 2024; 14:18983. [PMID: 39152167 PMCID: PMC11329665 DOI: 10.1038/s41598-024-69750-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 08/08/2024] [Indexed: 08/19/2024] Open
Abstract
Intracranial vessel wall imaging (VWI), which requires both high spatial resolution and high signal-to-noise ratio (SNR), is an ideal candidate for deep learning (DL)-based image quality improvement. Conventional VWI (Conv-VWI, voxel size 0.51 × 0.51 × 0.45 mm3) and denoised super-resolution DL-VWI (0.28 × 0.28 × 0.45 mm3) of 117 patients were analyzed in this retrospective study. Quality of the images were compared qualitatively and quantitatively. Diagnostic performance for identifying potentially culprit atherosclerotic plaques, using lesion enhancement and presence of intraplaque hemorrhage (IPH), was evaluated. DL-VWI significantly outperformed Conv-VWI in all image quality ratings (all P < .001). DL-VWI demonstrated higher SNR and contrast-to-noise ratio (CNR) than Conv-VWI, both in normal walls (basilar artery; SNR 4.83 ± 1.23 vs. 3.02 ± 0.59, P < .001) and lesions (contrast-enhanced images; SNR 22.12 ± 11.68 vs. 8.33 ± 3.26, P < .001). In the assessment of 86 lesions, DL-VWI showed higher confidence of detection (4.56 ± 0.55 vs. 2.62 ± 0.77, P < .001), more concordant IPH characterization (Cohen's Kappa 0.85 vs. 0.59) and greater enhancement. For culprit plaque identification, IPH exhibited higher sensitivity in DL-VWI compared to Conv-VWI (70.6% vs. 23.5%) and excellent specificity (94.3% vs. 94.3%). Deep learning application of intracranial vessel wall images successfully improved the quality and resolution of the images. This aided in detecting vessel wall lesions and intraplaque hemorrhage, and in identifying potentially culprit atherosclerotic plaques.
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Affiliation(s)
- Minkook Seo
- Department of Radiology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | | | | | | | - Ilah Shin
- Department of Radiology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Ji Young Lee
- Department of Radiology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Kook-Jin Ahn
- Department of Radiology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Bum-Soo Kim
- Department of Radiology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Jinhee Jang
- Department of Radiology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, 06591, Republic of Korea.
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Alzein MM, Patel A, Abdalla RN, Cantrell DR, Shaibani A, Ansari SA. MR Vessel Wall Imaging for Atherosclerosis and Vasculitis. Neuroimaging Clin N Am 2024; 34:251-260. [PMID: 38604709 DOI: 10.1016/j.nic.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Conventional imaging modalities, such as computed tomography angiography, MR angiography, transcranial Doppler ultrasonography, and digital subtraction angiography, are utilized in evaluating intraluminal or intravascular pathology of the intracranial vessels. Limitations of luminal imaging techniques can lead to inaccurate diagnosis, evaluation, and risk stratification, as many cerebrovascular pathologies contain an extrinsic vessel wall component. Furthermore, vessel wall imaging can provide information regarding extent, treatment response, and biopsy targets for vasculitis cases. Overall, while vessel wall imaging can provide robust data regarding intracranial pathologies, further prospective, multicenter studies are required to improve diagnostic application and accuracy.
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Affiliation(s)
- Mohamad M Alzein
- Department of Radiology, Northwestern University, Feinberg School of Medicine
| | - Abhinav Patel
- Department of Radiology, Northwestern University, Feinberg School of Medicine
| | - Ramez N Abdalla
- Department of Radiology, Northwestern University, Feinberg School of Medicine; Department of Radiology, Lurie Children's Hospital; Department of Radiology, Ain Shams University, Faculty of Medicine
| | - Donald R Cantrell
- Department of Radiology, Northwestern University, Feinberg School of Medicine; Department of Radiology, Lurie Children's Hospital
| | - Ali Shaibani
- Department of Radiology, Northwestern University, Feinberg School of Medicine; Department of Radiology, Lurie Children's Hospital; Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine
| | - Sameer A Ansari
- Department of Radiology, Northwestern University, Feinberg School of Medicine; Department of Radiology, Lurie Children's Hospital; Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine; Department of Neurology, Northwestern University, Feinberg School of Medicine.
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3
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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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Ke J, Li J, Chen J, Lai C, Zheng W, Fu X, Fang X, Guo L, Shi Z. A Non-Linear Role of Hyperlipidemia on Progression of Intracranial Atherosclerotic Plaques and Acute Downstream Ischemic Events. J Atheroscler Thromb 2023; 30:1448-1460. [PMID: 36709996 PMCID: PMC10564665 DOI: 10.5551/jat.63971] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/13/2022] [Indexed: 01/28/2023] Open
Abstract
AIM Intracranial atherosclerotic stenosis (ICAS) is the leading cause of ischemic stroke worldwide. Hyperlipidemia is a major contributor to atherosclerosis. However, the effect of hyperlipidemia on the evolution of intracranial atherosclerotic plaques and downstream ischemic episodes remains unclear. In this study, we aimed to assess the radiological features of ICAS plaques and to explore the relationship between hyperlipidemia and plaque progression. METHODS We included people with ICAS (≥50% stenosis) undergoing high-resolution magnetic resonance imaging. The culprit plaque was defined as the sole, or in case of multiple stenosis, the narrowest plaque on the intracranial artery responsible for acute ischemic stroke. Demographic, clinical data, plaque features on MRI, and lipid parameters were compared between culprit and non-culprit plaques. Plaque enhancement was graded as Grade 0, 1 and 2 by comparing to the adjacent normal vessel wall and pituitary funnel after contrast enhancement on T1-weighted sequences. RESULTS 162 patients were included (mean age 57.7±12.1 years, male 61.6%), 110 of whom were identified as culprit plaque with an ipsilateral acute stroke. High-grade enhancement was the most prominent MRI feature of the culpable plaque (Grade-2: OR 6.539, 95%CI 1.706-23.707, p=0.006). LDL cholesterol was significantly associated with overall acute ischemic stroke caused by culprit plaque. After stratification by enhancement grading LDL was independently associated with ischemic events in Grade-1 enhancement plaques (OR 6.778, 95%CI 2.122-21.649, p=0.001). In patients with Grade-2 enhancement plaques, however, LDL was not associated with ischemic event; in contrast, Neutrophil/Lymphocyte ratio was independently associated with ischemic events caused by Grade-2 enhancement plaques (OR 2.188, 95%CI 1.209-3.961, p=0.010). CONCLUSIONS LDL was related with ischemia events in intermediate stage of intracranial atherosclerotic plaque progression, an excellent period for intensive lipid-lowering treatment. In advanced stage, inflammatory agents maybe the main contributor to ischemic events.
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Affiliation(s)
- Jianxia Ke
- Department of Neurology and Stroke Center, Affiliate Dongguan People’s Hospital, Southern Medical University, Dongguan, China
| | - Jinrui Li
- Department of Neurology and Stroke Center, Affiliate Dongguan People’s Hospital, Southern Medical University, Dongguan, China
| | - Junting Chen
- Department of Neurology and Stroke Center, Affiliate Dongguan People’s Hospital, Southern Medical University, Dongguan, China
| | - Chengze Lai
- Dongguan Key Laboratory of Environmental Medicine, School of Public Health, Guangdong Medical University, Dongguan, China
| | - Weicheng Zheng
- Department of Neurology and Stroke Center, Affiliate Dongguan People’s Hospital, Southern Medical University, Dongguan, China
| | - Xiaoli Fu
- Department of Neurology and Stroke Center, Affiliate Dongguan People’s Hospital, Southern Medical University, Dongguan, China
| | - Xuewen Fang
- Department of Radiology, Affiliate Dongguan People’s Hospital, Southern Medical University, Dongguan, China
| | - Lianxian Guo
- Dongguan Key Laboratory of Environmental Medicine, School of Public Health, Guangdong Medical University, Dongguan, China
| | - Zhu Shi
- Department of Neurology and Stroke Center, Affiliate Dongguan People’s Hospital, Southern Medical University, Dongguan, China
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Ahmed SY, Hassan FF. Optimizing imaging resolution in brain MRI: understanding the impact of technical factors. J Med Life 2023; 16:920-924. [PMID: 37675169 PMCID: PMC10478647 DOI: 10.25122/jml-2022-0212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/24/2022] [Indexed: 09/08/2023] Open
Abstract
Magnetic resonance imaging (MRI) exams are essential for diagnostic procedures, but their lengthy duration and associated costs limit their accessibility. Shorter scan times would reduce expenses and allow for more MRI exams, expanding the range of diagnostic procedures. This study investigated technical factors that could decrease scan time without compromising image quality, including field-of-view (FOV), phase field of view, phase oversampling, cross-talk, brain MRI imaging resolution, and scan time. Data were collected from September 2021 to June 2022. All patients underwent brain scans in the transverse plane following a standardized protocol using a 1.5-tesla Siemens Avanto MRI scanner. The protocol employed T2-weighted Turbo Spin Echo imaging. Twenty-four cases were included in this study. Initially, all participants underwent brain MRI scans using the original protocols with axial sections. The results indicated that altering the FOV phase and phase oversampling significantly affected the scan time, whereas other factors did not have a direct impact. The original protocol had a scan time of 3.47 minutes with a FOV of 230 mm, 90% FOV phase, and 0% phase oversampling. After implementing the modified protocol, the scan time was reduced to 2.18 minutes with a FOV of 217 mm and 93.98% phase oversampling of 13.96%. Statistical analysis confirmed the high significance of FOV phase and phase oversampling in reducing scan time. By optimizing these technical factors, MRI exams can be performed more efficiently, resulting in shorter scan times and potentially reducing costs. This would enhance patient comfort and enable a greater number of MRI exams, facilitating a more comprehensive range of diagnostic procedures.
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Affiliation(s)
- Shapol Yousif Ahmed
- Department of Basic Sciences, College of Medicine, Hawler Medical University, Erbil, Iraq
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Hedjoudje A, Darcourt J, Bonneville F, Edjlali M. The Use of Intracranial Vessel Wall Imaging in Clinical Practice. Radiol Clin North Am 2023; 61:521-533. [PMID: 36931767 DOI: 10.1016/j.rcl.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Three-dimensional vessel wall MR imaging has gained popularity in the diagnosis and management of patients with cerebrovascular disease in clinical practice. Vessel wall MR imaging is an imaging technique that delivers a fundamentally different viewpoint by emphasizing on the pathology of the vessel wall as opposed to traditional descriptions that focus on the vessel lumen. It shows a crucial power in detecting vessel wall changes in patients with diseases including, but not limited to, central nervous system vasculitis, moyamoya disease, aneurysms, dissections, and intracranial atherosclerotic disease.
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Affiliation(s)
- Abderrahmane Hedjoudje
- Department of Diagnostic and Interventional Neuroradiology, Sion Hospital, CHVR, Sion, Switzerland; Laboratoire D'imagerie Biomédicale Multimodale (BioMaps), Université Paris-Saclay, CEA, CNRS, Inserm, Service Hospitalier Frédéric Joliot, Orsay, France.
| | - Jean Darcourt
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Purpan, Toulouse, France
| | - Fabrice Bonneville
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Purpan, Toulouse, France
| | - Myriam Edjlali
- Laboratoire D'imagerie Biomédicale Multimodale (BioMaps), Université Paris-Saclay, CEA, CNRS, Inserm, Service Hospitalier Frédéric Joliot, Orsay, France; Department of Radiology, APHP, Hôpitaux Raymond-Poincaré & Ambroise Paré, DMU Smart Imaging, GH Université Paris-Saclay, Paris, France
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Tian B, Zhu C, Tian X, Kang Q, Shao C, Mossa-Basha M, Lu J, Saloner DA. Baseline vessel wall magnetic resonance imaging characteristics associated with in-stent restenosis for intracranial atherosclerotic stenosis. J Neurointerv Surg 2023; 15:288-291. [PMID: 35232754 PMCID: PMC9985703 DOI: 10.1136/neurintsurg-2021-018473] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 01/30/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Imaging factors, specifically baseline plaque features on high-resolution magnetic resonance vessel wall imaging (HR-VWI) that could be associated with in-stent restenosis (ISR), are still unknown. We aimed to investigate the presenting clinical and plaque features on HR-VWI associated with ISR. METHODS Sixty-four patients with intracranial stent placement for intracranial atherosclerotic stenosis who had pre- and post-contrast T1-weighted HR-VWI on 3.0T prior to stenting were included in this analysis. Student's t-test, Mann-Whitney U test, χ2 test, or the Cochran-Mantel-Haenszel (CMH) test were used to compare clinical and baseline HR-VWI characteristics of the patients between the ISR and non-ISR groups. Univariable and multivariable logistic analysis were used to test the clinical and imaging factors associated with ISR. RESULTS Among the 64 patients, 9 patients (14.06%) developed ISR during the 2-year follow-up period. Plaque burden (median 0.89 vs 0.92, P=0.04), minimum lumen area (0.009 cm2 vs 0.006 cm2, P=0.04), plaque eccentricity (55.6% vs 89.1%, P<0.01), enhancement ratio (1.36 vs 0.84, P<0.01), and enhancement involvement (type 2 represents ≥50% cross-sectional wall involvement; 100% vs 63.6%, P=0.03) all significantly differed between patients with and without ISR. Multivariable analysis revealed that lower frequency of plaque eccentricity (OR 0.18, 95% CI 0.04 to 0.96, P=0.04) and higher enhancement ratio (OR 3.57, 95% CI 1.02 to 12.48, P=0.04) were independently associated with ISR. CONCLUSIONS Preliminary findings showed that ISR was independently associated with plaque concentricity and higher enhancement ratios on pre-stenting HR-VWI for patients with symptomatic intracranial atherosclerotic stenosis.
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Affiliation(s)
- Bing Tian
- Radiology, Changhai Hospital, Shanghai, China
| | - Chengcheng Zhu
- Radiology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Xia Tian
- Radiology, Changhai Hospital, Shanghai, China
| | - Qinqin Kang
- Radiology, Changhai Hospital, Shanghai, China
| | | | - Mahmud Mossa-Basha
- Radiology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jianping Lu
- Radiology, Changhai Hospital, Shanghai, China
| | - David A Saloner
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
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Gómez-Vicente B, Hernández-Pérez M, Martínez-Velasco E, Rodríguez-Velasco M, Munuera J, Rubiera M, Vert C, Dorado L, de Lera M, Calleja AI, Cortijo E, Agulla J, López-Cancio E, Arenillas JF. Intracranial atherosclerotic plaque enhancement and long-term risk of future strokes: A prospective, longitudinal study. J Neuroimaging 2023; 33:289-301. [PMID: 36536493 DOI: 10.1111/jon.13077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/09/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND PURPOSE The prognostic significance of postcontrast enhancement of intracranial atheromatous plaque is uncertain. Prospective, long-term follow-up studies in Caucasians, using a multicenter design, are lacking. We aimed to evaluate whether this radiological sign predicts long-term new stroke in symptomatic and asymptomatic intracranial atherosclerotic disease (ICAD) patients. METHODS This was a prospective, observational, longitudinal, multicenter study. We included a symptomatic and an asymptomatic cohort of ICAD patients that underwent 3T MRI including high-resolution sequences focused on the atheromatous plaque. We evaluated grade of stenosis, plaque characteristics, and gadolinium enhancement ratio (postcontrast plaque signal/postcontrast corpus callosum signal). The occurrence of new events was evaluated at 3, 6, 9, and 12 months and annually thereafter. The association between plaque characteristics and new stroke was studied using Cox multiple regression survival analysis and Kaplan-Meier curves. RESULTS Forty-eight symptomatic and 13 asymptomatic patients were included. During 56.3 ± 16.9 months, 11 patients (18%) suffered a new event (seven ischemic, two hemorrhagic, and two transient ischemic attacks). A receiver operating characteristic curve identified an enhancement ratio of >1.77 to predict a new event. In a multivariable Cox regression, postcontrast enhancement ratio >1.77 (hazard ratio [HR]= 3.632; 95% confidence interval [CI], 1.082-12.101) and cerebral microbleeds (HR = 5.244; 95% CI, 1.476-18.629) were independent predictors of future strokes. Patients with a plaque enhancement ratio >1.77 had a lower survival free of events (p < .05). CONCLUSIONS High intracranial postcontrast enhancement is a long-term predictor of new stroke in ICAD patients. Further studies are needed to elucidate whether postcontrast enhancement reflects inflammatory activity of intracranial atheromatous plaque.
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Affiliation(s)
- Beatriz Gómez-Vicente
- Stroke Program, Department of Neurology, Hospital Clínico Universitario, Valladolid, Spain.,Neurovascular Research Laboratory, Unidad de Excelencia Instituto de Biología y Genética Molecular (IBGM), Consejo Superior de Investigaciones Científicas (CSIC) y Universidad de Valladolid, Valladolid, Spain
| | - María Hernández-Pérez
- Stroke Unit, Neuroscience Department, Hospital Universitari Germans Trias I Pujol, Universitat Autònoma de Barcelona (UAB), Badalona, Spain
| | - Elena Martínez-Velasco
- Stroke Program, Department of Neurology, Hospital Clínico Universitario, Valladolid, Spain
| | | | - Josep Munuera
- Imatge Diagnòstica i Terapèutica, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Servei de Diagnòstic per la Imatge, Hospital Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Marta Rubiera
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Carla Vert
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Laura Dorado
- Stroke Unit, Neuroscience Department, Hospital Universitari Germans Trias I Pujol, Universitat Autònoma de Barcelona (UAB), Badalona, Spain
| | - Mercedes de Lera
- Stroke Program, Department of Neurology, Hospital Clínico Universitario, Valladolid, Spain
| | - Ana Isabel Calleja
- Stroke Program, Department of Neurology, Hospital Clínico Universitario, Valladolid, Spain
| | - Elisa Cortijo
- Stroke Program, Department of Neurology, Hospital Clínico Universitario, Valladolid, Spain
| | - Jesús Agulla
- Neurovascular Research Laboratory, Unidad de Excelencia Instituto de Biología y Genética Molecular (IBGM), Consejo Superior de Investigaciones Científicas (CSIC) y Universidad de Valladolid, Valladolid, Spain.,Molecular Neurobiology Laboratory, Instituto de Biología Funcional y Genómica (IBFG), Consejo Superior de Investigaciones Científicas (CSIC) y Universidad de Salamanca, Salamanca, Spain
| | - Elena López-Cancio
- Department of Neurology, Stroke Unit, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Juan Francisco Arenillas
- Stroke Program, Department of Neurology, Hospital Clínico Universitario, Valladolid, Spain.,Neurovascular Research Laboratory, Unidad de Excelencia Instituto de Biología y Genética Molecular (IBGM), Consejo Superior de Investigaciones Científicas (CSIC) y Universidad de Valladolid, Valladolid, Spain
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Wajihah SA, Sankar DS. A review on non-Newtonian fluid models for multi-layered blood rheology in constricted arteries. ARCHIVE OF APPLIED MECHANICS = INGENIEUR-ARCHIV 2023; 93:1771-1796. [PMID: 36743075 PMCID: PMC9886544 DOI: 10.1007/s00419-023-02368-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 01/13/2023] [Indexed: 06/18/2023]
Abstract
Haemodynamics is a branch of fluid mechanics which investigates the features of blood when it flows not only via blood vessels of smaller/larger diameter, but also under normal as well as abnormal flow states, such as in the presence of stenosis, aneurysm, and thrombosis. This review aims to discuss the rheological properties of blood, geometry of constrictions, dilations and the emergence of single-layered fluid to four-layered fluid models. To discuss further the influence of the aforesaid parameters on the physiologically important flow quantities, the mathematical formulation and solution methodology of the two-layered and four layered arterial blood flow problems studied by the authors (Afiqah and Sankar in ARPN J Eng Appl Sci 15:1129--1143, 2020, Comput Methods Programs Biomed 199:105907, 2021. 10.1016/j.cmpb.2020.105907) are recalled. It should be pointed out that the increasing resistive impedance to flow in three distinct states encompassing healthy, anaemic, and diabetic demonstrates that the greater the restriction in the artery, very few blood is carried to the pathetic organs, leading to subjects' death. It is also discovered that the pulsatile nature of blood movement produces a dynamic environment that poses a slew of intriguing and unstable fluid mechanical state. It is hoped that the intriguing results gathered from this literature survey and review conducted may help the medical practitioners to forecast blood behaviour mobility in stenotic arteries. Furthermore, the physiological information gathered from the available clinical data from the literature on patients diagnosed with diabetes and anaemia may be beneficial to doctors in deciding the therapeutic procedure for treating some particular cardiovascular disease.
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Affiliation(s)
- S. Afiqah Wajihah
- Applied Mathematics and Economics Programme Area, School of Applied Sciences and Mathematics, Universiti Teknologi Brunei, Jalan Tungku Link, Gadong, Bandar Seri Begawan, BE1410 Brunei Darussalam
| | - D. S. Sankar
- Applied Mathematics and Economics Programme Area, School of Applied Sciences and Mathematics, Universiti Teknologi Brunei, Jalan Tungku Link, Gadong, Bandar Seri Begawan, BE1410 Brunei Darussalam
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Tian X, Shi Z, Wang Z, Xu B, Peng WJ, Zhang XF, Liu Q, Chen SY, Tian B, Lu JP, Shao CW. Characteristics of culprit intracranial plaque without substantial stenosis in ischemic stroke using three-dimensional high-resolution vessel wall magnetic resonance imaging. Front Neurosci 2023; 17:1160018. [PMID: 37034175 PMCID: PMC10076565 DOI: 10.3389/fnins.2023.1160018] [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: 02/06/2023] [Accepted: 03/09/2023] [Indexed: 04/11/2023] Open
Abstract
Background and aims We aim to analyze the difference in quantitative features between culprit and non-culprit intracranial plaque without substantial stenosis using three-dimensional high-resolution vessel wall MRI (3D hr-vw-MRI). Methods The patients with cerebral ischemic symptoms of the unilateral anterior circulation were recruited who had non-stenotic intracranial atherosclerosis (<50%) confirmed by computed tomographic angiographic (CTA) or magnetic resonance angiography (MRA). All patients underwent 3D hr-vw MRI within 1 month after symptom onset. 3D hr-vw-MRI characteristics, including wall thickness, plaque burden, enhancement ratio, plaque volume and intraplaque hemorrhage, and histogram features were analyzed based on T2-, precontrast T1-, and post-contrast T1-weighted images. Univariate and multivariate logistic regression analysis were used to identify key determinates differentiating culprit and non-culprit plaques and to calculate the odds ratios (ORs) with 95% confidence intervals (CIs). Results A total of 150 plaques were identified, of which 133 plaques (97 culprit and 36 non-culprit) were in the middle cerebral artery, three plaques (all culprit) were in the anterior cerebral artery (ACA) and 14 (11 culprit and three non-culprit) were in the internal carotid artery (ICA). Of all the quantitative parameters analyzed, plaque volume, maximum wall thickness, minimum wall thickness, plaque burden, enhancement ratio, coefficient of variation of the most stenotic site, enhancement ratio of whole culprit plaque in culprit plaques were significantly higher than those in non-culprit plaques. Multivariate logistic regression analysis found that plaque volume [OR, 1.527 (95% CI, 1.231-1.894); P < 0.001] and enhancement ratio of whole plaque [OR, 1.095 (95% CI, 1.021-1.175); P = 0.011] were significantly associated with culprit plaque. The combination of the two features obtained a better diagnostic efficacy for culprit plaque with sensitivity and specificity (0.910 and 0.897, respectively) than each of the two parameters alone. Conclusion 3D hr-vw MRI features of intracranial atherosclerotic plaques provided potential values over prediction of ischemic stroke patients with non-stenotic arteries. The plaque volume and enhancement ratio of whole plaque of stenosis site were found to be effective predictive parameters.
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Affiliation(s)
- Xia Tian
- Department of Radiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zhang Shi
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhen Wang
- Department of Radiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Bing Xu
- Department of Radiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Wen-Jia Peng
- Department of Radiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Xue-Feng Zhang
- Department of Radiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Qi Liu
- Department of Radiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Shi-Yue Chen
- Department of Radiology, Changhai Hospital, Naval Medical University, Shanghai, China
- Shi-Yue Chen,
| | - Bing Tian
- Department of Radiology, Changhai Hospital, Naval Medical University, Shanghai, China
- *Correspondence: Bing Tian,
| | - Jian-Ping Lu
- Department of Radiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Cheng-Wei Shao
- Department of Radiology, Changhai Hospital, Naval Medical University, Shanghai, China
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Ma Z, Huo M, Xie J, Liu G, Li G, Liu Q, Mao L, Huang W, Liu B, Liu X. Wall characteristics of atherosclerotic middle cerebral arteries in patients with single or multiple infarcts: A high-resolution MRI Study. Front Neurol 2022; 13:934926. [DOI: 10.3389/fneur.2022.934926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
Background and purposeUnderstanding the stroke mechanism of middle cerebral artery (MCA) atherosclerosis may inform secondary prevention. The aim of this study was to explore the relationship between vascular wall characteristics and infarction patterns using high-resolution magnetic resonance imaging (HRMRI) and diffusion-weighted imaging (DWI).MethodsFrom November 2018 to March 2021, patients with acute ischemic stroke due to MCA atherosclerotic disease were retrospectively analyzed. The wall characteristics of atherosclerotic MCA, including conventional characteristics and histogram-defined characteristics, were evaluated using HRMRI. Patients were divided into single-infarction and multiple-infarction groups based on DWI, and wall characteristics were compared between the two groups.ResultsOf 92 patients with MCA plaques, 59 patients (64.1%) had multiple infarcts, and 33 (35.9%) had single infarcts. The histogram-defined characteristics showed no differences between the single-infarction and multiple-infarction groups (P>0.05). Plaque burden, degree of stenosis, and prevalence of intraplaque hemorrhage (IPH) were significantly greater in the multiple-infarction group than in the single-infarction group (plaque burden: P = 0.001; degree of stenosis: P = 0.010; IPH: P = 0.019). Multivariate analysis showed that plaque burden (odds ratio: 1.136; 95% confidence interval: 1.054–1.224, P = 0.001) and IPH (odds ratio: 5.248; 95% confidence interval: 1.573–17.512, P = 0.007) were independent predictors for multiple infarction.ConclusionIPH and plaque burden are independently associated with multiple infarcts. HRMRI may provide new insight into the mechanisms underlying the different MCA infarction patterns.
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Li S, Wei J, Huang R, Li C, Chen H, Qiu Z, Jiang Y, Wu L. High-risk features of basilar artery atherosclerotic plaque. Front Neurol 2022; 13:1019036. [PMID: 36388175 PMCID: PMC9650051 DOI: 10.3389/fneur.2022.1019036] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 08/22/2022] [Indexed: 10/31/2023] Open
Abstract
INTRODUCTION High-resolution magnetic resonance imaging (HR-MRI) is used to characterize atherosclerotic plaque. The present study aimed to determine the high-risk features of the basilar artery (BA) atherosclerotic plaque. METHODS Patients with advanced BA stenosis were screened. The features including the ruptured fibrous cap (RFC), lipid core, intraplaque hemorrhage (IPH), plaque enhancement, and calcification were assessed by using high-resolution MRI. The relationship between the features and acute infarction was analyzed. RESULTS From 1 June 2014 to 31 December 2018, a total of 143 patients with 76 new strokes were included. RFC was identified in 25% of symptomatic and 10.4% of asymptomatic patients. IPH was identified in 48.7% of symptomatic and 25.4% of asymptomatic patients. RFC (3.157, 95% CI 1.062 to 9.382, p = 0.039) and IPH (2.78, 95% CI 1.127 to 6.505, p = 0.026) were independent risk factors for acute infarction. CONCLUSION Our study showed that RFC and IPH of BA plaque were independent risk factors for acute infarction.
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Affiliation(s)
- Shaojun Li
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiana Wei
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ruiyun Huang
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chenghao Li
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Hongbing Chen
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhihua Qiu
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yongjun Jiang
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Li Wu
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Baradaran H, Kamel H, Gupta A. The role of cross-sectional imaging of the extracranial and intracranial vasculature in embolic stroke of undetermined source. Front Neurol 2022; 13:982896. [PMID: 36090870 PMCID: PMC9459011 DOI: 10.3389/fneur.2022.982896] [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: 06/30/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
Despite an extensive workup, nearly one third of ischemic strokes are defined as Embolic Stroke of Undetermined Source (ESUS), indicating that no clear etiologic cause has been identified. Since large vessel atherosclerotic disease is a major cause of ischemic stroke, we focus on imaging of large vessel atherosclerosis to identify further sources of potential emboli which may be contributing to ESUS. For a stroke to be considered ESUS, both the extracranial and intracranial vessels must have <50% stenosis. Given the recent paradigm shift in our understanding of the role of plaque vulnerability in ischemic stroke risk, we evaluate the role of imaging specific high-risk extracranial plaque features in non-stenosing plaque and their potential contributions to ESUS. Further, intracranial vessel-wall MR is another potential tool to identify non-stenosing atherosclerotic plaques which may also contribute to ESUS. In this review, we discuss the role of cross-sectional imaging of the extracranial and intracranial arteries and how imaging may potentially uncover high risk plaque features which may be contributing to ischemic strokes.
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Affiliation(s)
- Hediyeh Baradaran
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, United States
| | - Hooman Kamel
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, United States
| | - Ajay Gupta
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, United States
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
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Che F, Mi D, Wang A, Ju Y, Sui B, Geng X, Zhao X, Zhao X. Extracranial carotid plaque hemorrhage predicts ipsilateral stroke recurrence in patients with carotid atherosclerosis – a study based on high-resolution vessel wall imaging MRI. BMC Neurol 2022; 22:237. [PMID: 35764942 PMCID: PMC9238155 DOI: 10.1186/s12883-022-02758-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 06/20/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Intraplaque hemorrhage (IPH) is a hallmark of carotid plaque vulnerability. We aim to investigate the association between IPH and recurrent ipsilateral ischemic stroke.
Methods
Patients with a recent stroke or transient ischemic attack (TIA) were prospectively recruited and underwent an ultrasonographic examination and carotid HR VWMRI on the side consistent with symptoms. Carotid plaque was defined as carotid intima-media-thickness (IMT) by ultrasound≥1.5 mm. IPH was determined that the ratio of the plaque signal intensity relative to that of adjacent muscle was > 1.5. All enrolled patients were clinically followed until an ipsilateral ischemic stroke, TIA, carotid endarterectomy (CEA)/carotid artery stenting (CAS), or death within 12 months. Univariate analysis was used to analyze the correlation between clinical characteristics and IPH. Kaplan-Meier survival analysis and a log-rank test were used to compare recurrence-free survival time between the IPH and non-IPH groups. Cox regression models evaluated IPH as the predictor of ipsilateral stroke recurrence.
Results
A total of 171 patients (mean age, 60.13 ± 10.04 years; 118 males) were included in the final analysis. Thirty-two patients (18.7%) showed carotid IPH. During the follow-up, patients with carotid IPH suffered 60.9% (14 of 23) of recurrent ipsilateral strokes and 60.0% (3 of 5) TIA. Multivariate Cox regression analysis proved IPH as a strong predictor of ipsilateral stroke; the adjusted hazard ratio (HR) was 6.64 (95% confidence interval [CI], 2.84–15.54, P < 0.001). Meanwhile, Cox regression analysis also proved that IPH could predict recurrent ischemic events; the adjusted HR was 8.08 (95% CI, 3.65–17.91, P < 0.001).
Conclusions
Carotid intraplaque hemorrhage is strongly associated with recurrent ischemic events and could predict recurrent ipsilateral stroke.
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Hu F, Lu F, Xiao H, Dong M, Xu Y. Relationship Between Hypertension and Basilar Atherosclerosis in Chinese Han Population: A High-Resolution Magnetic Resonance Imaging Study. Front Cardiovasc Med 2022; 9:830664. [PMID: 35571152 PMCID: PMC9094699 DOI: 10.3389/fcvm.2022.830664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/29/2022] [Indexed: 11/28/2022] Open
Abstract
Objective To investigate the relationship between hypertension and basilar atherosclerosis evaluated by high-resolution magnetic resonance imaging (HR-MRI) in the Chinese Han population. Methods High resolution-MRI vessel wall imaging was performed in selected 193 patients for various indications. Multivariable logistic regression models based on odds ratio (OR) with their associated 95% confidence interval (CI) were used to assess the relationship between hypertension and basilar artery (BA) plaque, moderate or severe stenosis of BA plaque, and vulnerable plaque. A linear regression model was used to assess the relationship between hypertension and BA plaque numbers. Results Patients with hypertension had a higher proportion of BA plaque and vulnerable plaque as well as more number of enhancements of BA plaque and serious plaque compared with normotensive patients (all values of p < 0.05). Multivariable logistic regression analysis indicated that patients with hypertension had an increased risk for and more number of enhancements of BA plaque (adjusted-OR: 4.32, 95% CI 1.89–9.88, p < 0.001; adjusted-β: 0.55, 95% CI 0.14–0.96, p = 0.009, respectively) and had a higher proportion of moderate or severe stenosis of BA plaque and vulnerable plaque (adjusted-OR: 3.08, 95% CI 0.77–12.32, p = 0.111; adjusted-OR: 4.52, 95% CI 1.50–13.64, p = 0.007, respectively) compared with the normotensive group. Moreover, there was a saturation effect of age on the prevalence of BA plaque and vulnerable plaque. Conclusion Hypertension was the independent risk factor of BA plaque and vulnerable plaque assessed by HR-MRI in the Chinese Han population.
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Affiliation(s)
- Feng Hu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Feng Lu
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Huiling Xiao
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Meixue Dong
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yan Xu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- *Correspondence: Yan Xu,
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16
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Jia Y, Liu X, Zhang L, Kong X, Chen S, Zhang L, Wang J, Shu S, Liu J, Fu X, Liu D, Wang J, Shi H. Integrated head and neck imaging of symptomatic patients with stroke using simultaneous non-contrast cardiovascular magnetic resonance angiography and intraplaque hemorrhage imaging as compared with digital subtraction angiography. J Cardiovasc Magn Reson 2022; 24:19. [PMID: 35307027 PMCID: PMC8935695 DOI: 10.1186/s12968-022-00849-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 02/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Both stenosis rate and intraplaque hemorrhage (IPH) are important predictors of stroke risk. Simultaneous non-contrast angiography and intraplaque hemorrhage (SNAP) cardiovascular magnetic resonance (CMR) imaging can detect both stenosis rate and IPH. We aimed to evaluate consistency between SNAP and digital subtraction angiography (DSA) to assess symptomatic patients with stroke and explore the performance of SNAP to identify IPH and the clinical factors associated with IPH. METHODS Eighty-one symptomatic patients with stroke, admitted to Wuhan Union Hospital who underwent CMR high-resolution vessel wall imaging (HR-VWI) and SNAP, were retrospectively identified. For patients who received interventional therapy, the imaging functions of SNAP and HR-VWI were compared with DSA. The diameters of the intracranial and carotid vessels were measured, and stenotic vessels were identified. The consistency of SNAP and HR-VWI in identifying IPH was also examined, and the correlations between IPH and clinical factors were analyzed. RESULTS SNAP was more consistent with DSA than HR-VWI in measuring vascular stenosis (intraclass correlation coefficient [ICC]SNAP-DSA = 0.917, ICC HR-VWI-DSA = 0.878). Regarding the diameter measurements of each intracranial and carotid vessel segment, SNAP was superior or similar to HR-VWI, and both were consistent with DSA in the measurement of major intracranial vascular segments. HR-VWI and SNAP exhibited acceptable agreement in identifying IPH (Kappa = 0.839, 95% confidence interval [CI]: 0.704-0.974). Patients who underwent interventional therapy had a higher plaque burden (P < 0.001). Patients with IPH had lower levels of high-density lipoprotein cholesterol (HDL) (P = 0.038) and higher levels of blood glucose (P = 0.007) and cystatin C (P = 0.040). CONCLUSIONS CMR SNAP is consistent with DSA in measuring vessel diameters and identifying atherosclerosis stenosis in each intracranial and carotid vessel segment. SNAP is also a potential alternative to HR-VWI in identifying stenosis and IPH.
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Affiliation(s)
- Yuxi Jia
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Xiaoming Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Lan Zhang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Xiangchuang Kong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Shuo Chen
- Center for Biomedical Imaging Research, Tsinghua University School of Medicine, Haidian District, Beijing, China
| | - Lei Zhang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jiazheng Wang
- Clinical & Technical Solutions, Philips Healthcare, Beijing, China
| | - Shenglei Shu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Jia Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Xiaona Fu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Dingxi Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Jing Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
| | - Heshui Shi
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
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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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Li J, Yang WJ, Zheng L, Du H, Chu WCW, Leung TWH, Chen XY. Vertebrobasilar Junction Angle Over 90°: A Potential Imaging Marker Associated With Vertebrobasilar Atherosclerosis. Front Neurosci 2022; 15:789852. [PMID: 35069103 PMCID: PMC8766791 DOI: 10.3389/fnins.2021.789852] [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: 10/05/2021] [Accepted: 11/23/2021] [Indexed: 11/22/2022] Open
Abstract
Objective: Whether the cerebral vascular variations play an important role in the progression of intracranial atherosclerosis is yet largely unclear. We aimed to investigate the relationship between the magnitude of the vertebrobasilar junction (VBJ) angle and the imaging features of vertebrobasilar artery atherosclerosis. Methods: Adult patients with acute ischemic stroke or transient ischemic attack undergoing a 3.0-tesla vessel wall magnetic resonance imaging (VW-MRI) scanning were consecutively included. Imaging features of vertebrobasilar artery atherosclerosis were assessed on the reconstructed short axis of VW-MRI at the most stenotic site. The VBJ angle degree was measured on magnetic resonance angiography and classified into the angle ≥90° or <90°. Results: Among 68 patients (mean age = 63.5 ± 9.4 years old; 63.2% were male) with vertebrobasilar atherosclerosis, 33 had a VBJ angle ≥90° and 35 had a VBJ angle <90°. Compared to the vertebrobasilar plaques with VBJ angle <90°, those with VBJ angle ≥90° had a heavier plaque burden (84.35 vs. 70.58%, p < 0.001) and higher prevalence of intraplaque hemorrhage (17.1 vs. 3.3%, p = 0.01). In the regression analyses, the VBJ angle ≥90° was also robustly associated with plaque burden (odds ratio, 1.11; 95% confidential interval, 1.043–1.18; p = 0.001) and intraplaque hemorrhage (odds ratio, 5.776; 95% confidential interval, 1.095–30.46; p = 0.039) of vertebrobasilar atherosclerosis. Conclusion: The VBJ angle over 90° might aggravate the vessel wall condition of the atherosclerotic vertebrobasilar arteries, which might serve as a potential risk factor for vertebrobasilar atherosclerosis.
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Affiliation(s)
- Jia Li
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Wen-Jie Yang
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, Baltimore, MD, United States
| | - Lu Zheng
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Heng Du
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Winnie Chiu-Wing Chu
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Thomas Wai-Hong Leung
- Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Xiang-Yan Chen
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
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20
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Sun J, Liu G, Zhang D, Wu Z, Liu J, Wang W. The Longitudinal Distribution and Stability of Curved Basilar Artery Plaque: A Study Based on HR-MRI. J Atheroscler Thromb 2021; 28:1333-1339. [PMID: 33642443 PMCID: PMC8629706 DOI: 10.5551/jat.62448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 01/13/2021] [Indexed: 11/30/2022] Open
Abstract
AIMS This study aims to evaluate the differences in the characteristics of atherosclerotic plaques in the proximal, curved, and distal segments of the curved basilar artery (BA) through high-resolution magnetic resonance imaging(HR-MRI). METHODS The imaging and clinical data of 146 patients were retrospectively analyzed. On the basis of three-dimensional (3D) time -of -flight magnetic resonance angiography (3D-TOF-MRA), 51 patients with BA curvature were selected for the study. The BA plaque is divided into three groups: proximal, curved, and distal. Plaques were identified and analyzed according to spin echo acquisition imaging via T1-weighted 3D volumetric isotropic Tse acquisition (T1W-3D -VISTA), and compare the differences in clinical related factors and plaque characteristics between groups. Diffusion-weighted imaging (DWI) and/or T2WI identified brainstem infarction. The patients were divided into symptomatic and asymptomatic groups. The correlation between plaque location and symptoms was identified and analyzed. RESULTS Among 51 patients, a total of 376 plaques were detected. Plaques in the proximal and curved segments are more common than those in the distal segments. Proximal plaques are more likely to have intraplaque hemorrhage ( P=0.002 <0.05). There was no significant difference in the distribution of criminal plaques and non-criminal plaques between each group (P=0.36 >0.05). CONCLUSION Plaques in the proximal and curved segments of the BA are more common than those in the distal segments. The proximal plaque is more prone to intraplaque hemorrhage.
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Affiliation(s)
- Jiali Sun
- The First Affiliated Hospital of Harbin Medical University
| | - Guoqiang Liu
- The First Affiliated Hospital of Harbin Medical University
| | - Dingyue Zhang
- The First Affiliated Hospital of Harbin Medical University
| | - Zhigang Wu
- The First Affiliated Hospital of Harbin Medical University
| | - Jingyao Liu
- The First Affiliated Hospital of Harbin Medical University
| | - Wei Wang
- The First Affiliated Hospital of Harbin Medical University
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21
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Kang HG, Lee CH, Shin BS, Chung GH, Kwak HS. Characteristics of Symptomatic Basilar Artery Stenosis Using High-Resolution Magnetic Resonance Imaging in Ischemic Stroke Patients. J Atheroscler Thromb 2021; 28:1063-1070. [PMID: 33191363 PMCID: PMC8560850 DOI: 10.5551/jat.58214] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Aim:
Arterial narrowing associated with the progression of atherosclerosis leads to serious conditions such as stroke, coronary artery disease, or even death. High-resolution magnetic resonance imaging (HR-MRI) is better for detecting arterial wall status and discriminating tissue characteristics than conventional imaging. We used HR-MRI to investigate the frequency of patients with basilar artery (BA) stenosis observed distinctively on routine angiography and identify the clinical features associated with this imaging. We analyzed the nature of the vessel wall causing the basal artery stenosis by HR-MRI, and related clinical factors.
Methods:
Patients with BA stenosis underwent HR-MRI. The association between atherosclerosis (with or without intraplaque hemorrhage [IPH]) and dissection was analyzed. High signal intensity within a BA plaque on magnetization-prepared rapid acquisition with gradient echo was defined as an area with a signal intensity >200% that of the adjacent muscle.
Results:
Fifteen patients were diagnosed with BA dissection on HR-MRI. IPH was identified in 14 patients. Patients with BA plaque with IPH were older and had higher prevalence of hypertension and hyperlipidemia than the other patients. The frequencies of alcohol drinking and number of current smokers were higher in the dissection group than in the other groups. Hyperlipidemia was identified as an influencing factor for IPH development in atherosclerotic plaque. Young age was identified as the influencing factor for the occurrence of BA dissection.
Conclusions:
The etiology of stenosis or occlusion was unclear until the development of HR-MRI. With HR-MRI, stroke etiology is better understood, and factors affecting each etiology can be identified. Further studies that clarify the etiology of posterior circulation stroke are required.
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Affiliation(s)
- Hyun Goo Kang
- Department of Neurology and Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital
| | - Chan-Hyuk Lee
- Department of Neurology and Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital
| | - Byoung-Soo Shin
- Department of Neurology and Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital
| | - Gyung Ho Chung
- Department of Radiology and Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital
| | - Hyo Sung Kwak
- Department of Radiology and Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital
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22
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Combined Assessment of Elevated Plasma Lipoprotein-Associated Phospholipase A 2 and Plaque Enhancement Improved Accuracy in the Risk of Acute Ischemic Stroke in Patients with Intracranial Artery Stenosis. J Stroke Cerebrovasc Dis 2021; 30:106103. [PMID: 34587576 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/28/2021] [Accepted: 08/31/2021] [Indexed: 01/29/2023] Open
Abstract
PURPOSE We evaluated the relationship between plasma lipoprotein-associated phospholipase A2 (Lp-PLA2) concentration and plaque characteristics in patients with intracranial artery stenosis and their clinical relevance in acute ischemic stroke. METHODS Eighty-seven patients with intracranial atherosclerotic stenosis (66 males, 21 females) were retrospectively enrolled. Plasma Lp-PLA2 concentration was measured, and vessel wall magnetic resonance imaging (VW-MRI) was used to determine intracranial vascular stenosis and plaque characteristics, including plaque enhancement, surface morphology, and T1 hyperintensity. Binary logistic regression was used to evaluate the relationship between Lp-PLA2 concentration and plaque characteristics of intracranial artery after adjusting for demographic and confounding factors and to assess their diagnostic efficacy for the risk of acute ischemic stroke. RESULTS After adjustment for demographic, medication and related lipid factors, Lp-PLA2 elevation was associated with plaque enhancement (odds ratio [OR]=12.7, 95% confidence interval [CI] 2.51-64.82, P=0.002) and surface irregularity (OR=2.9, 95% CI 1.06-7.98, P=0.038). Both Lp-PLA2 elevation (OR=8.8, 95% CI 1.64-47.72, P=0.011) and plaque enhancement (OR=34.3, 95% CI 5.88-200.4, P=0.001) were associated with acute ischemic stroke. Receiver operating characteristic curve analysis showed that the area under the curve for Lp-PLA2 concentration and plaque enhancement combined in the diagnosis of acute ischemic stroke was 0.884, significantly higher than that for Lp-PLA2 concentration (0.724) and plaque enhancement (0.794) alone. CONCLUSION Elevated Lp-PLA2 is associated with plaque enhancement and plaque surface irregularity. Combined assessment of Lp-PLA2 concentration and plaque enhancement is of greater diagnostic value for the risk of acute ischemic stroke in patients with intracranial artery stenosis.
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23
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Zhang F, Ran Y, Zhu M, Lei X, Niu J, Wang X, Zhang Y, Li S, Zhu J, Gao X, Mossa-Basha M, Cheng J, Zhu C. The Use of Pointwise Encoding Time Reduction With Radial Acquisition MRA to Assess Middle Cerebral Artery Stenosis Pre- and Post-stent Angioplasty: Comparison With 3D Time-of-Flight MRA and DSA. Front Cardiovasc Med 2021; 8:739332. [PMID: 34568466 PMCID: PMC8458737 DOI: 10.3389/fcvm.2021.739332] [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: 07/10/2021] [Accepted: 08/18/2021] [Indexed: 01/25/2023] Open
Abstract
Background and Purpose: 3D pointwise encoding time reduction magnetic resonance angiography (PETRA-MRA) is a promising non-contrast magnetic resonance angiography (MRA) technique for intracranial stenosis assessment but it has not been adequately validated against digital subtraction angiography (DSA) relative to 3D-time-of-flight (3D-TOF) MRA. The aim of this study was to compare PETRA-MRA and 3D-TOF-MRA using DSA as the reference standard for intracranial stenosis assessment before and after angioplasty and stenting in patients with middle cerebral artery (MCA) stenosis. Materials and Methods: Sixty-two patients with MCA stenosis (age 53 ± 12 years, 43 males) underwent MRA and DSA within a week for pre-intervention evaluation and 32 of them had intracranial angioplasty and stenting performed. The MRAs' image quality, flow visualization within the stents, and susceptibility artifact were graded on a 1-4 scale (1 = poor, 4 = excellent) independently by three radiologists. The degree of stenosis was measured by two radiologists independently on DSA and MRAs. Results: There was an excellent inter-observer agreement for stenosis assessment on PETRA-MRA, 3D-TOF-MRA, and DSA (ICCs > 0.90). For pre-intervention evaluation, PETRA-MRA had better image quality than 3D-TOF-MRA (3.87 ± 0.34 vs. 3.38 ± 0.65, P < 0.001), and PETRA-MRA had better agreement with DSA for stenosis measurements compared to 3D-TOF-MRA (r = 0.96 vs. r = 0.85). For post-intervention evaluation, PETRA-MRA had better image quality than 3D-TOF-MRA for in-stent flow visualization and susceptibility artifacts (3.34 ± 0.60 vs. 1.50 ± 0.76, P < 0.001; 3.31 ± 0.64 vs. 1.41 ± 0.61, P < 0.001, respectively), and better agreement with DSA for stenosis measurements than 3D-TOF-MRA (r = 0.90 vs. r = 0.26). 3D-TOF-MRA significantly overestimated the stenosis post-stenting compared to DSA (84.9 ± 19.7 vs. 39.3 ± 13.6%, p < 0.001) while PETRA-MRA didn't (40.6 ± 13.7 vs. 39.3 ± 13.6%, p = 0.18). Conclusions: PETRA-MRA is accurate and reproducible for quantifying MCA stenosis both pre- and post-stenting compared with DSA and performs better than 3D-TOF-MRA.
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Affiliation(s)
- Feifei Zhang
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuncai Ran
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ming Zhu
- Department of Intervention, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaowen Lei
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junxia Niu
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiao Wang
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yong Zhang
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shujian Li
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jinxia Zhu
- MR Collaboration, Siemens Healthcare, Ltd., Beijing, China
| | - Xuemei Gao
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington, Seattle, WA, United States
| | - Jingliang Cheng
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chengcheng Zhu
- Department of Radiology, University of Washington, Seattle, WA, United States
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24
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Salerno A, Strambo D, Nannoni S, Dunet V, Michel P. Patterns of ischemic posterior circulation strokes: A clinical, anatomical, and radiological review. Int J Stroke 2021; 17:714-722. [PMID: 34581223 PMCID: PMC9358301 DOI: 10.1177/17474930211046758] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Posterior circulation and anterior circulation strokes share many clinical,
pathogenetic and radiological features, although some clinical signs are highly specific
to posterior circulation strokes. Arterial stenosis and occlusions occur in significant
numbers in both acute posterior circulation and anterior circulation strokes, making
them good candidates for endovascular treatment. Among posterior circulation strokes,
basilar artery occlusions stand out because of the diagnostic and acute treatment
challenges. Methods We reviewed the literature on clinical stroke syndromes and neuroimaging findings and
systematically describe for each anatomical site of stroke the detailed clinical and
radiological information (anatomical representation, diffusion weighted imaging and
angiographic sequences). The principles of neuroimaging of posterior circulation strokes
and the prognosis for each stroke localization are also discussed. Review summary Stroke syndromes in the territories of the vertebral, basilar, cerebellar, and
posterior cerebral arteries are presented. Features typical of posterior circulation
strokes are highlighted, including patterns of basilar artery occlusions. Clinical
severity and prognosis of posterior circulation strokes are highly variable, and given
that they are more difficult to detect on CT-based neuroimaging, magnetic resonance
imaging is the technique of choice in suspected posterior circulation strokes. Rapid
identification of arterial occlusion patterns may provide prognostic information and
support acute revascularization decisions. Conclusions Posterior circulation stroke syndromes tightly reflect lesion localization and arterial
occlusion patterns. Although many clinical and pathogenetic features are similar to
anterior circulation strokes, notable differences exist in terms of clinical
presentation, stroke mechanism, prognosis, and response to acute recanalization.
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Affiliation(s)
- Alexander Salerno
- Stroke Center, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Davide Strambo
- Stroke Center, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Stefania Nannoni
- Stroke Center, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Vincent Dunet
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Patrik Michel
- Stroke Center, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Switzerland
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25
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Sun B, Wang L, Li X, Zhang J, Zhang J, Liu X, Wu H, Mossa-Basha M, Xu J, Zhao B, Zhao H, Zhou Y, Zhu C. Intracranial Atherosclerotic Plaque Characteristics and Burden Associated With Recurrent Acute Stroke: A 3D Quantitative Vessel Wall MRI Study. Front Aging Neurosci 2021; 13:706544. [PMID: 34393761 PMCID: PMC8355600 DOI: 10.3389/fnagi.2021.706544] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Intracranial atherosclerotic disease (ICAD) tends to affect multiple arterial segments, and previous studies rarely performed a comprehensive plaque analysis of the entire circle of Willis for the evaluation of recurrent stroke risk. We aimed to investigate the features of circle of Willis ICAD on 3D magnetic resonance vessel wall imaging (MR-VWI) and their relationships with recurrent acute stroke. Methods: Patients with either acute ischemic stroke (within 4 weeks after stroke) or chronic ischemic stroke (after 3 months of stroke) due to intracranial atherosclerotic plaque underwent 3D contrast-enhanced MR-VWI covering major cerebral arteries. Participants were divided into three groups: first-time acute stroke, recurrent acute stroke, and chronic stroke. Culprit plaque (defined as the only lesion or the most stenotic lesion when multiple plaques were present within the same vascular territory of the stroke) and non-culprit plaque characteristics, including total plaque number, plaque thickness, plaque area, plaque burden (calculated as plaque area divided by outer wall area), enhancement ratio (ER), eccentricity, and stenosis, were measured and compared across the three groups. Associations between plaque characteristics and recurrent acute stroke were investigated by multivariate analysis. Results: A total of 176 participants (aged 61 ± 10 years, 109 men) with 702 intracranial plaques were included in this study. There were 80 patients with first-time acute stroke, 42 patients with recurrent acute stroke, and 54 patients with chronic stroke. More intracranial plaques were found per patient in the recurrent acute stroke group than in the first-time acute stroke or chronic stroke group (5.19 ± 1.90 vs. 3.71 ± 1.96 and 3.46 ± 1.33, p < 0.001). Patients in the recurrent acute stroke group had greater culprit plaque burden (p < 0.001) and higher culprit ER (p < 0.001) than the other two groups. After adjustment of clinical demographic factors, in multivariate analysis, coronary artery disease (CAD) (odds ratio, OR = 4.61; p = 0.035), total plaque number (OR = 1.54; p = 0.003), culprit plaque ER (OR = 2.50; p = 0.036), and culprit plaque burden (OR per 10% increment = 2.44; p = 0.010) were all independently associated with recurrent acute stroke compared to the first-time acute stroke. Conclusion: Increased intracranial atherosclerotic plaque number, higher culprit plaque ER, greater culprit plaque burden, and CAD are independently associated with recurrent acute stroke.
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Affiliation(s)
- Beibei Sun
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Lingling Wang
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xiao Li
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jin Zhang
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jianjian Zhang
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xiaosheng Liu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Hengqu Wu
- Department of Neurology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington, Seattle, WA, United States
| | - Jianrong Xu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Bing Zhao
- Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Huilin Zhao
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yan Zhou
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Chengcheng Zhu
- Department of Radiology, University of Washington, Seattle, WA, United States
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26
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Zhao JJ, Lu Y, Cui JY, Ma LQ, Zhang RP, Xu Z. Characteristics of symptomatic plaque on high-resolution magnetic resonance imaging and its relationship with the occurrence and recurrence of ischemic stroke. Neurol Sci 2021; 42:3605-3613. [PMID: 34236554 DOI: 10.1007/s10072-021-05457-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/02/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Atherosclerosis is the most common cause of ischemia stroke. Computed tomographic angiography (CTA) and digital subtraction angiography (DSA) are used to evaluate the degree of lumen stenosis. However, these examinations are invasive and can only reveal mild to moderate stenosis. High-resolution magnetic resonance imaging (HRMRI) seems a more intuitive way to show the pathological changes of vascular wall. Hence, we conducted a systematic retrospective study to determine the characteristics of symptomatic plaques in patients with intracranial atherosclerosis on HRMRI and their association with the occurrence and recurrence of ischemic stroke events. METHODS The PubMed database was searched for relevant studies reported from January 31, 2010, to October 31, 2020. RESULTS We selected 14 clinical outcome studies. We found that plaque enhancement and positive remodeling on HRMRI indicate symptomatic plaques. Besides, intraplaque hemorrhage and positive remodeling index are closely related to the occurrence of stroke. However, it is still controversial whether the initial enhancement of plaque and the occurrence and recurrence of stroke are related. There is also no significant correlation between vascular stenosis and symptomatic plaque or the occurrence and recurrence of ischemic stroke. CONCLUSION High-resolution magnetic resonance imaging can be used as an assessment tool to predict the risk of stroke onset and recurrence in patients with atherosclerosis, but further research is also needed.
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Affiliation(s)
- Jie-Ji Zhao
- Department of Neurology, The First Affiliated Hospital of Soochow University, No. 899, Pinghai Road, Suzhou, Jiangsu Province, China
| | - Yue Lu
- Department of Neurology, The First Affiliated Hospital of Soochow University, No. 899, Pinghai Road, Suzhou, Jiangsu Province, China
| | - Jun-Yi Cui
- Department of Neurology, The People's Hospital of Suzhou New District, No. 95, Huashan Road, Suzhou, Jiangsu Province, China
| | - Lin-Qing Ma
- Department of Neurology, The People's Hospital of Suzhou New District, No. 95, Huashan Road, Suzhou, Jiangsu Province, China.
| | - Run-Ping Zhang
- Department of Neurology, The People's Hospital of Suzhou New District, No. 95, Huashan Road, Suzhou, Jiangsu Province, China.
| | - Zhuan Xu
- Department of Neurology, The First Affiliated Hospital of Soochow University, No. 899, Pinghai Road, Suzhou, Jiangsu Province, China.
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27
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Kim MJ, Kwak HS, Hwang SB, Chung GH. One-step evaluation of intraplaque hemorrhage in the carotid artery and vertebrobasilar artery using simultaneous non-contrast angiography and intraplaque hemorrhage. Eur J Radiol 2021; 141:109824. [PMID: 34126430 DOI: 10.1016/j.ejrad.2021.109824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 05/23/2021] [Accepted: 06/08/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To investigate the one-step detection of intraplaque hemorrhage (IPH) in the carotid artery (CA) and vertebrobasilar artery (VBA) using simultaneous non-contrast angiography and intraplaque hemorrhage (SNAP). METHODS From January 2019 to March 2020, 1820 consecutive patients who visited our emergency room for evaluation of neurologic symptoms underwent brain MR imaging, including the SNAP sequence. SNAP imaging examined the coronal section from the CA to the VBA. IPH was defined as plaque in the CA and VBA with 200 % higher signal intensity on SNAP than in adjacent muscle in at least two consecutive slices. RESULTS Of these patients, 360 (19.8 %) had carotid plaque (both sides = 141, 39.2 %; single side = 219, 61.8 %). Of patients with carotid plaque, 185 (51.4 %) had IPH. Of 141 patients with plaques on both sides, 35 (24.8 %) had bilateral IPH. In total, 73 (4.0 %) patients had VBA IPH (30 with carotid plaque, 43 without carotid plaque). In addition, 18 (1.0 %) patients had carotid IPH and VBA IPH. Maximal wall thickness was significantly higher in the carotid IPH groups (4.5 ± 0.1 vs. 4.1 ± 0.1, p = 0.009). Prevalence of high grade stenosis (>70 %) was significantly higher in the carotid IPH group (17.5 % vs. 6.2 %, p < 0.001). CONCLUSIONS SNAP imaging can be evaluated with a one-step examination of CA and VBA IPH.
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Affiliation(s)
- Min Jee Kim
- Department of Radiology and Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Republic of Korea
| | - Hyo Sung Kwak
- Department of Radiology and Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Republic of Korea.
| | - Seung Bae Hwang
- Department of Radiology and Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Republic of Korea
| | - Gyung Ho Chung
- Department of Radiology and Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Republic of Korea
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Abstract
Magnetic resonance (MR) imaging is a crucial tool for evaluation of the skull base, enabling characterization of complex anatomy by utilizing multiple image contrasts. Recent technical MR advances have greatly enhanced radiologists' capability to diagnose skull base pathology and help direct management. In this paper, we will summarize cutting-edge clinical and emerging research MR techniques for the skull base, including high-resolution, phase-contrast, diffusion, perfusion, vascular, zero echo-time, elastography, spectroscopy, chemical exchange saturation transfer, PET/MR, ultra-high-field, and 3D visualization. For each imaging technique, we provide a high-level summary of underlying technical principles accompanied by relevant literature review and clinical imaging examples.
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Affiliation(s)
- Claudia F Kirsch
- Division Chief, Neuroradiology, Professor of Neuroradiology and Otolaryngology, Department of Radiology, Northwell Health, Zucker Hofstra School of Medicine at Northwell, North Shore University Hospital, Manhasset, NY
| | - Mai-Lan Ho
- Associate Professor of Radiology, Director of Research, Department of Radiology, Director, Advanced Neuroimaging Core, Chair, Asian Pacific American Network, Secretary, Association for Staff and Faculty Women, Nationwide Children's Hospital and The Ohio State University, Columbus, OH; Division Chief, Neuroradiology, Professor of Neuroradiology and Otolaryngology, Department of Radiology, Northwell Health, Zucker Hofstra School of Medicine at Northwell, North Shore University Hospital, Manhasset, NY.
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29
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Shi Z, Li J, Zhao M, Zhang X, Degnan AJ, Mossa-Basha M, Saloner D, Lu J, Liu Q, Zhu C. Progression of Plaque Burden of Intracranial Atherosclerotic Plaque Predicts Recurrent Stroke/Transient Ischemic Attack: A Pilot Follow-Up Study Using Higher-Resolution MRI. J Magn Reson Imaging 2021; 54:560-570. [PMID: 33600033 PMCID: PMC8359205 DOI: 10.1002/jmri.27561] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Patients with intracranial atherosclerotic disease (ICAD) have a high frequency of stroke recurrence. However, there has been little investigation into the prognostic value of higher-resolution magnetic resonance imaging (HR-MRI). PURPOSE To investigate the use of intracranial atherosclerotic plaques features in predicting risk of recurrent cerebrovascular ischemic events using HR-MRI. STUDY TYPE Prospective. POPULATION Fifty-eight patients with acute/subacute stroke (N = 46) or transient ischemic attack (N = 12). FIELD STRENGTH/SEQUENCE A 3.0 T, 3D time-of-flight gradient echo sequence and T1- and T2-weighted fast spin echo sequences with 0.31 x 0.39 mm2 in-plane resolution, twice (with >3 months between scans) following the initial event. ASSESSMENT Patients were also followed clinically for recurrent ischemic events for up to 48 months or until a subsequent event occurred. The degree of stenosis, plaque burden (PB), minimal lumen area (MLA), and contrast enhancement ratio were assessed at each scanning session and the percentage change of each over time was calculated. STATISTICAL TESTS Univariable and multivariable Cox regression analyses were used to calculate the hazard ratio (HR) and 95% confidence interval (CI) for predicting recurrent events. RESULTS The mean time interval between baseline and follow-up MRI scans was 6.2 ± 4.1 months. After the second MRI scan, 20.7% of patients (N = 12) had experienced ipsilateral recurrent TIA/stroke within 10.9 ± 9.2 months. Univariable analyses showed that baseline triglyceride, percentage change of PB, and progression of PB were significantly associated with recurrent events (all P < 0.05). Multivariable Cox regression indicated that progression of PB (HR, 6.293; 95% CI, 1.620-24.444; P < 0.05) was a significant independent imaging feature for recurrent ischemic events. DATA CONCLUSION Progression of PB was independently associated with recurrent ischemic cerebrovascular events. HR-MRI may help risk stratification of patients at risk of recurrent stroke. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 4.
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Affiliation(s)
- Zhang Shi
- Department of Radiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Jing Li
- Department of Radiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Ming Zhao
- Department of Neurology, Changhai Hospital, Naval Medical University, Shanghai, China.,The 983th Hospital of Joint Logistics Support Forces of Chinese PLA, Tianjin, China
| | - Xuefeng Zhang
- Department of Radiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Andrew J Degnan
- Department of Radiology, Abington Hospital - Jefferson Health, Philadelphia, Pennsylvania, USA.,Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - David Saloner
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
| | - Jianping Lu
- Department of Radiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Qi Liu
- Department of Radiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Chengcheng Zhu
- Department of Radiology, University of Washington, Seattle, Washington, USA.,Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
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30
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Acute ischemic stroke versus transient ischemic attack: Differential plaque morphological features in symptomatic intracranial atherosclerotic lesions. Atherosclerosis 2021; 319:72-78. [PMID: 33486353 DOI: 10.1016/j.atherosclerosis.2021.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/18/2020] [Accepted: 01/06/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND AIMS Intracranial atherosclerotic disease (ICAD) is a major etiologic cause for acute ischemic stroke (AIS) and transient ischemic attack (TIA). The study was designed to investigate if differential morphological features exist in symptomatic atherosclerotic lesions between AIS and TIA patients. METHODS The culprit plaques from 45 AIS patients and 42 TIA patients were analyzed for the degree of stenosis, vessel wall irregularity, normalized wall index (NWI), remodeling index, plaque-wall contrast ratio (CR), high signal intensity on T1-weighted images, plaque enhancement ratio and enhancement grade. These plaque features along with clinical characteristics were compared between AIS and TIA groups as well as between their stenosis degree-matched subgroups. RESULTS Overall, grade 2 enhancement (OR 3.85, 95%CI 1.42-10.46, p = 0.006) and hyperlipidemia (OR 3.04, 95%CI 1.13-8.22, p = 0.025) were independent indicators for AIS, whereas high NWI (OR 1.47, 95%CI 0.76-2.86, p = 0.004) was associated with TIA. In the comparison between the subgroups with moderate (30%-69%) stenosis, high plaque-wall CR (OR 5.38, 95%CI 1.39-20.75, p = 0.008) was associated with AIS, whereas high NWI (OR 2.50, 95%CI 0.61-10.00, p = 0.006) was associated with TIA. CONCLUSIONS Our study reveals differential morphological features in symptomatic ICAD lesions between AIS and TIA patients. Probing these features with MR vessel wall imaging may provide insights into the prognosis of patients with ICAD.
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Pacheco FT, Cruz Junior LCHD, Padilha IG, Nunes RH, Maia Junior ACM, Campos CMS, Amaral LLFD, Massaro AR, Rocha AJD. Current uses of intracranial vessel wall imaging for clinical practice: a high-resolution MR technique recently available. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:642-650. [PMID: 33084739 DOI: 10.1590/0004-282x20200044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 04/05/2020] [Indexed: 12/12/2022]
Abstract
Intracranial vessel wall imaging plays an increasing role in diagnosing intracranial vascular diseases. With the growing demand and subsequent increased use of this technique in clinical practice, radiologists and neurologists should be aware of the choices in imaging parameters and how they affect image quality, clinical indications, methods of assessment, and limitations in the interpretation of these images. Due to the improvement of the MRI techniques, the possibility of accurate and direct evaluation of the abnormalities in the arterial vascular wall (vessel wall imaging) has evolved, adding substantial data to diagnosis when compared to the indirect evaluation based on conventional flow analyses. Herein, the authors proposed a comprehensive approach of this technique reinforcing appropriated clinical settings to better use intracranial vessel wall imaging.
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Affiliation(s)
- Felipe Torres Pacheco
- Irmandade da Santa Casa de Misericórdia de São Paulo, Departamento de Radiologia, São Paulo SP, Brazil.,Diagnósticos da América S.A., Departamento de Imagens Médicas, Divisão de Neurorradiologia, São Paulo SP, Brazil
| | | | - Igor Gomes Padilha
- Irmandade da Santa Casa de Misericórdia de São Paulo, Departamento de Radiologia, São Paulo SP, Brazil.,Diagnósticos da América S.A., Departamento de Imagens Médicas, Divisão de Neurorradiologia, São Paulo SP, Brazil
| | - Renato Hoffmann Nunes
- Irmandade da Santa Casa de Misericórdia de São Paulo, Departamento de Radiologia, São Paulo SP, Brazil.,Diagnósticos da América S.A., Departamento de Imagens Médicas, Divisão de Neurorradiologia, São Paulo SP, Brazil
| | - Antônio Carlos Martins Maia Junior
- Irmandade da Santa Casa de Misericórdia de São Paulo, Departamento de Radiologia, São Paulo SP, Brazil.,Fleury Medicina e Saúde, Departamento de Neurorradiologia, São Paulo, Brazil
| | | | - Lázaro Luís Faria do Amaral
- Hospital Beneficência Portuguesa de São Paulo, BP Medicina Diagnóstica, Departamento de Neurorradiologia, São Paulo SP, Brazil
| | | | - Antônio José da Rocha
- Irmandade da Santa Casa de Misericórdia de São Paulo, Departamento de Radiologia, São Paulo SP, Brazil.,Diagnósticos da América S.A., Departamento de Imagens Médicas, Divisão de Neurorradiologia, São Paulo SP, Brazil
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Song JW, Pavlou A, Burke MP, Shou H, Atsina KB, Xiao J, Loevner LA, Mankoff D, Fan Z, Kasner SE. Imaging endpoints of intracranial atherosclerosis using vessel wall MR imaging: a systematic review. Neuroradiology 2020; 63:847-856. [PMID: 33029735 DOI: 10.1007/s00234-020-02575-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 09/29/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The vessel wall MR imaging (VWI) literature was systematically reviewed to assess the criteria and measurement methods of VWI-related imaging endpoints for symptomatic intracranial plaque in patients with ischemic events. METHODS PubMed, Scopus, Web of Science, EMBASE, and Cochrane databases were searched up to October 2019. Two independent reviewers extracted data from 47 studies. A modified Guideline for Reporting Reliability and Agreement Studies was used to assess completeness of reporting. RESULTS The specific VWI-pulse sequence used to identify plaque was reported in 51% of studies. A VWI-based criterion to define plaque was reported in 38% of studies. A definition for culprit plaque was reported in 40% of studies. Frequently scored qualitative imaging endpoints were plaque quadrant (21%) and enhancement (21%). Frequently measured quantitative imaging endpoints were stenosis (19%), lumen area (15%), and remodeling index (14%). Reproducibility for all endpoints ranged from good to excellent (range: ICCT1 hyperintensity = 0.451 to ICCstenosis = 0.983). However, rater specialty and years of experience varied among studies. CONCLUSIONS Investigators are using different criteria to identify and measure VWI-imaging endpoints for culprit intracranial plaque. Early awareness of these differences to address methods of acquisition and measurement will help focus research resources and efforts in technique optimization and measurement reproducibility. Consensual definitions to detect plaque will be important to develop automatic lesion detection tools particularly in the era of radiomics.
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Affiliation(s)
- Jae W Song
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
| | - Athanasios Pavlou
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Morgan P Burke
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Haochang Shou
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Kofi-Buaku Atsina
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Jiayu Xiao
- Department of Biomedical Sciences, Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Laurie A Loevner
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - David Mankoff
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Zhaoyang Fan
- Department of Biomedical Sciences, Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Scott E Kasner
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Mura M, Della Schiava N, Long A, Chirico EN, Pialoux V, Millon A. Carotid intraplaque haemorrhage: pathogenesis, histological classification, imaging methods and clinical value. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1273. [PMID: 33178805 PMCID: PMC7607119 DOI: 10.21037/atm-20-1974] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Vulnerable carotid atherosclerotic plaques are characterised by several risk factors, such as inflammation, neovascularization and intraplaque haemorrhage (IPH). Vulnerable plaques can lead to ischemic events such as stroke. Many studies reported a relationship between IPH, plaque rupture, and ischemic stroke. Histology is the gold standard to evaluate IPH, but it required carotid endarterectomy (CEA) surgery to collect the tissue sample. In this context, several imaging methods can be used as a non-invasive way to evaluate plaque vulnerability and detect IPH. Most imaging studies showed that IPH is associated with plaque vulnerability and stroke, with magnetic resonance imaging (MRI) being the most sensitive and specific to detect IPH as a predictor of ischemic events. These conclusions are however still debated because of the limited number of patients included in these studies; further studies are required to better assess risks associated with different IPH stages. Moreover, IPH is implicated in plaque vulnerability with other risk factors which need to be considered to predict ischemic risk. In addition, MRI sequences standardization is required to compare results from different studies and agree on biomarkers that need to be considered to predict plaque rupture. In these circumstances, IPH detection by MRI could be an efficient clinical method to predict stroke. The goal of this review article is to first describe the pathophysiological process responsible for IPH, its histological detection in carotid plaques and its correlation with plaque rupture. The second part will discuss the benefits and limitations of imaging the carotid plaque, and finally the clinical interest of imaging IPH to predict plaque rupture, focusing on MRI-IPH.
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Affiliation(s)
- Mathilde Mura
- Univ Lyon, University Claude Bernard Lyon 1, Interuniversity Laboratory of Human Movement Biology EA7424, Lyon, France
| | - Nellie Della Schiava
- Department of Vascular and Endovascular Surgery, Groupement Hospitalier Est, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France.,Institut National des Sciences Appliquées Lyon, Laboratoire de Génie Electrique et Ferroélectricité EA 682, Villeurbanne, France
| | - Anne Long
- Univ Lyon, University Claude Bernard Lyon 1, Interuniversity Laboratory of Human Movement Biology EA7424, Lyon, France.,Departement of Internal Medicine and Vascular Medicine, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Erica N Chirico
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Vincent Pialoux
- Univ Lyon, University Claude Bernard Lyon 1, Interuniversity Laboratory of Human Movement Biology EA7424, Lyon, France.,Institut Universitaire de France, Paris, France
| | - Antoine Millon
- Department of Vascular and Endovascular Surgery, Groupement Hospitalier Est, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France.,Univ Lyon, University Claude Bernard Lyon 1, CarMeN Laboratory, INSERM U1060, Bron, France
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Tian X, Tian B, Shi Z, Wu X, Peng W, Zhang X, Malhotra A, Mossa-Basha M, Sekhar L, Liu Q, Lu J, Hu C, Zhu C. Assessment of Intracranial Atherosclerotic Plaques Using 3D Black-Blood MRI: Comparison With 3D Time-of-Flight MRA and DSA. J Magn Reson Imaging 2020; 53:469-478. [PMID: 32864816 DOI: 10.1002/jmri.27341] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/06/2020] [Accepted: 08/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Noninvasive assessment of intracranial stenosis is important to manage ischemic stroke patients. However, few previous studies have compared 3D black-blood MRI with 3D time-of-flight (TOF), magnetic resonance angiography (MRA), and digital subtraction angiography (DSA) for intracranial artery plaque assessment. PURPOSE To compare 3D black-blood MRI and 3D TOF-MRA, using DSA as the reference standard for intracranial stenosis and atherosclerotic plaque assessment in patients with posterior circulation stroke or transient ischemic attacks (TIAs). STUDY TYPE Prospective, cohort study. POPULATION One hundred and one patients with posterior circulation stroke and/or TIA (age 63 ± 10 years, 84 male) who underwent DSA and MRI within 4 weeks of each other. FIELD STRENGTH/SEQUENCE 3D fast-spin-echo MRI for intracranial vessel wall imaging (IVWI) and 3D TOF at 3T. ASSESSMENT Two radiologists independently measured the degree of stenosis on 3D IVWI and TOF, using DSA as a reference. Plaque enhancement was recorded when the plaque was stenosis-free on DSA. STATISTICAL TESTS Shapiro-Wilk's test, Student's t-test, Mann-Whitney U-test, Spearman correlation, Bland-Altman analysis, and interclass correlation coefficient (ICC). RESULTS A total of 238 intracranial plaques (203 posterior, 35 anterior) were included. 3D IVWI showed better agreement with DSA in measuring stenosis than TOF (ICC = 0.89 vs. 0.64). 3D IVWI had higher sensitivity and specificity for detecting stenosis >50% and stenosis >75% than TOF, using DSA as the standard. TOF significantly overestimated the degree of stenosis compared to DSA (65 ± 19% vs. 51 ± 15%, P < 0.001). DSA did not observe 62 nonstenotic plaques (26.1%) that were shown only on 3D IVWI, in which 36 plaques (58.1%) showed contrast enhancement. The interreader agreement for measuring stenosis were excellent, with ICCs >0.90 for all three modalities. DATA CONCLUSION 3D black-blood MRI is accurate and reproducible for quantifying intracranial artery stenosis compared with DSA, and performs better than 3D TOF. As compared to DSA, it detects more nonstenotic plaques. Level of Evidence 1 Technical Efficacy Stage 2 J. MAGN. RESON. IMAGING 2021;53:469-478.
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Affiliation(s)
- Xia Tian
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China.,Department of Radiology, Changhai Hospital, Shanghai, China
| | - Bing Tian
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Zhang Shi
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Xiao Wu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Wenjia Peng
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Xuefeng Zhang
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Ajay Malhotra
- Department of Radiology, Yale University, New Haven, Connecticut, USA
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Laligam Sekhar
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Qi Liu
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Jianping Lu
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Chunhong Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chengcheng Zhu
- Department of Radiology, University of Washington, Seattle, Washington, USA
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Wu F, Yu H, Yang Q. Imaging of intracranial atherosclerotic plaques using 3.0 T and 7.0 T magnetic resonance imaging-current trends and future perspectives. Cardiovasc Diagn Ther 2020; 10:994-1004. [PMID: 32968656 DOI: 10.21037/cdt.2020.02.03] [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] [Indexed: 12/11/2022]
Abstract
Intracranial atherosclerotic disease (ICAD) is one of the most common causes of ischemic stroke and carries a relatively high risk of stroke recurrence. Advances in high-resolution magnetic resonance imaging (HRMRI) techniques of intracranial arteries now have made it possible to directly visualize atherosclerotic plaque itself, allowing detailed assessments of plaque morphology and components. Currently available intracranial HRMRI could be performed with 2-dimensional (2D) and 3D acquisitions, and multicontrast weightings in clinically reasonable scan times. Until now, HRMRI research of ICAD has focused on the identification of plaque vulnerability, and the relationship between plaque characteristics and ischemic stroke. HRMRI at ultra-high-field strength (7.0 T) holds promise in better visualizing intracranial vessel walls, as well as identifying early lesions and total burden of ICAD. As a result, intracranial HRMRI provides great insights into pathology of intracranial atherosclerotic plaques, stroke mechanisms, and future stroke risk. In this article, we will review the technical implementation, preclinical research, clinical applications, and future directions of HRMRI for the evaluation of ICAD at 3.0 T and 7.0 T.
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Affiliation(s)
- Fang Wu
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Huan Yu
- Department of Radiology, Liangxiang Teaching Hospital, Capital Medical University, Beijing 102401, China
| | - Qi Yang
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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36
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Shi Z, Li J, Zhao M, Peng W, Meddings Z, Jiang T, Liu Q, Teng Z, Lu J. Quantitative Histogram Analysis on Intracranial Atherosclerotic Plaques: A High-Resolution Magnetic Resonance Imaging Study. Stroke 2020; 51:2161-2169. [PMID: 32568660 PMCID: PMC7306260 DOI: 10.1161/strokeaha.120.029062] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Intracranial atherosclerosis is one of the main causes of stroke, and high-resolution magnetic resonance imaging provides useful imaging biomarkers related to the risk of ischemic events. This study aims to evaluate differences in histogram features between culprit and nonculprit intracranial atherosclerosis using high-resolution magnetic resonance imaging. METHODS Two hundred forty-seven patients with intracranial atherosclerosis who underwent high-resolution magnetic resonance imaging sequentially between January 2015 and December 2016 were recruited. Quantitative features, including stenosis, plaque burden, minimum luminal area, intraplaque hemorrhage, enhancement ratio, and dispersion of signal intensity (coefficient of variation), were analyzed based on T2-, T1-, and contrast-enhanced T1-weighted images. Step-wise regression analysis was used to identify key determinates differentiating culprit and nonculprit plaques and to calculate the odds ratios (ORs) with 95% CIs. RESULTS In total, 190 plaques were identified, of which 88 plaques (37 culprit and 51 nonculprit) were located in the middle cerebral artery and 102 (57 culprit and 45 nonculprit) in the basilar artery. Nearly 90% of culprit lesions had a degree of luminal stenosis of <70%. Multiple logistic regression analyses showed that intraplaque hemorrhage (OR, 16.294 [95% CI, 1.043-254.632]; P=0.047), minimum luminal area (OR, 1.468 [95% CI, 1.032-2.087]; P=0.033), and coefficient of variation (OR, 13.425 [95% CI, 3.987-45.204]; P<0.001) were 3 significant features in defining culprit plaques in middle cerebral artery. The enhancement ratio (OR, 9.476 [95% CI, 1.256-71.464]; P=0.029), intraplaque hemorrhage (OR, 2.847 [95% CI, 0.971-10.203]; P=0.046), and coefficient of variation (OR, 10.068 [95% CI, 2.820-21.343]; P<0.001) were significantly associated with plaque type in basilar artery. Coefficient of variation was a strong independent predictor in defining plaque type for both middle cerebral artery and basilar artery with sensitivity, specificity, and accuracy being 0.79, 0.80, and 0.80, respectively. CONCLUSIONS Features characterized by high-resolution magnetic resonance imaging provided complementary values over luminal stenosis in defined lesion type for intracranial atherosclerosis; the dispersion of signal intensity in histogram analysis was a particularly effective predictive parameter.
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Affiliation(s)
- Zhang Shi
- Department of Radiology (Z.S., J. Li, W.P., T.J., Q.L., J. Lu), Changhai Hospital, Naval Medical University, Shanghai, China
- Department of Radiology, University of Cambridge, United Kingdom (Z.S., Z.M., Z.T.)
| | - Jing Li
- Department of Radiology (Z.S., J. Li, W.P., T.J., Q.L., J. Lu), Changhai Hospital, Naval Medical University, Shanghai, China
| | - Ming Zhao
- Department of Neurology (M.Z.), Changhai Hospital, Naval Medical University, Shanghai, China
| | - Wenjia Peng
- Department of Radiology (Z.S., J. Li, W.P., T.J., Q.L., J. Lu), Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zakaria Meddings
- Department of Radiology, University of Cambridge, United Kingdom (Z.S., Z.M., Z.T.)
| | - Tao Jiang
- Department of Radiology (Z.S., J. Li, W.P., T.J., Q.L., J. Lu), Changhai Hospital, Naval Medical University, Shanghai, China
| | - Qi Liu
- Department of Radiology (Z.S., J. Li, W.P., T.J., Q.L., J. Lu), Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zhongzhao Teng
- Department of Radiology, University of Cambridge, United Kingdom (Z.S., Z.M., Z.T.)
- Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, China (Z.T.)
| | - Jianping Lu
- Department of Radiology (Z.S., J. Li, W.P., T.J., Q.L., J. Lu), Changhai Hospital, Naval Medical University, Shanghai, China
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Influence of Vertebrobasilar Stenotic Lesion Rigidity on the Outcome of Angioplasty and Stenting. Sci Rep 2020; 10:3923. [PMID: 32127642 PMCID: PMC7054424 DOI: 10.1038/s41598-020-60906-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 01/31/2020] [Indexed: 11/08/2022] Open
Abstract
Stenotic lesion rigidity (SLR) has an unclear influence on the outcome of percutaneous transluminal angioplasty and stenting (PTAS) for intracranial arterial stenosis. This study evaluated the outcome of PTAS and the relationship of vertebrobasilar SLR to features on vessel wall MRI (VW-MRI) for identifying pathologies of vertebrobasilar stenosis (VBS) and evaluating PTAS outcome. We retrospectively evaluated the results of PTAS in 31 patients with severe VBS. Stenotic lesions were classified as soft (based on predilatation pressure [PP] ≦ 4 atm) in 15 patients or hard (PP >4 atm) in 16 patients. We examined the relationship of SLR to clinical and MR findings. Patients with hard vs soft lesions had atherosclerosis (8/16 [50.0%] vs 2/15 [13.3%]), dissection (0/16 [0.0%] vs 12/15 [80.0%]), and dissection in atherosclerosis (8/16 [50.0%] vs 1/15 [6.7%], P < 0.0001); high intensity signal on the T1WI of VW-MRI (5/16 [31.3%] vs 14/15 [93.3%]) and iso- to low intensity signal (11/16 [68.7%] vs 1/15 [6.7], P = 0.001), and significant in-stent restenosis (>50%) in 5/15 (33.3%) vs 0/15 (0.0%) (P = 0.0421) in the 30 patients who successfully completed PTAS. Vertebrobasilar SLR correlated well with lesion etiology, findings on VW-MRI, and PTAS outcome. Patients with hard stenotic lesions need close follow-up after PTAS.
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Why is middle cerebral artery plaque augmented by contrast media? A phantom study using middle cerebral artery stenotic silicon model. Neuroradiology 2019; 61:1173-1180. [DOI: 10.1007/s00234-019-02271-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/29/2019] [Indexed: 01/03/2023]
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39
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Lipid-Rich Necrotic Core of Basilar Artery Atherosclerotic Plaque: Contrast-Enhanced Black Blood Imaging on Vessel Wall Imaging. Diagnostics (Basel) 2019; 9:diagnostics9030069. [PMID: 31269676 PMCID: PMC6787719 DOI: 10.3390/diagnostics9030069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 06/30/2019] [Accepted: 07/01/2019] [Indexed: 11/30/2022] Open
Abstract
Purpose: We wished to evaluate the lipid-rich necrotic core (LRNC) using contrast-enhanced T1-weighted (CE-T1W) black-blood (BB) imaging for vessel walls. Methods: Ninety-five patients with basilar artery (BA) stenosis who underwent magnetic resonance angiography between January 2016 and August 2018 were enrolled into this present study. CE-T1W BB imaging was considered as a reference method for identifying an LRNC. Results: Ten (10.5%) patients were identified as having an LRNC on CE-T1W BB imaging. Of these patients, 9 had acute symptoms. The extent of stenosis in patients with an LRNC on CE-T1W BB imaging was significantly greater than that of patients without an LRNC (p < 0.001). The maximum wall thickness in patients with an LRNC on CE-T1W imaging was significantly thicker than that of patients without an LRNC (p = 0.008). Conclusions: Identification of an LRNC on CE-T1W BB imaging was associated with high-grade stenosis and massive plaque burden from BA atherosclerosis.
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Culprit intracranial plaque without substantial stenosis in acute ischemic stroke on vessel wall MRI: A systematic review. Atherosclerosis 2019; 287:112-121. [PMID: 31254918 DOI: 10.1016/j.atherosclerosis.2019.06.907] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 06/11/2019] [Accepted: 06/19/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS Intracranial atherosclerotic plaque is associated with ischemic strokes without substantial stenosis, and needs better characterization. We aim to investigate the clinical significance of intracranial plaque without substantial stenosis by high resolution vessel wall MRI (vwMRI) through a systematic review of existing studies. METHODS Studies investigating intracranial arterial atherosclerotic plaques without substantial stenosis in acute ischemic stroke patients using vwMRI were systematically identified by searching the PubMed and Medline database and article reference lists. Study characteristics were recorded, the methodological quality of eligible studies was assessed, relevant clinical data were extracted, and collective data was analyzed. RESULTS Twenty-one studies were identified as eligible. 463 patients were included without stenosis of the intracranial arteries, and 651 patients were included with stenosis <50%. The prevalence of intracranial plaque revealed by vwMRI among acute/subacute ischemic stroke patients with non-stenotic Magnetic Resonance Angiography (MRA) was 50.6% (95% confidence interval (CI), 46.1%-55.1%). The prevalence of <50% MRA stenotic culprit plaque among acute/subacute ischemic stroke patients with a clinical diagnosis of intracranial atherosclerosis was 51.2% (95% CI, 38.4%-64.0%). Plaques features, including wall enhancement, positive remodeling, intraplaque hemorrhage, plaque location and eccentricity, were associated with acute stroke, progressive motor deficits and unfavorable overall functional outcomes. CONCLUSIONS Intracranial high-risk plaque with zero or mild degree of stenosis is more prevalent than previously acknowledged, and is associated with ischemic stroke and unfavorable outcome. VwMRI can identify the high-risk plaque features, which may act as a promising tool to better risk stratify these patients.
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Lee HN, Ryu CW, Yun SJ. Vessel-Wall Magnetic Resonance Imaging of Intracranial Atherosclerotic Plaque and Ischemic Stroke: A Systematic Review and Meta-Analysis. Front Neurol 2018; 9:1032. [PMID: 30559708 PMCID: PMC6287366 DOI: 10.3389/fneur.2018.01032] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 11/16/2018] [Indexed: 01/25/2023] Open
Abstract
Introduction: Vessel-wall magnetic resonance imaging (MRI) has been suggested as a valuable tool for assessing intracranial arterial stenosis with additional diagnostic features. However, there is limited conclusive evidence on whether vessel-wall MR imaging of intracranial atherosclerotic plaques provides valuable information for predicting vulnerable lesions. We conducted this systematic review and meta-analysis to evaluate which characteristics of intracranial-plaque on vessel-wall MRI are markers of culprit lesions. Methods: The MEDLINE, EMBASE, and Cochrane Library of Clinical Trials databases were searched for studies reporting the association between vessel-wall MRI characteristics of intracranial plaque and corresponding stroke events. Odds ratios (ORs) for the prevalence of stroke with intracranial-plaque MRI characteristics were pooled in a meta-analysis using a random-effects model. Results: Twenty studies were included in this review. We found a significant association between plaque enhancement (OR, 10.09; 95% CI, 5.38-18.93), positive remodeling (OR, 6.19; 95% CI, 3.22-11.92), and plaque surface irregularity (OR, 3.94; 95% CI, 1.90-8.16) with stroke events. However, no significant difference was found for the presence of eccentricity (OR, 1.22; 95% CI, 0.51-2.91). Conclusion: Based on current evidence, intracranial plaque contrast enhancement, positive remodeling, and plaque irregularity on MRI are associated with increased risk of stroke events. Our findings support the design of future studies on intracranial-plaque MRI and decision making for the management of intracranial atherosclerotic plaques.
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Affiliation(s)
- Han Na Lee
- Department of Radiology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Chang-Woo Ryu
- Department of Radiology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Seong Jong Yun
- Department of Radiology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, South Korea
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Zhu C, Tian X, Degnan AJ, Lu J, Liu Q. Reply. AJNR Am J Neuroradiol 2018; 40:E2. [PMID: 30442701 DOI: 10.3174/ajnr.a5895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- C Zhu
- Department of Radiology and Biomedical Imaging University of California, San Francisco San Francisco, California
| | - X Tian
- Department of Radiology Changhai Hospital Shanghai, China
| | - A J Degnan
- Department of Radiology Children's Hospital of Philadelphia Philadelphia, Pennsylvania
| | - J Lu
- Department of Radiology Changhai Hospital Shanghai, China
| | - Q Liu
- Department of Radiology Changhai Hospital Shanghai, China
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Yuan W, Sun J. T1-Hyperintense Plaques on Intracranial-versus-Extracranial Vessel Wall MRI. AJNR Am J Neuroradiol 2018; 40:E1. [PMID: 30442702 DOI: 10.3174/ajnr.a5878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- W Yuan
- Department of Radiology Navy Qingdao No. 1 Sanatorium of People's Liberation Army Qingdao, Shandong, China
| | - J Sun
- Department of Radiology University of Washington Seattle, Washington
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