Abstract
BackgroundIt has been shown that intracranial atherosclerotic stenosis (ICAS) has heterogeneous features in terms of plaque instability and vascular remodeling. Therefore, quantitative information on the changes of intracranial atherosclerosis and lenticulostriate arteries (LSAs) may potentially improve understanding of the pathophysiological mechanisms underlying stroke and may guide the treatment and work-up strategies. Our present study aimed to use a novel whole-brain high-resolution cardiovascular magnetic resonance imaging (WB-HRCMR) to assess both ICAS plaques and LSAs in recent stroke patients.MethodsTwenty-nine symptomatic and 23 asymptomatic ICAS patients were enrolled in this study from Jan 2015 through Sep 2017 and all patients underwent WB-HRCMR. Intracranial atherosclerotic plaque burden, plaque enhancement volume, plaque enhancement index, as well as the number and length of LSAs were evaluated in two groups. Enhancement index was calculated as follows: ([Signal intensity (SI)plaque/SInormal wall on post-contrast imaging] − [SIplaque/SInormal wall on matched pre-contrast imaging])/(SIplaque / SInormal wall on matched pre-contrast imaging). Logistic regression analysis was used to investigate the independent high risk plaque and LSAs features associated with stroke.ResultsSymptomatic ICAS patients exhibited larger enhancement plaque volume (20.70 ± 3.07 mm3 vs. 6.71 ± 1.87 mm3P = 0.001) and higher enhancement index (0.44 ± 0.08 vs. 0.09 ± 0.06 P = 0.001) compared with the asymptomatic ICAS. The average length of LSAs in symptomatic ICAS (20.95 ± 0.87 mm) was shorter than in asymptomatic ICAS (24.04 ± 0.95 mm) (P = 0.02). Regression analysis showed that the enhancement index (100.43, 95% CI − 4.02-2510.96; P = 0.005) and the average length of LSAs (0.80, 95% CI − 0.65-0.99; P = 0.036) were independent factors for predicting of stroke.ConclusionWB-HRCMR enabled the comprehensive quantitative evaluation of intracranial atherosclerotic lesions and perforating arteries. Symptomatic ICAS had distinct plaque characteristics and shorter LSA length compared with asymptomatic ICAS.
Highlights
It has been shown that intracranial atherosclerotic stenosis (ICAS) has heterogeneous features in terms of plaque instability and vascular remodeling
The inclusion criteria: (1) age 18–80 years old; (2) symptomatic ICAS referred to first time acute ischemic stroke in the middle cerebral artery (MCA) territory identified by diffusion weighted imaging (DWI) performed within 72 h of symptom onset, and asymptomatic ICAS referred to patients who were diagnosed with other diseases without history of stroke but had MCA stenosis confirmed on image screening; (3) All enrolled subjects had moderate or severe MCA stenosis, confirmed by magnetic resonance angiography (MRA), computed tomography angiography (CTA), or digital subtraction angiography
Patient characteristics One hundred and one patients were consecutively recruited in the study and forty-nine patients were excluded from analysis due to poor image quality (N = 5), < 50% MCA stenosis (N = 4), evidence of cardio embolism (N = 7), patients with other etiologies (N = 13), and patients with lacunar infarction (N = 20)
Summary
It has been shown that intracranial atherosclerotic stenosis (ICAS) has heterogeneous features in terms of plaque instability and vascular remodeling. Our present study aimed to use a novel whole-brain high-resolution cardiovascular magnetic resonance imaging (WB-HRCMR) to assess both ICAS plaques and LSAs in recent stroke patients. High-resolution cardiovascular magnetic resonance imaging (HR-CMR) has been used to directly depict intracranial vessel wall plaques [9, 10]. Limited spatial temporal resolution hampered its application in quantitative measurement of vessel wall dimensions and visualization of lenticulostriate arteries (LSAs). Our recent studies have demonstrated the feasibility of whole-brain high-resolution magnetic resonance imaging (WB-HRCMR),which enables combined evaluation of plaque and LSAs in one image setting [17, 18]. In this study, we aimed to use WB-HRCMR to quantitatively investigate different features of plaque and LSAs in symptomatic versus asymptomatic ICAS groups
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