3D whole-brain vessel wall cardiovascular magnetic resonance imaging: a study on the reliability in the quantification of intracranial vessel dimensions

Abstract

BackgroundOne of the potentially important applications of three-dimensional (3D) intracranial vessel wall (IVW) cardiovascular magnetic resonance (CMR) is to monitor disease progression and regression via quantitative measurement of IVW morphology during medical management or drug development. However, a prerequisite for this application is to validate that IVW morphologic measurements based on the modality are reliable. In this study we performed comprehensive reliability analysis for the recently proposed whole-brain IVW CMR technique.MethodsThirty-four healthy subjects and 10 patients with known intracranial atherosclerotic disease underwent repeat whole-brain IVW CMR scans. In 19 of the 34 subjects, two-dimensional (2D) turbo spin-echo (TSE) scan was performed to serve as a reference for the assessment of vessel dimensions. Lumen and wall volume, normalized wall index, mean and maximum wall thickness were measured in both 3D and 2D IVW CMR images. Scan-rescan, intra-observer, and inter-observer reproducibility of 3D IVW CMR in the quantification of IVW or plaque dimensions were respectively assessed in volunteers and patients as well as for different healthy subjectsub-groups (i.e. < 50 and ≥ 50 years). The agreement in vessel wall and lumen measurements between the 3D technique and the 2D TSE method was also investigated. In addition, the sample size required for future longitudinal clinical studies was calculated.ResultsThe intra-class correlation coefficient (ICC) and Bland-Altman plots indicated excellent reproducibility and inter-method agreement for all morphologic measurements (All ICCs > 0.75). In addition, all ICCs of patients were equal to or higher than that of healthy subjects except maximum wall thickness. In volunteers, all ICCs of the age group of ≥50 years were equal to or higher than that of the age group of < 50 years. Normalized wall index and mean and maximum wall thickness were significantly larger in the age group of ≥50 years. To detect 5% - 20% difference between placebo and treatment groups, normalized wall index requires the smallest sample size while lumen volume requires the highest sample size.ConclusionsWhole-brain 3D IVW CMR is a reliable imaging method for the quantification of intracranial vessel dimensions and could potentially be useful for monitoring plaque progression and regression.Electronic supplementary materialThe online version of this article (10.1186/s12968-018-0453-z) contains supplementary material, which is available to authorized users.

Assessment of carotid atherosclerotic disease using three-dimensional cardiovascular magnetic resonance vessel wall imaging: comparison with digital subtraction angiography

“…Analysis of inter-observer reproducibility is an essential requirement for validation of an imaging modality. Zhang et al [27] previously performed a comprehensive reliability analysis for the 3D wholebrain CMR VWI technique. However, this study was limited by the small sample size of clinical patients.…”

“…The morphologic measurements, including the lumen diameter of the CCA and segments C1-C7, and the stenosis diameter, stenosis degree, reference diameter, and lesion length, as measured by 3D CMR VWI, displayed excellent accordance with those measured by DSA (ICC > 0.84). One possible reason for the excellent performance of the 3D CMR VWI technique is that a non-selective excitation radio-frequency pulse has been used to shorten the echo time, which helps improve the SNR of images [23,24,27]. Additionally, 3D CMR VWI provided a high isotropic resolution of 0.63 × 0.63 × 0.63 mm 3 , and achieves good flexibility with regard to image visualization, which thereby enables the visualization of plaques located in the tortuous and deep-seated intracranial carotid.…”

“…Recently, a three-dimensional (3D) CMR vessel wall imaging (VWI) technique based on 3D T1 weighted (T1w) Sampling Perfection with Application-optimized Contrast using different flip-angle Evolutions (SPACE) has become technically feasible and gained increasing attention for the diagnosis of atherosclerosis [22][23][24][25][26]. This technique is advantageous over conventional two-dimensional techniques, as it has sufficient BB effects, large spatial coverage, high isotropic resolution and signal-to-noise ratio (SNR), excellent scan efficiency, and remarkable cerebrospinal fluid (CSF) signal attenuation [23,24,27]. It therefore shows a unique capability for evaluating both lumen and wall features.…”

“…It therefore shows a unique capability for evaluating both lumen and wall features. Zhang et al [27] demonstrated the reliability (excellent intra-and inter-observer agreement and scan-rescan reproducibility) of the 3D whole-brain intracranial VWI technique for quantifying intracranial vessel dimensions in 34 healthy subjects and 10 patients with known intracranial atherosclerotic disease. However, the diagnostic accuracy of 3D CMR VWI with respect to the luminal features involved in atherosclerosis has not been systematically validated against the clinical gold standard.…”

Intracranial artery stenosis magnetic resonance imaging aetiology and progression study: Rationale and design

“…For subjects who were diagnosed with ICAD ( n > 200), the clinical follow‐up will be conducted at 3, 6, 12, and 24 months and the MR imaging follow‐up will be performed at 12 and 24 months, respectively. Previous studies reported that the progression rate of ICAS was 3.86% per year (Ryu et al., ) and the intra‐reader and inter‐scan variation in measuring maximum wall thickness of intracranial plaques was 6.67% (Zhang et al., ). Therefore, it might be reasonable to detect the 2 years’ progression of intracranial atherosclerosis disease (7.72%) which is greater than the variation of quantitative measurement by MRI.…”