A High-Resolution MRI Study of the Relationship Between Plaque Enhancement and Ischemic Stroke Events in Patients With Intracranial Atherosclerotic Stenosis

Abstract

Purpose: To investigate the relationships among the degree of intracranial atherosclerotic stenosis (ICAS), plaque enhancement (PE), and ischemic stroke events (ISEs) using 3. 0 T high-resolution magnetic resonance imaging (HR-MRI).Materials and Methods: Fifty-two ICAS patients who underwent HR-MRI were retrospectively analyzed. The patients were divided into two groups according to the results of whole-brain digital subtraction angiography (DSA): the mild-moderate stenosis group (group MID) and the severe stenosis group (group SEV). According to the onset time of the ISEs, the plaques were divided into the acute/sub-acute phase culprit plaque group (group ACU, within 1 month), the chronic-phase culprit plaque group (group CHR, more than 1 month), and the non-culprit plaque group (group NON). Two neuroradiologists independently measured the signal intensity of PE and pituitary enhancement in the HR-MRI and calculated the ratio of the two indices. According to the ratio, the patients were divided into three groups: the marked enhancement group (group MA), the mild enhancement group (group ME), and the no enhancement plaque group (group NO). The relationships among the degree of ICAS, the degree of PE and ISEs were analyzed.Results: Seventy-two ICAS plaques were identified in 52 patients. The multiple independent samples Kruskal-Wallis H test showed that the differences among group ACU, CHR, and NON were significant in the degree of PE (P = 0.002). Group CHR and group NON were combined as the non-acute phase group (group non-ACU). Group NO and group ME were combined as the non-marked enhancement group (group non-MA). The comparison between group ACU and group non-ACU showed significant differences in the degree of both ICAS (P = 0.014) and PE (P = 0.006) according to the univariate logistic regression. The multivariate logistic regression model was used to analyze the impact of the degree of ICAS and PE on ISEs, and the results showed that severe stenosis (P = 0.036) and marked PE (P = 0.013) were independent risk factors for acute ISEs, respectively.Conclusion: Severe intracranial arterial stenosis and marked plaque enhancement are independent risk factors for acute ischemic stroke events, respectively. The study provides new ideas for further exploring the pathogenesis of stroke caused by intracranial atherosclerotic stenosis.

Assessing the characteristics and diagnostic value of plaques for patients with acute stroke using high-resolution magnetic resonance imaging

“…In recent years, some investigations have researched the clinical value of plaque enhancement in intracranial artery stenosis. Their results showed that the plaque enhancement identified on HRMRI could potentially serve as a marker of culprit plaques (6,13,17). Pathological studies have arrived at similar conclusions.…”

“…Previous studies (1,14) have reported that PR is related to acute stroke. Other studies have suggested that obviously enhanced plaques are associated with recent ischemic events (13,15,16). Research has also found that patients with MCA-induced stroke recurrence have a higher plaque burden (11).…”

“…In recent years, the focus of a rising number of studies and scholars has shifted to the vessel wall, in particular the features and stability of atherosclerotic plaques from the stenotic degree of intracranial arteries (6)(7)(8)(9)(10). Meanwhile, high-resolution magnetic resonance imaging (HRMRI) has become a widely used non-invasive method for depicting the characteristics of plaques and stenotic vessel walls (11)(12)(13).…”

Assessment of Intracranial Atherosclerotic Plaques Using 3D Black‐Blood MRI: Comparison With 3D Time‐of‐Flight MRA and DSA

“…Enhancement of intracranial arteries, associated with increased neovascularization and endothelial permeability, is an important marker that has been used as a high‐risk feature of unstable plaques 33 . Wang et al showed that plaque enhancement was an independent risk factor for acute ischemic stroke events 34 . Determination of unstable, nonstenotic plaques using 3D IVWI could help appropriately direct treatment planning, for example, giving more aggressive medical treatment for patients with unstable plaque.…”

MRI tracing of ultrasmall superparamagnetic iron oxide nanoparticle‑labeled endothelial progenitor cells for repairing atherosclerotic vessels in rabbits

“…The present study investigated the potential effect of USPION-labeled EPCs homing to injured endothelium and whether local atherosclerosis could be prevented by this EPC administration. High-resolution MRI can detect plaque components in vivo , such as intra-plaque or subintimal hemorrhage, fibrous cap and lipid-rich plaque core ( 78 – 80 ). Thus, using USPIONs to enhance MRI could be used to show plaque inflammation in vivo ( 81 , 82 ).…”