Case Report: Serial MR Vessel Wall Imaging Visualizes the Response of Intracranial Plaques and Assists in Decision-Making

Abstract

Intracranial atherosclerotic disease (ICAD) is a dynamic process that leads to ischemic stroke. Symptomatic ICAD patients still suffer a high recurrent rate even under standard treatment. In this case report, to better understand the response of intracranial atherosclerotic plaques to medication, serial MR imaging was added to standard clinical workup in a 47-year-old male patient with acute occipital lobe infarction at baseline, 3-month, 6-month, and 12-month post index stroke to directly visualize the morphology and signal change of plaques. We noticed that one of the plaques showed dramatic worsening at 3-month imaging follow-up despite a decrease in low-density lipoprotein level. Early identification of patients who do not respond well to medication is critical to prevent the recurrence of cardiovascular events in ICAD patients.

Vessel Wall MRI in the Diagnosis and Follow-Up of Nonstenosing Intracranial Atherosclerotic Lesions in Acute Stroke

“…2 Besides improving diagnostic accuracy, the noninvasive nature of the examination gives VWMRI the potential to monitor plaque evolution and its response to medical treatment. 6 However, there is no evidence that using VWMRI to guide treatment decisions improves patient outcomes, so further research is needed before it is used routinely in clinical practice.…”

“…Besides improving diagnostic accuracy, the noninvasive nature of the examination gives VWMRI the potential to monitor plaque evolution and its response to medical treatment. 6…”