Characterisation of symptomatic intracranial plaque without substantial stenosis using high-resolution vessel wall MRI

Yang, Huan; Ji, Chaonan; Wang, H.; Lin, Liangjie; Yuan, Xiaodong; Liu, Bo; Wang, X.

doi:10.1016/j.crad.2021.01.008

Cited by 7 publications

(6 citation statements)

References 25 publications

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“…ICAS plaques were defined by wall thickening on both unenhanced and contrast-enhanced HR-VWI images (21). Plaque enhancement was evaluated according to the pre-and postcontrast HR-VWI T1-weighted sequences.…”

Section: Image Analysismentioning

confidence: 99%

The lymphocyte-to-monocyte ratio predicts intracranial atherosclerotic stenosis plaque instability

Huang

et al. 2022

Front. Immunol.

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Background and purposeGadolinium enhancement on high-resolution vessel wall imaging (HR-VWI) is an imaging marker of intracranial atherosclerotic stenosis (ICAS) plaque instability. This study aimed to evaluate the relationships between hematological inflammatory indicators and the enhancement of ICAS plaques and to search for hematological indicators that can predict ICAS plaque instability.MethodsConsecutive adult patients diagnosed with ICAS from April 2018 to December 2021 were recruited retrospectively, and every patient underwent HR-VWI. Plaque enhancement was measured qualitatively and quantitatively. The plaque-to-pituitary stalk contrast ratio (CR) indicated the degree of plaque enhancement. Clinical and laboratory data, including the lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR), and systemic immune inflammation index (SII), were recorded. The hematological inflammatory indicators were compared between ICAS patients with and without plaque enhancement and between patients with and without symptomatic plaque. The hematological inflammatory indicators and the CR were compared using linear regression. Furthermore, receiver operating characteristic curve analysis was performed to assess the discriminative abilities of the inflammatory indicators to predict plaque instability.ResultsFifty-nine patients were included. The NLR, SII and LMR were significantly correlated with plaque enhancement. The LMR was independently associated with plaque enhancement, and a linear negative correlation was observed between the LMR and CR (R = 0.716, P < 0.001). The NLR, LMR, plaque enhancement and CR were significantly associated with symptomatic ICAS, and the LMR and plaque enhancement were independent risk factors for symptomatic ICAS. The optimal cutoff value of the admission LMR to distinguish symptomatic plaque from asymptomatic plaque was 4.0 (80.0% sensitivity and 70.6% specificity).ConclusionThe LMR was independently associated with ICAS plaque enhancement and showed a linear negative correlation with CR. The LMR and plaque enhancement were independent risk factors for symptomatic ICAS. An LMR ≤ 4.0 may predict ICAS plaque instability.

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Section: Image Analysismentioning

confidence: 99%

The lymphocyte-to-monocyte ratio predicts intracranial atherosclerotic stenosis plaque instability

Huang

et al. 2022

Front. Immunol.

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“…Up to now, the most studies of intracranial arterial wall imaging focus on the plaque with moderate to severe degree of stenosis (>50%) ( Teng et al, 2016 ; Zhu et al, 2018 ; Huang et al, 2019 ). The analysis of vessel wall imaging characteristics in plaque without substantial stenosis (<50%) has been reported in several researches ( Shi et al, 2021 ; Yang et al, 2021 ). In this study, we found that plaque volume was an independent risk factor of culprit plaque in non-stenotic intracranial artery.…”

Section: Discussionmentioning

confidence: 99%

“…But most of these intracranial vessel wall imaging studies mainly focused on the high-grade stenosis (>50%) ( Turan et al, 2011 ; Ryu et al, 2014 ; Wu et al, 2018 ). Recently, the potential of 3D hr-vw-MRI in intracranial plaque with low-grade stenosis (<50%) has just been preliminarily studied ( Lu S. S. et al, 2018 ; Yang et al, 2021 ). Unfortunately, they have mostly focused on lesion morphological and compositional features.…”

Section: Introductionmentioning

confidence: 99%

Characteristics of culprit intracranial plaque without substantial stenosis in ischemic stroke using three-dimensional high-resolution vessel wall magnetic resonance imaging

et al. 2023

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Background and aimsWe 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).MethodsThe 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).ResultsA 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.Conclusion3D 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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“…It can also be used to identify ruptured aneurysms and facilitate surgical decision-making. HRMRI has developed from simple sequences to the assessment of the degree of vascular stenosis to multi-contrast sequences of black blood and bright blood, including 3D-TOF-MRA, T1WI, T2WI, PDWI, CE-T1WI, black blood magnetic resonance imaging (BBMRI) [ 86 , 87 ], and magnetic sensitive weighted imaging. The 1.5 T, 3.0 T to 7.0 T MRA [ 54 ], and multi-planar whole-cerebral vascular imaging through 2D imaging technology to 3D imaging technology can improve the accuracy of diagnosis.…”

Section: Future Development Of Hrmrimentioning

confidence: 99%

The Role of High-Resolution Magnetic Resonance Imaging in Cerebrovascular Disease: A Narrative Review

Liu

Zhu

et al. 2023

Brain Sciences

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High-resolution magnetic resonance imaging (HRMRI) is the most important and popular vessel wall imaging technique for the direct assessment of vessel wall and cerebral arterial disease. It can identify the cause of stroke in high-risk plaques and differentiate the diagnosis of head and carotid artery dissection, including inflammation, Moya Moya disease, cerebral aneurysm, vasospasm after subarachnoid hemorrhage, reversible cerebral vasoconstriction syndrome, blunt cerebrovascular injury, cerebral arteriovenous malformations, and other stenosis or occlusion conditions. Through noninvasive visualization of the vessel wall in vitro, quantified assessment of luminal stenosis and pathological features of the vessel wall can provide clinicians with further disease information. In this report, technical considerations of HRMRI are discussed, and current clinical applications of HRMRI are reviewed.

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Characterisation of symptomatic intracranial plaque without substantial stenosis using high-resolution vessel wall MRI

Cited by 7 publications

References 25 publications

The lymphocyte-to-monocyte ratio predicts intracranial atherosclerotic stenosis plaque instability

The lymphocyte-to-monocyte ratio predicts intracranial atherosclerotic stenosis plaque instability

Characteristics of culprit intracranial plaque without substantial stenosis in ischemic stroke using three-dimensional high-resolution vessel wall magnetic resonance imaging

The Role of High-Resolution Magnetic Resonance Imaging in Cerebrovascular Disease: A Narrative Review

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